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ilovefroglet ECS's blog: ""

created on 02/17/2012  |  http://fubar.com/-/b346565  |  1 followers

Four years of nursing school, textbooks and classroom lectures have failed to fully calm my heart, mind, and spirit as our next trauma patient is rushed through the double doors of the emergency room on a wobbly six foot stretcher. Injuries uncertain, responsiveness still to be determined, vital signs unknown. "CODE TRAUMA NOW" resounds throughout the department on the overhead pager. MD Attending, MD Resident, OR Residents, Respiratory Specialists, Nurses and Emergency Service Assistants arrive in the trauma room of the ER. Each clinician dons gowns, gloves, and glasses and the patient is methodically moved from the Paramedic's stretcher to the hospital stretcher. Like clockwork, the Paramedic begins to report, as all eyes in the room are on the pale, female, approximately 19 years old, lying before us covered in blood under a white blanket. Both her arms appear broken, glass is strewn in her hair, deep cuts line her face along her eyes and nose. Her head is swollen, bloody and bruised. The room is silent as the paramedic describes what happened. While we try to stabilize the patient I hear bits and fragments of the paramedic's report.

High-speed motor vehicle accident?… What?… Unconscious at scene?… I think to myself, is that what I just heard?

Then the doctor's trauma assessment begins. The MD Resident, a tall dark haired 29 year old woman takes charge. The attending faculty physician looks on—as the young doctor begins her verbal full body assessment of the young motor vehicle accident victim. While the team listens—they work quickly to get the young patient's clothing off and bring the necessary equipment to the bedside to perform emergent imaging to make sure there is no damage to her internal organs. One of the nurses in the room begins to document all trauma findings on the trauma flow sheet as the MD Resident dictates. An Emergency Service Assistant hastily places the cardiac monitor on the patient to get a current set of vital signs. Blood pressure: 82/54, heart rate: 130's, respiratory rate: 26.

My role as the trauma nurse is to find intravenous access to immediately begin administering fluids, medications and blood products. I look at the bloodied, severely injured patient to find a place where I can access a vein with an IV catheter. My first attempt to place the needle in a vein in her left forearm fails because her bones are broken and her veins there are weak. I look for another vein and easily place a large IV in her right wrist, followed by a second large IV in her right anticubital area—inside her elbow. I am successful and the IV fluids are running through the patient as the MD resident continues her assessment. The resident has ordered me to begin administering blood products because the patient's blood pressure is low which can indicate she has lost a lot of blood from her motor vehicle accident. I grab a bag of blood from the coolers that are in the trauma room and start giving it through the IV's.

Thoughts continue to rush through my head. Is the patient breathing on her own? Are we going to need to intubate her and should I begin to draw up the necessary medications to perform this procedure? What are her current vital signs? What is her respiratory rate, heart rate, blood pressure, and temperature now? Are these stable? Are my IV's working and running? At this point I only have visual clues as to the status of my patient. I see blood coming from her legs—how deep are the cuts? Is her leg broken? There is bruising around her abdomen—is she bleeding internally?

The MD resident states that because the patient is loosing a lot of blood, her injuries are not completely known at this time, and her blood pressure is low, heart rate is fast, and she is breathing at a rapid pace. We need to place a breathing tube down her throat to allow a ventilator to breath for her. The resident yells out the dose and medications she wants to use for the intubation and I quickly draw them up in a syringe ready to administer them. Respiratory personnel are present in the trauma room and have the ventilator ready. With encouragement and cooperation from the emergency medical team the resident asks me to administer the medications to paralyze, sedate, and take away all feeling of pain the patient may be experiencing. Easily the tube is placed down her throat and her chest starts to rise with the breaths given to her body by the ventilator.

The patient is then moved to radiology for x-rays and CT scans. It turns out she has a broken left arm, broken right femur, multiple facial fractures around her eyes and mouth, two broken vertebras in the middle of her back, and a cut on her liver causing her to lose a lot of blood.

Through all my emotions and through quick thinking and using my knowledge to help perform the necessary interventions to help save this patient's life, I am able to stay calm, for I see that everyone in that room is working as a team, an Emergency Medical Team, and together we are delivering the best care we can for this patient.

