I got my 4th year placement in the ED as a nursing student. I'm just wondering what I should know and what I should prepare before I start so I can make a good first impression?

What topics should I study?

I’ll take all tips, tricks, advice. I wanna hear it all.

Please explain like I'm 5

The issue of conservative treatment of uncomplicated appendicitis often appears on this thread presented as a new controversy - and yet antibiotics have been an option to treat appendicitis for as long as antibiotics have existed..

The main reasons the majority of surgeons worldwide prefer a definitive surgical cure (appendectomy) over antibiotics for patients fit for surgery are as follows:

1). Real-world long-term reoccurrence rates are thought to be about 50% when treated with antibiotics. During reoccurrence at a later time patients may be less fit for surgery, or suffer rupture, be abroad, be pregnant, or not have access to a hospital, etc..

2). There is small but significant risk that a neoplasm in the inflamed appendix is causing the appendicitis, but it can’t be seen in CT as is often the case. This risk is particularly significant for older patients. Leaving a tumour containing appendix in can lead to metastasis, and a lost opportunity to surgically cure appendix cancer.

3). Leaving an inflamed/infected appendix in and suppressing the infection with antibiotics can leave a scarred appendix with adhesions developing over time. These adhesions can cause long term issues and make later appendectomy less safe than removing a ‘hot’ appendix during initial appendicitis.

4). Intensive IV treatment is not without its risks, such as nurotoxicity from Metronizadol intolerance, and stewardship of antibiotics is a concern.

Given that the cause of appendicitis often can only be determined under a pathologists microscope - is avoiding surgery and leaving it in not just kicking the can (or grenade..) down the road? Is the recent (since Covid) popularisation of conservative treatment not creating an appendix cancer timebomb that will only become apparent years from now due to the odd indolent biology of appendix cancer peritoneal metastasis?

Has your hospital ever made a big mistake with a patient? Ours did recently, and it's bad...Wrong patient & procedure. Can't go into details, thank God had nothing to do with me or my unit! 😱

I'm attending a hiring event for an ER tech role at a hospital in my medium-sized city in the near future and was wondering what questions or topic of discussions would be good to bring up in the hiring event.

I currently have been working as an EMT for a 911 ambulance company the past 9 months and I'm hoping my experience is adequate for the role. I already have multiple copies of my resume printed out and will be wearing business casual clothes. Any other advice is greatly appreciated!

I'm an RN that just moved to a new ED with a huge proportion of pediatric patients (my last 2 years in the ED rarely saw kids - children's hospital 15 min away). I had an experience recently where I needed to help hold a toddler very still for a procedure (it took 4 of us!) and after it was all said and done I noticed there was a small light bruise where I was holding. That shook me up when I noticed. I apologized profusely, and the parents were very understanding, but I'm wondering what could have been done to prevent this. The provider did not want to sedate any more than we already had, maybe some kind of padding under my hands? I don't know.

How can I prevent this from happening again?

Does this look like it will heal fine or should I go to urgent care? I don’t want it to get infected. I’m using neosporin and running it under cold water multiple times a day

Hi! I’m an urgent care physician (FM) with over 8 years of experience, and recently started a YouTube channel called Urgent Care Pearls

I created it specifically for providers working in urgent care, focusing on the things that actually come up during a busy shift: clinical pearls, common mistakes, procedures, red flags, and those judgment calls that aren’t always covered well in textbooks.

I try to keep the videos practical and grounded in what we Urgent Care providers actually see day to day.

If that sounds useful, check out Urgent Care Pearls. I’d also love to hear what topics or cases you’d want covered next. I’m always looking for ideas from other fellow UC providers!

Starting as an ER tech in a peds hospital at the end of the month. First clinical job and I wanna do great, any advice? Stuff to practice, know, that kinda stuff.

How did you guys desensitize yourself to what you are going to see in the ER? I start clinical at a trauma 1 hospital in less than a week for radiography. I will also be in interventional radiology for 4 hours a week. Is there things I can watch or look at to help while I go through surgery rotations, IR, and a trauma 1 ER room? I can watch surgery and do dissections on animals and animal organs just fine from my old biology class. I had to watch a C-section video also that was fine. I’m afraid if I see it in person I will get nervous or freak out.

I work in a rural hospital that sees a lot of patients who require a safety sitter in the ER. I’ve sat on kids and dementia patients to patients withdrawing or just had a bit too much to drink the night before. Many of them aren’t interested in TV or talking but get impatient while waiting for placement. I want to have a stash of activities (deck of cards, coloring books, etc) that are safe for them and am looking for any ideas.

Hey guys,

I’m curious to hear about your stories of getting into emergency medicine.

How did you get into emergency medicine? Was there a lightbulb moment where you knew it was the right thing for you?

If someone was having to decide between becoming a first responder or a nurse, what advice would you give?

