Emergency Department Journal

S (situation): Hi, my name Kelsey and I am a nurse in the emergency department. I am calling about Shannon O’Reilly’s most recent laboratory results.

There are many components to a hospital or medical facility. All of them are necessary to have a properly functioning environment. The emergency department of a hospital is a fast paced world. You have to be constantly on your toes and prepared for whatever may come through the doors. There are many people that work in an emergency room to make it run smoothly. Techs, nurses, CNA’s, LVN’s, and doctors all work side by side to help those who are critically injured. Without all these people it would be complete chaos.

A paramedic is an allied health professional whose primary purpose is to provide advanced emergency medical care for critical and emergent patients who access the emergency medical system. As medical providers, paramedics perform interventions with basic as well as advanced equipment under medical oversight. At a national level, the National Highway Traffic Safety Administration (NHTSA) defines the various titles given to pre-hospital medical workers within the United States based on the level of care they provide and the level of education they receive prior to licensure. (National EMS Scope) A paramedic’s education and skill set can vary from state to state. At a minimum, most paramedic education and certifying programs require that

When a trauma patient has significant pain, an order for morphine is yelled out during the chaos. Other orders are yelled out to check the blood pressure and heart rate and order a chest x-ray (CXR) stat. The charge nurse delegates to the EMT to order the CXR and draw up the morphine in a syringe. An RN on orientation watches as her mentor, the charge nurse, places the blood pressure cuff and EKG monitor and then administers the 10 mg of I.V. morphine that was handed to her by the

Kendra Chappell is a clinical shift manager (CSM) in the emergency department at Forsyth Medical Center (FMC). According to their website, Forsyth Medical Center is a 921-bed, not-for-profit, regional medical center in Winston-Salem, North Carolina, that offers a full range of medical, surgical, rehabilitative and behavioral health services (About us, n.d.). FMC has earned magnet designation from the American Nurses Credentialing Center (About us, n.d.). Kendra has twenty years of nursing experience including working as a Practical Nurse before obtaining her Register Nurse degree 15 years ago. She was a staff nurse in the emergency department for ten years before being promoted to CSM. She has earned a bachelor of science in nursing at Appalachian State University and is a Certified Emergency Nurse. She is certified in basic life support, advanced cardiac life support, pediatric advanced life support, trauma nursing core course, and emergency nursing pediatric course, certifications that are required of all emergency nurses at FMC. Kendra oversees the 81 bed FMC emergency department from 7 a.m. to 7 p.m. every Friday, Saturday, and Sunday. She supervises 25 to 30 nurses and 10 to 15 nursing assistants throughout the course of each shift.

My day in the E.R. was slow for the first hour and a half. We got our first patient at 7:57 am, and it went at a brisk pace for the rest of the day. The first patient came in with sinus tachycardia. She received one liter of NS 0.9% at a rate of 1L/hr. and two doses of IV diltiazem 10 mg each to cardiovert her, and it was successful. She was released home with instructions to follow up with her cardiologist. There were two patients with chest pain one patient received Nitro Sublingual tablets x3, and the other received Nitro Paste one inch on the left side of his chest. Troponin labs CMP, and CBC on both patients were within normal range. The urine culture on the patient who received the Nitro tabs had WBC in it. When I left the nurse was waiting for blood cultures and lactic acid labs to come back to try and pinpoint a reason for WBC in the urine the physician wanted to admit this patient to the

Paramedics work closely with doctors and nurses in hospital’s emergency departments, briefing them as their patient arrives at hospital (Paramedic). For example, if a patient has a heart problem, they can receive fast transportation to a healthcare facility (Ch. 15 PowerPoint, slide 3). There is a program called race used when patients are having heart problems (Kerry Slate, Personal conversation, July 13, 2015). This means that the first EKG is ran by the paramedics and sent straight to the emergency department’s physician. By the physician getting this type of information he can decide the diagnoses right away and prepare cath labs if necessary. This is why the existence of paramedics are so important. If the arteries are opened within the first ninety minutes there is a greater chance for no heart damage.

The Nationwide Emergency Department Sample (NEDS) is the largest all-payer emergency department (ED) database in the U.S., producing national assessments of hospital-based ED visits beginning in 2004. NEDS gathers information from 31 million ED visits at 950 hospitals. The age is coded 0 to 90 years, and any age greater than 90 is set to 90 [7]. The races include white, black, Hispanic, Asian/Pacific Islander, Native American, and other. The NEDS was designed to enable investigations of ED use patterns and to strengthen public health professionals, administrators, policy makers, and clinicians in their decision-making concerning this critical source of care. The ED serves a dual role in the U.S. health care system infrastructure, as a point

It was noted that subjective diagnostic approaches created different work flow demands within the emergency room. Because each patient received subjective assessments by clinical staff, different treatment archetypes emerged. Times to patient diagnosis and treatment versus times to patient discharge or in-patient admissions were based solely upon the experience of the clinical staff. Thus, the effectiveness and experience of the clinical staff was directly related to their speed and accuracy of assessment, treatment, and discharge

Well, I've worked in large city emergency departments for 21 years. Working hard, hustling, breaking my back for a non-stop 12-hour shift, it takes a big toll on you, I'm not as young as I use to be I have to admit. But loving what I do still today has given me satisfaction and sense of purpose in my career over the years. I could not imagine having another profession. The patients are sicker, expectations of you, though not unachievable focus not as much on the care we provided, but the patients experience, including family members and how satisfied were they with the care given during their visit also did we meet their expectation. I understand why changes are being mandated as part of our care we provide. I've have held jobs in areas of

Despite the fact that the studies previously mentioned were not carried out in an emergency care setting, the results are translatable as emergency departments care for similar patients, in many cases more acutely ill and on a shorter-term basis. Furthermore, often the groups studied are “frequent” emergency care area patients. One such study,

Jesse is a strong and reliable member of the department. He makes verbal commitments that are consistent with his actions. He excels in interpersonal communication with co-workers and is an empathetic listener. He is able to cope with the pressures of the department and maintains composure effectively. Jesse also supports the emergency department by helping to orient the new employees as well as helping peers with the placement of ultrasound guided IV lines. Jesse is an asset to have in our

The medical emergency team (MET) is responsible to responding and providing health care in an emergency situation for example, a suspected cardiac arrest. Each workplace will have a different guideline/policy as to who are the members of the MET team. The MET team at South West Health Care is comprised of Medical Registrar on call for the day, Senior Nurse from either ICU or ED, Medial Intern of the day assigned to the Physician, and the Clinical Coordinator (South West Health Care, 2012). Both the Medical Registrar and the Senior Nurse must current training and competencies in Advance Support Life training

Emergency medical services provide prehospital medical care to out-of-hospital cardiac arrest patients on scene and while transporting the patient to the hospital. In rural areas, the responding emergency medical services’ scope of practice varies from basic life support capabilities, which may be limited to effective chest compressions and use of a bag-mask device, to advanced life support capabilities encompassing a set of interventions and medication treatments intended to support airway, breathing, and circulation.

Challenges facing the ER are endless especially as a student. The biggest challenge to me is modifying positions based off what the patient can do. Many times the patient might not be able to move into a certain position in order obtain a certain projection. So you have to think outside the box and manipulate the x-ray tube to get the necessary views. Then there are times when a patient comes into the ER and you’d swear they are dyeing or in horrible pain, but when you take an x-ray everything looks completely normal. I find it funny the people who are really