policies and procedures sunrise ED

Question 1

1. what 12 things go into your report

Answer 1

1. name
2. age
3. allergies
4. code status
5. primary DX
6. quick story (1-2 sentences)
7. medical HX
8. abnormal labs (pertinent)
9. diagnostic tests done & results
10. IV, Central Line, Foley, NG, anything external going into patient. What fluid are going in it?
11. other abnormal interventions you did.
12. what is left for the RN to do.

Question 2

1. What three questions must we must we ask after intubation?
2. Who should we anticipate calling if we are going to intubate someone?
3. What 4 pieces info should we ask RT once patient is on the vent?

Answer 2

1. Size of ET tube, Centimeters at the lip, is there a good color change (purple is what we want)
2. Chest x-ray so we don’t have to wait for them.
3. Tidal volume, FIO2, PEEP, Rate

Question 3

1. On the code sheet, what is super important to remember to get?
2. Meds on the code sheet need to match what?
3. What do we do with the crash cart after its been opened?

Answer 3

1. Dr signature
2. The pharmacist’s or doctors meds list
3. Call PATRA or take it to pharmacy to be restocked

Question 4

1. What meds are on the cart?
2. Which. of these meds aren’t part of the ACLS protocol? What must we do if we use these meds?

Answer 4

1. Epi, Bicarb, D50, Calcium Chloride, Atropine, Narcan, Amiodarone, Levophed, Dopamine, and Lidocaine
2. Levophed and Dopamine. Must scan them and chart them.

Question 5

1. What is the concentration of EPI in the cart?
2. If we need to draw up additional epi, how do you do it?
3. How do we give Bicarb?
4. How do we give D50?

Answer 5

1. 1: 10,000 (1mg of epi in each prefilled syringe)
2. Take a NS 10mL flush. Waste 1 mL of NS (making 9mL of NS) then, draw up one mL of Epi 1:10,000.
3. Make sure you have a good line. You will inject the entire 50 mleq amp. Its very hard to push.
4. Give entire amp. Slam it IO for patients with low blood sugar.

Question 6

1. What is the concentration of Atropine, and how much can we give?
2. What to watch out for with Narcan?

Answer 6

1. It comes in 1mg/10mL. Can give up to 3 times.
2. Not for longterm Benzo users. Pro tip- call RT in advance, have yankeur, and non-rebreather

Question 7

1. What is amiodarone for and what are the dosages?
2. Are amiodarone drips used in block charting?
3. How do you mix Levophed?
4. What must you do once your bag is mixed?
5. What patients can’t have dopamine? What does dopamine require to infuse?

Answer 7

1. Antidysrhythmic. A-fib. Bolus with 300mg followed by 150. If patient’s HR still won’t go down, ask for a drip starting at 1mg.
2. no
3. Comes in a 4mg vial. Pull up 2 vials (8mg) shoot into a 250ml bag of D5 or NS
4. Label the bag with whats in it!!
5. Renal probs and dialysis. Central line

Question 8

1. If you have a patient on 4L NC and they are still struggling, what do you put them on?
2. Can you leave patients on a non-rebreather for extended periods?

Answer 8

1. High flow nasal cannula
2. No. It will shut down their respiratory drive. Use it only for a short while, then get them on high flow cannula

Question 9

1. What are the mandatory assessments to chart within 15 min?
2. If you find patient to be moderate or high risk of suicide, what do you do?
3. Where can you look in Meditech to get an overall picture for handoff and SBAR?

Answer 9

1. Rapid, Fall, suicide
2. Tell doctor, remove clothes, belongings, zip tie cables, curtain, get rid of bags etc. Zip tie cabinets closed. Must get dr to do ORL (overall risk level)
3. Review - Assessments - SBAR - Summary - HCA Handoff

Question 10

1. In meditech, where do we document all interactions with Dr and other RNs etc.? Should we just put interactions in a patient note?
2. How do we access preformatted notes like AMA etc?
3. What key is for Lookup?
4. What key is for save?

