What to study?

[ahosoda]

I found out my practicum will be in the ED! I am beyond excited, but I feel at a loss when it comes to what I should be studying. This particular ER is very busy, but there is a higher level trauma center right down the road so I may not see too many traumas or codes. My preceptor told me she rarely sees codes, and when a patient is too acute they are usually transported down the road.

I've read a lot of great advice on here about attitude, time-management skills, being a team player etc. This advice is great, but at this point I'm trying to focus more on what I can study. So any advice on common diagnoses, assessments, skills, presentations, medications... that would be the most helpful. Ex. do you interpret a lot of EKGs, do you see a lot of overdoses, etc... just wondering what you see commonly so I don't look like a total dork when I walk through the ER doors.

Thank you!

[Lev, MSN, RN, NP]

My ED is also a very busy place and we are not a trauma center but we still get plenty of codes. We are the preferred hospital for EMS providers in the area. They come to us even if we are the only one on yellow. Most things that come to the ER are not emergancies. People use the ER as their primary care doctor. So you see lots of small stuff. Stitches, med refills, sore throats etc. There are always a large number of people with some form of abdominal pain and then you have your drunks. Depending on your area, you will see different types of overdoses. In my area, we see a lot of heroin and also people who overdose on their prescription meds to commit suicide. Then you will get those dementia patients who their families just cant care for and they stay in the ER til we find gerpsych placement for them. We also get a lot of stroke ruleouts. And of course your chest pains - some cardiac, some musculoskeletal. When I started in the ER, I was surprised at how many patients were treated in the ER and sent home, especially if they came in looking really bad.

While we look at things on the monitor all the time and can make the judgement when a patient needs an EKG, the doctors are the ones who sign off on the EKGs, especially important in STEMI cases.

My advice is to be involved and ask questions. The ER is so fast that sometimes its hard to learn things thoroughly, but you will learn a lot and gain a broad spectrum of knowledge.

[ahosoda]

Thank you Lev

[CraigB-RN, MSN, RN]

It really doesn't matter what the level of your ED is. It can all come through your front door. This is the outline of material covered by the CEN exam.

CEN Content Outline – BCEN

Ear aches, abd pain, constipation, dental problems, bloody noses, scabies, bed bugs, People taking to much of their prescription medicine such as their BP meds. Forgetting to take their insulin or just being non compliant. Suicidal ideation, crying baby, urinary tract infection. These are all things that can walk through your front or back door.

[Kristenlaurenw]

Expects lots of clinic stuff (colds, stomach viruses, headaches, chronic back pain) but be prepared to see anything. Lots of chest pain work ups. A good prep would be to get very familiar with common ER meds and their administration. Off the top of my head, think of meds for allergic reactions, UTIs, pain management, ACLS, blood pressure (especially fast acting like IV lopressor), chest pain/MI, sedation and paralyzation for intubation, and diabetes.

[CraigB-RN, MSN, RN]

One of the things that makes emergency nursing an appealing area to work in is that you pretty much have to know a little bit about all areas of nursing, with a lot of depth in some area's and a passing acquaintance in others.

I've been an ED nurse for almost 40 years now and I'm still amazed the things I have to know.

Another important thing to study is make sure you know about ways to teach patients and evaluate their understanding of discharge instructions. You have to be aware of cultural barriers to education and treatment.

Lots to know. Fun Stuff!!!!

[NurseOnAMotorcycle, ASN, RN]

Know your differential diagnoses and how to anticipate what will be ordered. Chest pain? Could be a cough, PE, MI, anxiety, broken ribs, sore muscles. Abdominal pain? Headache and nausea?

I tell all of my students in the ER: It is EASY to get so over-focused on the single cool critical patient. But an ER nurse has a full assignment. Your experience there is to try to see what you would do as if you were the ER nurse with a full assignment.

Do not get so wrapped up that you forget that abdominal pain (possible acute appendicitis) has had IV fluids and pain medication ordered while you were helping to reduce that dislocated shoulder under moderate sedation, the head cold is angry that no one has brought him a ginger ale, the baby with an ear infection is waiting to be discharged with some take home antibiotics, and everyone is overdue to have their vital signs documented.

As a student, look at everything that has to be done and prioritize and re-prioritize.

If your ER just sort of throws you in without anything specific to do right away, then follow each ambulance stretcher, get the pt undressed and VS taken as soon as they are on a hospital stretcher. Just that alone will make you a fantastic student and people will be much more willing to show you the cool stuff.

And come tell us how it's going!!

[AZQuik]

Honestly, work hard and jump at the opportunity to clean up pts, know sick vs not sick, and then do they need an intervention now, or in the near future.

Differentials, what's going to be ordered for who, how to read blood gases or UA's, starting IV's, or dropping a tube somewhere. All that comes with time. You're going to be there what 12 shifts? Those things are not things you will master.

Do everything you can. Once you're shown once you will be expected to try if allowed. Ask all you can. Learn as much as possible, but you will still be totally new when done.

If you know who needs something now, you don't need to know what, someone else there will. Doorway assessments are big, focused assessments are big. Know them.

Working in the Ed is a very collaborating environment. Speak up.

Don't forget to have fun. Last run as a student, after this its your license signing off on things