How is a resuscitation ran in the ED?

[aussie_rn]

Our codes run here in our ED run pretty smoothly I would say, of course you have those who act as chiefs and want to do everything, but as far as nursing goes, there are three of us, 1 to manage the airway, assist with intubation, mechanical ventilation, second nurse to draw up medications and give medications and the third to be scribe or scout. Usually our students whether they be nursing or medical students, we let get in and do CPR otherwise, they're the gophers and send bloods off, take ABG's to be checked etc. You'll know when you gotta start CPR, we normally hook them up to our defib machines straight away and as soon as you see VT then shock them, or if asystole start CPR, within a matter of seconds. Our resus' are fairly controlled, we've had ambos helping out with CPR quite often which has been good, "share it around a bit". Anyways, all the best for your new job, and training, let us know how it goes!

[mediccjh]

You gotta love how 2 people can work an arrest without a problem out of the hospital, and 5 people in the hospital can f--k it up.

[Medic253]

God I guess I am buying breakfast again...

[edogs334]

I dislike how many people there are in the trauma room sometimes. Like Rid said... way "too many chefs." Your role as a tech in codes will most likely be to do compressions and get stuff that the RN's and MD's need (if you aren't doing compressions). Still a VERY important role- how could the patient have a prayer of surviving if someone didn't do compressions (along with securing the airway)? Moreover, how could the docs and RN's do their job if they didn't have the equipment to do it with? Fortunately, there are many RN's and MD's that realize this, and actively appreciate the work that techs do. Codes at my hospital usually run quite smoothly; it's some of the traumas that present a problem with WAY too many people in the room. How many people are in the room will depend largely upon the staffing level at your facility and whether or not it is a teaching hospital. Codes and traumas at teaching hospitals will invariably have many more people attending them, since residents from the Emergency Medicine and/or Trauma Surgery service will be there.

Best of Luck. You may not be able to (officially) do assessments on patients (since that's usually the RN and MD's job in a hospital), but you'll definitely see and learn a whole lot. Sure beats doing non-emergent x-fers for some private ambulance service (been there, done that).

[chevy]

In our neck-of-the-woods, the person (Patient Care Assistant - PCA) does the chest compressions only. The vast array of other people RT's, RN's..... do everything else.

When CPR not in progress, PCA's help expose the Pt, roll-logs, get-stuff and that sort of thing.

[kubernesis]

There isn't many differences in the ER versus the field. The nice thing is you could just scream nurse or doctor. as far the job is concerned. They will mostly likely have you aid in compression since it is very difficult some nurses to do for extended periods of time. The important thing to remember is patient position. Where is the pt? on the floor or bed. If pt is on the hard flat surface like the floor have at it. But if you find the patient coding on a bed, have someone or yourself, adjust the bed to a lower position to make compression easier. and FIND A HARD FLAT SURFACE! it is vital that you give adequate perfusion to the pt and this can't happen if the pt sinks into the bed on every compression. Flat plastic back boards are usually found on the crash cart or near by. Hope this helps...

Mike

[VentMedic]

So, again I ask, if the hospital staff are such screw-ups and work a code as a cluster mess, why do so many paramedics run as fast as they can with L/S to get to the hospital? Especially with a cardiac arrest?

Maybe the hospitals here in my area of Florida are a little better than the rest of the rest of the country or so it seems from the posts.

No, not every code runs smoothly. Sometimes it just takes 1 thing to throw a knot into the situation. ED staff have many other patients also that demand attention especially in small EDs where there is limited staffing. This may be the 5th code they have had and it's not even 12:00. So yes, maybe they would like someone else to do compressions. I seriously doubt because they are a "nurse" that they can not do compressions. We rotate frequently like the quidelines and everyone gets a turn to keep the compressions adequate. Nurses, RTs and MDs all must maintain ACLS, PALS and NRP every two years if they work in an ED in most hospitals.

If the hospitals are messing up this bad on your patients, request a JCAHO review. Don't just sit around on a forum and bash away at a few incidents to make yourself look better. If the ED is really that incompetent, then inform the State and Federal agencies. Although, you had better have some good documentation to back up your claims. And, make sure you are perfect before you cast stones at other professionals.

As for as someone working in the ED as an ER Tech, you will have the opportunity to learn alot from many professionals. Most are more than willing to show and teach you anything. Even if your scope is limited, it doesn't mean you can not still acquire knowledge.

[Scaramedic]

A BUMP from a year and half ago? What's with all the old post BUMP's?

[iMac]

I currently work on an ICU and we have Nursing attendants on at all times. Part of their job description is also to do compressions.

You being a basic I wouldnt worry to much, when codes are ran internally there a lot of people. Make sure you are confident with your ability to give good compressions and make sure you are familiar with where all the equipment is as well as how the paging system works. Here our NAs are responsible for running and making the initial call to everyone while the rest of the staff focuses on the pt(s).

Good Luck.

[flapsdwn]

Right on. There is alot of really GREAT experience to be had working in an ER. As far as protocols, you guessed it.. things vary from area to area and hospital to hospital and even certain departments. For instance, some prehospital providers here can administer RSI drugs to get those really difficult airways and some can't even though we both schools of thought have the same medical direction/base hospital. As far as the "type" of CPR, some agencies here are having great success with the Sarver Heart CPR (no breaths, just chest compressions) but even so, the rest of us still have to go with the standard American Heart CPR until it is standard and not a trial school of thought. I'm sure what is expected of you there will vary with the crew you work with and perhaps vary from one call to the other. You might be directed to do BVM ventilations with supplemental oxygen on one patient (don't hyper ventilate) and then do chest compressions on a subsequent patient. On your first few times doing chest compressions, don't let the crepitus/cracking cartilage get to you. Better they have a sore chest tomorrow than too little 02 today. Watch the height of your compressions on the monitor for awhile. Don't be timid. Push those hands down. Listen for the team leader's instructions... they may want you to pause from time to time to get an advanced airway or check a carotid pulse. You may find your yourself "riding the rail" doing chest compressions while riding on a mobile gurney if an ambulance arrives code 3 working a code in the back. My advice is to ask the charge nurse each shift what they will expect of you each shift until they know you and you know them. Some RN's will toss you to the wolves right off and get your feet went... some might want you to observe for awhile and then ask questions later when the crew critiques the event. Some folks are approachable.. some aren't. Don't let the few crabby ones discourage you. It WILL happen. Some folks are just grumpy.. especially in an emergent event. Just remember that it is the patient's emergency NOT yours and don't take it personally. Its just a job. A very very wonderful job. Have fun and good luck. EMS is everything it is cracked up to be.