Medication
Maximum dose of Potassium that can be given over 24/24?
200mmol
What are the main two clinical indicators for a deteriorating pt in ED? 1.Increased RR&ACS, 2.Tachycardia&Fever, 3.Tachycardia&mild hypotension
1. Increased RR&ACS
cat 2-56 yr old male in WR presented with CP, ECG done and s/b CIC, an hour later ( while you called another pt to do bloods) he is c/o worsening CP, looks pale and diaphoretic, what is your immediate response?
check vitals immediately and repeat ECG-escalate concern.
A 58-year-old presents with crushing chest pain and diaphoresis. ECG shows ST elevation in leads II, III and aVF. Which region of the heart is affected?
Inferior wall
What is the most common fate of an ED nurse's favourite pen?
It disappears into the pocket of another healthcare professional, never to be seen again.
Patient presented with hematemesis, on warfarine for AF. What reversal agent we use in our practise?
Bariplex
70 yr old with T2DM and IHD presented with lethargy and confusion due viral illness for 2/52. Dec oral intake and dry mucus membrane++++ on examination. what is this pt at high risk of?
HHS(Hyperosmolar Hyperglycaemic State)
You are the only triage nurse and a RUSON doing obs in WR: while you are triaging a pt with stroke symptoms-onset an hour ago, you noticed a pt getting verbally and physically abusing another pt, at the same time there is another pt with COPD on 2L O2 on wheelchair looks grayish colour. what is your immediate response?
Hit the emergency buzzer and call 2222 for code gray and stroke call.
A patient with renal failure has potassium 7.1 mmol/L. ECG shows widening QRS complexes and tall peaked T waves. What is the priority?
Emergency management of hyperkalaemia
Calcium gluconate to stabilize the cardiac membrane
A grad nurse says to the T/L, “I've finished all my tasks! and I am up to date with my vitals for my 3 pts” What does the T/L usually say?
"Excellent! Now let's check if your buddy need a hand with anything"
Pt on DKA pathway, Insulin infusion running. pt tolerating F&F, repeat VBG shows:
Ph 7.32, CO2 45, HCO3 19, K 4.0, BGL 11. Ketone 0.6mmol
No insulin rate adjustment required APP, what else would you consider?
Pottassium infusion.
56 yr old male presents with fever, sweaty+++, Tachycardia, tremors, c/o headache, N&V. hx of chronic alcohol use, last drink 2/7 ago. what is is happening to this pt? what is he at risk of ?
Alcohol withdrawal, Alcohol withdrawal Seizures
Who should you consider first to do interventions (ECG/Bloods)?
Cat 3- 45/M Epigastric pain with T2DM& Hypercholestrol
Cat 3- 20/F Abdo pain with D&V-returned from Bali 5/7 ago.
Cat 3- 75/F Fall with HS 5/7 ago with headache and dec mobility.
Cat 3 Epigastric pain
A 76-year-old has HR 32/min, BP 75/40 and dizziness. ECG shows P waves and QRS complexes occurring independently. What is the rhythm and priority?
Complete Heart block
prepare for Pacing
What is the unofficial superpower of an experienced ED nurse?
Recognising that something is wrong with a patient before the monitor has even started alarming.
Pt who had a fall, past history of epilepsy from a HLCNH, CTB-NAD, moved to ESSU for waiting transport back to NH. What is one important thing you should check for this patient?
Medication order for pt's antiepileptics
32 yr old pt- 32/40 Gestation, presented with headache and vomiting on b/g of recent viral illness in the WR. Initial OBS: HR 110/mt, BP 148/92mmhg, Temp 36.8,SPO2 96% on RA, RR 22/mt, GCS 15.
Is there any concern? What else would you test?
BP is a concern. Urine FWT
in WR to do vitals/OBS which one is your priority?
A) cat 3-28/40 Gestation with N&V and headache
B) Cat 3-30 yr old with abdo pain and vomiting
C) Cat 3- 50 yr old Pleuritic chest pain post long flight
A)28/40 Gestation
A 67-year-old becomes hypotensive, BP 70/40, ECG shows a regular wide-complex tachycardia at 190/min. A pulse is present. pt is concoius, What should you do? what you are treating?
Concious VT
apply defib pad for possible cardioversion
What is the most powerful rain dance in an emergency department?
Announcing that you're finally going to have a cup of tea/break.
Amioderone injection is ordered for your pt with RAF. What would you consider before preparing the injection in terms of mediaction preparation?
A non-PVC 5% Dextrose from Resus.
You are Acute T/L: four junior nurses are asking help at the same time for:
1: A patient with DKA, BGL 18 mmol/L, potassium 3.0 mmol/L, prescribed an insulin infusion that has not yet commenced.
2: A patient receiving IV antibiotics develops wheeze, facial swelling and hypotension.
3: A patient with atrial fibrillation, HR 145, BP 125/80, alert and reporting palpitations.
4: A patient with a fractured neck of femur is reporting pain 9/10
Which one would you immediately go and check?
2. patient with ?Anaphylaxis (airway comes first)
70 yr old with LUQ abdo pain and viral illness, given Cat 3, vitals stable, 2 hrs later did bloods and ECG shows hyperacute T waves in V1,V2 & V3, Nil ST elevation,and abdo pain ongoing. WR nurse escalating concern that there is no CIC to shows ECG, as the triage nurse, what should you do?
Escalate immediately and ask for monitor bed while upgrading the category to 2 and doing troponin.
A patient has ongoing ischaemic chest pain. ECG shows horizontal ST depression in V1–V3 with tall R waves and upright T waves. What you think is your next step? why?
A posterior ECG with V7,V8,V9
possible posterior STEMI showing reciprocal ST depression.
What is harder than inserting an IV cannula into a patient with difficult access?
Finding the doctor who said, “I'll be back in two minutes!" to insert U/S guided IVC.