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BE PREPARED

Emergency room

Article originally posted on the Katie Duke blog

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Years of working in the Emergency Room will give you great ability to be prepared for the unexpected.
It’s a prized survival skill we learn all too well while working in the unpredictable world of Emergency Medicine and Nursing.

As you all know, I’ve spent many years in the ED, however, when I started my position as an NP OUTSIDE of the ED, I had a surprising awakening on the floors and step down units.

Not everyone and every unit was prepared for an emergency.  Shocking right? Especially considering that we all work in healthcare and hospitals.

I recall the first time I realized this. It was another random night shift and we had a code and I was one of the first providers in the room.  Immediately I channeled a mix of seasoned ER Nurse with NP on the scene.

“Do we have IV access?  What gauge?  How many?  Where is the suction setup?  Where is the AMBU bag?  Who is the runner? Who’s the bedside Nurse?  Who’s manning the crash cart and meds?  Who’s documenting?  Who’s doing compressions?  Who has called respiratory?”

Standard stuff right?

Everyone was looking around in complete disarray.  Not only did the patient not have a functioning IV line, but additionally, there was no suction setup, no AMBU bag, and none of the nurses or techs had pre-assigned roles.  This was a major issue.

This blog will go over a few tips from a seasoned ER Nurse about how we can all be prepared for an emergency.

Tip 1: Prepare yourself with supplies and your patient with access.

At the start to your shift, make 2 IV start kits.  Simple setups with a few different size gauges (I prefer 18 and 16, but always keep a 20 as well). Keep these setups at the nurses station in your corner or at your desk. I place mine in a lab bag so they’re easy to grab when in a hurry.

Mark sure your patient has a functioning IV. If it not- FIX IT. Don’t wait for the IV team to come around 8 hours later to replace it. An IV can be the simple most immediate need during a time of hemodynamics compromise. If you are inexperienced with starting IV’s the BEST and ONLY way to learn and eventually get experience is to do it! Grab a more senior nurse and have them show you some tricks. Even if you know the patient has difficult veins, try anyway! You will eventually get comfortable with both the easy and the hard sticks but this only comes with experience.

Tip 2: Prepare your rooms.

This is a given; Suction setup with Yankauer, AMBU bag, a FULL O2 tank under the bed, monitor leads. Always make sure your crash carts are stocked and locked and that your defibrillators are checked at lest once in your shift.
These items are all IMPERATIVE to the most fundamental needs during a code–>> AIRWAY, BREATHING, and CIRCULATION.

TIP 3: Assign roles for staff at the beginning of the shift.

The last thing that anyone wants to do in the midst of a code is think about who should do what and why. Take a 5 minute huddle at the beginning of each shift to assign roles.

There should always be the following: Bedside Nurse to administer meds, place IV, a runner to get supplies etc (can be a nurse or tech), documentation Nurse to record the events and orders, at least 2-3 people in rotation for CPR ( I always love to volunteer the new nurses or med students for this as it’s great experience), crash cart Nurse- to be the gatekeeper for what we have and what’s needed at the bedside, and any additional staff can help with crowd control or hold the fort down with the remaining patients on the floor until the code is done.

When you have these few preparations out of the way, I assure you that if and when an emergency occurs, it will be smoother and more organized. Additionally, you’ll develop a routine that will benefit both your work flow and your patients.

KD

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