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.
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.
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
1,970 Posts
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.