Answer 10

1. Treatments - Manage, Refer, Contact, Notify. No
2. Go to “N” for Note, N for New, F4 - F9. List of notes will come up.
3. F9
4. F12

Question 11

1. What are the questions asked when assessing cardiac?

Answer 11

1. previous diagnosis of heart problems?
   currently taking cardiac meds (blood thinners, water pills)?
   street drugs?
   signs of CASH (chest pain, altered mental, sob, hypo/hypertension
   n/v?
   skin appearance

Question 12

1. How long from triage to antibiotics on a sepsis?
2. What to do with hard stick?
3. When do we start fluid resuscitation?
4. When do we repeat the lactic?
5. What do we check after fluid resuscitation?

Answer 12

1. 60min.
2. Request IM antibiotics
3. after lactic results
4. Right after antibiotics and again after fluids
5. 2 BPs

Question 12

1. What things do we always assess in stroke or altered mental?

Answer 12

1. A&O? Blood sugar, pupils

Question 13

1. What do we assess for in GI complaints?
2. if someone has active GI bleed into mouth, what can we do?

Answer 13

1. n/v/d active?
   Active bleeding? Must look in mouth and anus.
   Does abdomen look normal ? Ask patient.
2. ng tube

Question 14

1. What interventions do we do for a hyperthermic patient who is intubated or otherwise not A&O?

Answer 14

1. Get a core temp (rectal). request temp foley order. Request cooling blanket or arctic sun. Can put ice in towels on groin or arm pits. Give sedation to prevent shivering. Do seizure precautions and document it. Give fluids and get 2 IVs.

Question 15

What 5 things do we need to know about drip titration?

Answer 15

1. What time we started
2. What is initial rate
3. What is our goal (parameters)
4. How much and how often can we titrate?
5. What is the max dose?

Question 16

1. What 9 things do we need to know about MVAs?

Answer 16

1. Airbags deployed?
2. How fast?
3. Windshield broke?
4. Wearing seatbelt?
5. How did you exit the vehicle?
6. On any blood thinners?
7. Did you hit your head?
8. Did you lose consciousness?
9. Assess for seatbelt sign

Question 17

1. When do we depart patients?
2. When do we change the room number?

Answer 17

1. When they physically leave the ER, or go to cath lab (because not coming back)
2. If the patient stays in the ER

Question 18

1. Which assessments do we NOT document for our L2Ks?

Answer 18

1. Behavioral Health Assessment
2. Suicide Risk detailed assessment
3. Behavioral Health suicide/home assessment

Question 19

1. • 2. What are the steps to do when we know patient needs blood?
2. What is the code for tube station?

Answer 19

1. Get consent. If PT cannot, get 2 RN’s to sign. Put in chart.
2. Watch TAR for blood to be ready. When ready, fill out request with Kate set vitals and send to blood bank (9). Watch tube station for blood to show up.
3. 7805

Question 20

1. If you need to restrain someone, what do you do right after restraining person (assuming restraint was applied emergently). Steps 1-5
2. What must you do within one hour for violent restraints?
3. When do soft restraints expire? Violent restraints?

Answer 20

1. Document “start restraint application”.
2. Get 2nd tier review (charge nurse to document). If 2nd tier isn’t approved, remove restraints right away.
3. Document “safety, rights, dignity” q20min
4. Document monitor RN assess q2hr. Document you letting, fluids, nutrition and rom.
5. Document restraint discontinuation
6. Document a Face to Face
7. 24h, 4hr

Question 21

What are considered ESI resources:

What are not ESI resources?

Answer 21

Labs, ecg, imaging, fluids, iv/im/nebs, specialty consults, simple and complex procedure like stitches

Poc testing, saline lock, oral meds, tetanus, prescription refill, primary care phone call, wound dressing, crutches, splints/slings