I chose to become an ER nurse because I thought it would be a job where I would never get bored. The energy, excitement, teamwork and the goal to save lives and the knowledge needed to do this is what continues to drive my daily passion for Emergency nursing. Whether I am the trauma room nurse or taking care of patients suffering from chronic illnesses, whether I am helping alleviate someone's pain from a broken bone or cut hand, whether I am sitting and talking with someone who does not feel safe to himself or to others around him, I desire to pour out comfort and compassion to those around me. I want to be a calming voice in the time of chaos and uncertainty. In the ER I never see the same thing that I saw the day before. Each patient is unique and the knowledge needed to assess every new patient is something that I know I will learn better through time and experience.

Some days are harder than others for me to care for my patients but this is my greatest challenge to come here every day ready to work and give of my time, knowledge, caring, calmness, and love to those who are often facing major turmoil.


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when ER/Trauma nurses sit around and give tribute to Jeff Foxwothy You might be a redneck!!!!YOU MIGHT BE AN E.R. NURSE IF . . . You believe that 90% of people are a poor excuse for protoplasm... Discussing dismemberment over a gourmet meal seems perfectly normal to you.. You believe a good tape job will fix anything... You have the bladder capacity of five people... You can identify the positive teeth to tattoo ratio... Your idea of a good time is a full arrest at shift change... You find humor in other people's stupidity... You believe in aerial spraying of Prozac... You disbelieve 90% of what you are told and 75% of what you see... You have your weekends off planned for a year in advance... You automatically assume the patient is a drug seeker when presented with the complaint of migraine, lower back pain, chronic myalgia (choose one of the above), a list of numerous allergies to meds (except Demerol), and the statement that the family doctor is from out of town... Your idea of comforting a child includes placing them in a papoose restraint You encourage an obnoxious patient to sign out AMA so you don't have to deal with them any longer... You believe that "shallow gene pool" should be a recognized diagnosis... You have discovered a new condition that you call "hypo-xanax-emia"... You believe that the government should require a permit to reproduce... You debate which is worse, spaghetti and meatballs or pizza and beer, while performing gastric lavage... You plan your dinner break while lavaging an overdose patient... You believe that "ask-a-nurse" is an evil plot thought up by Satan... You believe that unspeakable evils will befall you if the phrase "wow, it's really quiet" is uttered... You threaten to strangle anyone who even starts to say the "Q" word when the ER is even remotely calm... You refer to Friday as NH Dump Day and you don't mean New Hampshire... Your diet consists of food that has gone through more processing than most computers... You believe chocolate is a food group... You take it as a compliment when someone calls you a dirty name... You say to yourself "great veins" when looking at complete strangers ... You have ever referred to someone's death as a transfer to the eternal care unit... You don't think a referral to Dr. Kevorkian is inappropriate... You have ever referred to someone's death as a celestial transfer... You have ever answered a "lost condom" phone call... You refer to someone in severe respiratory distress as a "smurf"... Your idea of a good time is dueling shock rooms... You have ever wanted to hold a seminar entitled "Suicide...Doing It Right!".. You feel that most suicide attempts should be given a free subscription to "Guns and Ammo" magazine... You believe that "too stupid to live" should be a diagnosis... You have ever had to leave a patient's room before you begin to laugh uncontrollably... You have ever wanted to reply "yes" when someone calls and asks "Is my (husband, wife, mother, brother, friend, etc.) there?"... You have ever issued a "dead head" alert... You have ever referred to the E.R. Doc or triage nurse as a "shit magnet"... Your favorite hallucinogenic is exhaustion... You think that caffeine should be available in I.V. form... You have ever restrained someone and it was not a sexual experience... Your most common assessment question is "what changed, --- tonight ,to make it an emergency after 6 (hours, days, weeks, months, years)?"... You have witnessed the charge nurse muttering down the hallway "who's in charge of this mess anyway?"... You refer to vegetables and are not talking about a food group... You have ever used the phrase "health care reform" to instill fear into your coworkers' hearts... You believe the waiting room should be equipped with a valium fountain... You play poker by betting ectopics on EKG strips... You believe a "supreme being consult" is your patient's only hope... You want lab to order a "dumb s**t profile"... You are totally astounded when someone from a NH is understandable... You have been exposed to so many x-rays that you consider radiation a form of birth control... You believe your patient is demonically possessed... You have ever had a patient look you straight in the eye and say "I have no idea how that got stuck in there !"... You believe that waiting room time should be proportional to length of time from symptom onset ("you've had the pain for three weeks...well have a seat in the waiting room and we'll get to you in three days")... You know the phone number to the local Detox Center by heart... You have ever had a patient say, ". . .----But, I'm not pregnant; I can't be pregnant; how can I be having a baby?"... You have ever had a patient control his seizures when offered some food... You carry your own set of keys to the "leathers"... 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