Tips 'n Tricks: Pearls the Newbies Need to Know

[Music in My Heart]

I've been thinking about what simple advice we could give to those new to our ranks... a bullet list kind of thing... Tips 'n Tricks... Pearls... ED Nurse-Hacks...

Here's the one that I was thinking about that provoked this thread:

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+ Wear a gown and a face-shield to every trauma, every code, every time.

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It's much easier to discard PPE that you didn't need than to find a shower, clean scrubs, and time for post-exposure labs after you were inadvertently sprayed with ickiness.

A couple days ago, we ran a code for 30 mins or so on a drowning victim... multiple attempts at multiple lines... fem stick by an intern... vomit... feces... difficult airway... you know the story... so after it's called, several of us are working to get the victim tagged-n-bagged... the attending walks in and, for some unknown reason, presses on the guy's upper abdomen... at which point blood came shooting out of his NPA... all over the tech.

I've seen way too many people get blooded, etc for lack of PPE... and once the whole thing starts, there's no time to get the PPE in place.

It took me quite awhile to adopt this approach because the 'salty' ones didn't do it and I didn't want to look green. Now... I don't give a rip what I look like as long as I don't have blood goobers dripping off of me.

So, ED noobs... PPE for every trauma, every code, every time.

[icuRNmaggie, BSN, RN]

I had to take a pt to a tertiary care center last night and the medic put all of the IV bags on a carabiner and hooked it on the pole. I thought it was genius because there was no fumbling with multiple iv bags.

[LadyFree28, BSN, LPN, RN]

Keep em' coming-from a "newbie" coming into the ER!

Any specific tips for a Pedi ER?

[icuRNmaggie, BSN, RN]

Let mom hold the little one in her lap and give the albuterol neb as a blow by with a blue circuit.

Kids need about twice as much versed as adults to be sedated. That's a little scary when you do it the first time.

Try once then place the IO.

My peds experience is very limited.

[Lev, MSN, RN, NP]

From Adult ED

Always stay in the room when giving SL nitro for the first time - it can really drop that pressure!

When giving a new EKG to the doc, print out an old one for comparison

Any complaints of dizziness, suspicious abdominal pain, tachycardia, any history of arrhythmias, history of MI or cardiac issues, suspicion for stroke, syncope, HTN, electrolyte issues etc goes on the monitor. It's there, so you may as well use it.

When in doubt, transport your patient yourself

Make sure your IV aspirates before giving rapid flush after adenosine. Also helpful to use a stop-cock and attach syringe with 20-30 cc NS to one end. Another body doesn't hurt to man the flush.

Also good to set up your monitors to cycle BP q30 minutes for ESI 2s and up. And check alarm limits!

[icuRNmaggie, BSN, RN]

Ask do you take cialus levitra or viagra before giving nitro.

[icuRNmaggie, BSN, RN]

Know how to work the biphasic. Know the placement of the pads for defib vs pacing and cardioversion(front and back)

Also know how to set up a chest drainage system

look at the veins that appear with the bp cuff inflated. Use kelly clamps and gauze to clamp the nibp tubing and pop in an iv.

[icuRNmaggie, BSN, RN]

Put the lady on an upside down bedpan to see the meatus and ask her to cough.

males need lido jelly for foley insertion. Hold it in there for three minutes to numb the

urethra. Use a 14 if the man has a narrow meatus.

Sedative before paralytic in rapid sequence intubation.

[LJ85, ADN, BSN, CNA, LPN]

FYI if you wear danskos or other patent leather finish shoes those wipes will wipe the finish right off