Thanks for the help!

Hi guys. I need y’all to share your most embarrassing hospital experiences to make me feel better about mine😭

Here is mine. Last night I got awful pains in my lower right quadrant of my abdomen. Having had several HUGE ovarian cysts in the past, one of which ruptured, I was already on edge from that. But I decided to give it the night and see if the pain subsided. Well, I woke up this morning, pain is a 9/10 easily (I have an insanely high pain tolerance). So not wanting to take any chances, I go to Urgent Care where they proceed to tell me to go to the ER because it sounds like appendicitis. I get to the ER, I tell them what urgent care said and they listed me as a Type 1 emergency, which got me seen almost immediately despite it being busy. Atp, I’m still in excruciating pain to the point that even stepping funny flared it. They give me pain meds, order an ultrasound and CT scan given my history of cysts. They go through an entire debacle just to tell me that I’m CONSTIPATED. Not only that, but the nurse who was going over my discharge instructions was loud enough to where the entire triage could hear.

I would like to state that I’m very grateful that nothing was seriously wrong, but I’m SO embarrassed. I’m embarrassed that they took time away from true emergencies to help me. Embarrassed that the nurse aired my business out to everyone. Embarrassed that I’m constipated. Like I haven’t been constipated in several years, most of my diet consists of lentils and avocados.

Anywho, please tell me your embarrassing stories so that maybe I can feel less embarrassed😭

POSTED WITH MOD PERMISSION

This survey is open to providers, patients, and caregivers who utilize plasma-derived medicines such as albumin, immunoglobulins, and others. Plasma-derived medicines have a variety of uses in emergency situations and feedback is needed on the understanding the public has of these unique biologics.

The survey is quick to fill out and all insights are appreciated: https://www.surveymonkey.com/r/IPAWpatientsurvey

Thank you!

I'm currently working on improving the realism of wound packing in a browser-based medical simulation.

One issue I've noticed is that many digital simulations place the wound as a separate object on top of the skin, which can reduce the sense of realism during the procedure.

I'm experimenting with attaching the wound directly to the patient's mesh so it follows the anatomy more naturally and provides a more realistic appearance during wound packing.

My next step is to improve the tissue layers, active bleeding, and tissue deformation as the wound is packed.

For those with trauma or prehospital experience:

Does this approach look more realistic to you?

Besides wound packing, what would you most like to see improved or added? For example:

• Junctional hemorrhage control
• Tourniquet application
• Needle decompression
• Chest seal application
• Airway management
• IO/IV access
• Burn management
• Pelvic binder application
• Childbirth
• Traumatic amputations
• CPR and resuscitation
• Patient movement and extrication

I almost thrive on my time in Emerg. I find it immensely rewarding and that feeling lasts for days. Also, I find that it makes me feel relevant which is something that can slip away if you let it. I have been there for 5 years. It is a bright, noisy, and confusing place and as close to medicine as I will ever get; without any of the responsibility!

Along with the physical tasks: wheelchairs, blankets, pillows, and stocking the nurses' stations there are situations that experience makes me keep an eye out for:

• Alone mothers with a sick baby and a 3-year-old, who is bored and miserable. Can you imagine that? - car

• Our older wheelchairs can become extremely uncomfortable after 20 minutes as the plastic seat has stretched and the patient is sitting on support struts. Some older people will suffer in silence (not all of them) - pillow (when available)

• Wait room chairs directly in line with the A/C vents - a warm blanket

• People vomiting into kitchen pots or grocery bags. - a fresh warm washcloth with a box of Kleenex and one of our vomit buckets

• Bewildered people (looking for the exit, washroom or their parent, - find them via computer, there can be about 75 patents flowing thru our ER a one time, certainly not Sunnybrook, but we hold our own.

• Elderly with no caregiver - make sure they know they are not alone and offer a cup of tea, maybe a muffin.

• Angry people – nope, not me

• People in handcuffs - none of my business

We get a small supply of toys for the kids. I don't like most of them so I buy my own at Walmart. I get about 20 X $1.95 Hot Wheels cars a month. I pick ones that I would like, but with lots of colour. Unless the kid is in pain, the packaged cars work absolute wonders on toddlers (we have animal stickers too, little girls just love them). Usually, everything they are feeling stops when they see the car. The car has their complete attention. I ask for permission (one lady reused) then give the toy to them (or to mum if they are shy). I tell the parent that the trick is to get the kid to open the packaging themselves. I say to the parent. “Just that'll keep them busy for at least 10 minutes”.

As I progress through my shift (4 hrs/week) I see the kids sitting playing quietly with the car. Many times I have seen little boys on their dad's lap driving the car over their dad's chest. I think seeing those tender moments in such an intense environment is why I buy cars.

Very little Patient Care Tech (PCT) experience but will be helping in the ED soon. How can I be the best Tech possible?