this post will be loooOOONG....those who are not in medical line will be lost in translation, so if you intended to read, be ready to google some of the words used =)
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............ the place that will make you loss track of time...............
first stop : primary triage
basically, ED operates by triaging system. so, make sure you experienced how this system work. primary triage is the first line of screening a case where a checklist will be provided for you as a guide to do triaging. look for it and observe or assist the staff there. then vita sign will be taken. if there are abnormalities, the patient will be quickly sent to secondary triage for treatment. for non-emergency case, pt will have to wait for their turn. this is the best place to practice injection (mostly, ATT and Voltaren), sometimes ECG, and for daredevil, do take your chance to do blood sampling and indwelling cannulation. (and get your cross =) )
second stop : secondary triage
the routine are vital sign checking, doctors will do clerking and further assessment, iv line insertion and blood sampling. if pt aren't stable, they will be put under resusitation team. the less severe cases will be treated in the cubicles.
...................what to do in resuscitation room??
again for emergency cases, they will be pushed straight into resuscitation room. put on all the monitorings (BP, 3 lead ecg, spo2 ) and treat pt according to their emergency cases. some will need o2 therapy, ECG stat, echocardiogram and of course emergency medication and IV fluid. if you're lucky, you will see intubated pt there.
...................what to do in secondary triage cubicle
similar to resus, prepare the monitoring machine. at one time, you will feel bored to death because the cubicles are unoccupied. however don't be shock if suddenly the place became crowded with pt...i mean.. EVERYWHERE!
next stop: Asthma bay..
you should expect to see a number of asthmatic pt here if that day happened to be raining. you will practice nebulizer and peak flow meter. so be familiarize with drugs like salbutamol, atrovent, combivent and IV hydrocortisone. tips for you, a vial of 100mg hydrocort is diluted with 10ml water for injection. but do confirmed back with the staff before giving any treatment to pt.
there are other places such as OBS (observation ward), and clinic for 4th and 3rd triage cases.
NOW, here are the DO's and DON'Ts in ED setting...
Do..and pleaseeeee do...
1. Prepare your knowledge and skills. i mean ALL the skills that you had learn. yup. you never know what
will come to you. take note for skills such as:
- ECG (tons of them!) reading and if better simple interpretation. pt or their family will always ask
you, 'is my reading ok?' and to me, i hate it to respond 'wait for the doctor to see'. i mean, we are
degree students right, we should be able to at least say something...huhu, that's my opinion, ok, ignore it!
there are basically two types of ECG, 3 leads for monitoring and 12 leads for diagnostic.
- ABG ; if the doctor orders for blood for vbg or abg, just prepare a 1ml syringe, flushed it with heparin
before withdrawing the blood into the syringe. do ask or observe or explore how the ABG machine works.
- oxygen therapy, from nasal prong to CPAP.
- nebulizer and peak flow meter. mostly done in asthma bay. please confirm the dose and inform in
charged staff nurse before administering neb to patient.
- CBD insertion, which i got to practice and end up completed by the staff nurse huhuhu...there goes my
cross...
- Ryle's Tube insertion
- bandaging
- oral drugs such as GTN (sublingual), aspirin (chew and then let pt drink water) and drugs dilution such
as IV hydrocortisone for asthmatic patient or severe S.O.B, DDA drugs such as Tramal and pethidine (you
might not have a chance to do but do observed how they prepared it.)
- all types of immobilization techniques (cervical collar and etc.)
- Dressing (rare cases..)
2. Get involved. it's ok to be stupor on the first day, but it will be better to just wear your glove and offers
help. they'll appreciate it!
3. Worked as fast as you could! pt's life may depend on your action.
4. Eat early if you cannot worked with empty stomach. usually, the unit will be crowded around 9am and
 |
| hydration is important!! |
free time.
4. Get bold and try new procedures such as branula insertion. there are tons of them! get one of the MAs to help you, they are really nice and friendly amd willing to teach!
DON'T and never ever......
1. merely be an observer. you'll be sure to get doctors being sarcastic towards you.
2. do an invasive procedures without supervision!
3. hesitate especially in resus room. if you need to give oxygen therapy or vital signs monitoring, do it!
eventhough the doctors are busy examining the pt. don't wait.
overall, being in ED really helps to sharpen your critical thinking skills, and help you to practice all your nursing skills. there are really a lot of things you can learn here..i really hope to be posting there for another week, but oh well, i had my chance. for my clique who'll be posting there afterwards, please! get active and get involve! you'll get cold feet on the first day but subsequently, you will grow fond to this unit..
AND.......
prepare to be exhausted. we did not have our rest at all today. the unit was over crowded and the staff do depend on us to help them. working in a stressful area make people became a little bit aggressive. huhu, so you just have to accept being yelled or ridicule by the staff, they are ok, don't worry. just make sure you know what you're doing, then you'll be fine.
just want to share what i experience today, a doctor was being sarcastic to us while we're doing ECG to a pt. it was my fault at first, for being confused between left and right and misplaced the limb lead but the second time we did it correctly. when the ECG result shows irregular rhythm and marked tachycardia, she yelled (or may be, her voice tone was naturally loud...) for the staff nurse to see how we did the ECG. the nurse confirmed that we are doing it correctly. phew..!
hmm, i think i wrote enough. haha, thank you for reading!
