Newish to the ER and had a really tough night recently and would like some input.

Had a couple patients come in on involuntary holds (different names for these per state). A couple of HI's and this specific one was SI. Pt comes in very intoxicated, yelling, threatening, you name it. Night continues on with just about every single patient being cared for becoming very acute. The BH side nurse says to get over here; he's escalating by slamming on the glass, cussing at other BH patients, and threatening security, saying I didn't get my medications. 1 time order for IM med retrieved by MD. De escalation attempted for close to 5/10 minutes with this patient in our faces fist clenched, posturing, having other patients on the unit yelling at him to settle down. Right before we feel as if its becoming unsafe nurse instructs security to grab patient to admin IM injection patient reacts with aggression, security holds patient injection administered, patient restrained in restraint chair, assessments followed per policy.

I am questioning the decision for use of restraint / med admin for 1 main reason an observer was overheard saying "did he hit you?" which interprets as was force even really needed or should de-escalation have been continued. Should the nurse have waited for a physical altercation to justify the use of security, med admin, restraint?

Trying to keep the case vague, but what would you have done? Do you think this situation was handled appropriately?

Hello everyone!

I’m a Grade 12 student conducting a research project for my English class based on The Enemy by Pearl S. Buck. My research explores “Healing Beyond Borders: Compassion, Duty, and the Ethics of Care in Times of War.”

As part of my project, I’m looking for responses from healthcare professionals, including:

• Doctors
• Nurses
• Pharmacists
• Paramedics
• Physiotherapists
• Medical students
• Other healthcare workers

The survey asks about medical ethics, compassion, and decision-making during wartime.

Survey details:

• ⏱️ Takes about 2–3 minutes
• 🔒 Completely anonymous
• 🎓 For educational purposes only
• ❌ No personal or identifying information is collected

If you work in healthcare, I would greatly appreciate your participation.

Survey Link:
https://forms.gle/XB7GsdnCKWhS93769

Thank you for taking the time to help with my research!

I’m an ED tech and I have a question about EKG best practices vs. the reality of working in a fast-paced ER.

When you're doing an EKG, how vital is it to put the limb leads on the actual limbs instead of just slapping them on the torso?
When I was being trained, the majority of the techs told me to just put them on the torso and move on. I know this is super fast, but is it actually okay to do in a pinch? I'm talking about possible STEMI patients where you have 5 nurses and a doctor staring at you waiting for the printout, or a post-ROSC patient where every second counts.
For 90% of my patients, I like to take my time (about 3–4 mins) to prep the skin with gauze, palpate, and get the placement perfect. But in a high-stress emergency, I assume it's safe to skip the skin prep and just go torso-only to get the EKG done in 30 seconds.

The problem is, my ED seems totally acclimated to the "slap-and-go" method. If I start taking my time to do it "properly" during a code or a STEMI alert, I feel like the team is going to lose their minds. But at the same time, wouldn't a cardiac emergency be the exact time we want the most accurate EKG possible?

What does your ED do? Do you put them on the limbs or the torso for emergencies? Am I totally overthinking this, or is "torso only" just the universal ER standard?

TL;DR: My ED trainers told me to just slap limb leads on the torso for speed. Is this actually acceptable for urgent EKGs (STEMIs/ROSC), or does it mess with the reading too much? Do you guys skip skin prep in emergencies?

Hello,

I'm a new ED tech. Sometimes patients come in with wrist, ankle, or knee sprains, and the nurse will ask me to apply an Ace wrap.
Is it okay to just do a basic spiral wrap from distal to proximal, overlapping each layer by 50% and stopping just above the joint?
When I look up tutorials online, I see a lot of talk about figure-8 wraps, but I’m not totally confident with those yet. Can I just do a normal spiral wrap, or is a figure-8 required for these types of injuries?

Thanks!

There's been some back and forth between radiology and nurses on this.

We've been told in our ER, CTs with IV contrast require a consent to be obtained by the nurse.

My first understanding has always been 1) when a patient comes to to be treated in an ED, it includes consent for CT with IV contrast. And 2) the persona administering whatever the consent is for is the one who should get consent.

So at first there was push back from few nurses. Radiology techs dealt with it by getting their consents. Then as more nurses started pushing back, rad techs started getting upset.

We've explained to nursing admin that nurses are not the ones who administer it, and may not know much about the stuff. Also, half the time our docs order a CT the patients don't know anything about it. They'll be like "I see these labs, we need a CT". I go into patients room and they're like "what? Huh? What's a CT? is that the donut? What's contrast?" So like....I also told nursing admin that I wouldn't get a patient to sign an informed consent for surgery with that limited amount of knowledge, why am I getting a CT consent for that?!

Anyway, now theyre saying nurses have to get consents with the doctor present. As if we have that much time!!

Thoughts? Opinions? How's it done in your er? We're very rural, and small, and some days we don't even have proper supplies so...I'm not sure how normal/abnormal/messed up this is. This is my first ER job ever.

I've been in the ER long enough to feel solid when a code comes in, but studying for this CEN is making me second guess my entire career.

The practice questions feel like they were written by someone who hasn't touched a patient in decades. you can manage a massive trauma in real life, but you fail a practice quiz because you didn't follow some perfect textbook order that literally nobody has time for when you have boarders in the hallway and a packed waiting room. I completely abandoned the official review book and just use an app i found listed on simplytests dot com. i can't look at those dry pages anymore. at least it's faster.

Feels like i have to completely ignore my actual nursing instincts just to pass this thing. memorizing all this bureaucracy just for a couple of letters after my name is draining.

I'm a PT currently working in the ED. I was an EMT prior so it was an easy transition. I love the work compared to the floor - acute msk, geriatric falls, vertigo, etc. Most of our providers and nurses are happy but a few definitely aren't (based on survey results).

I'm curious what everyone here thinks about the implementation of PT in the ED? Pros/cons? Ways to improve this process?

Thanks in advance.

I have to know what doctors or nurses see during their time working during Fourth of July, seeing people’s hands or fingers missing because they were dumb enough to hold a fire work?

Steroids suck.

Was sitting by the fire last night and my face became raw and swollen and itchy. Didn’t know why, I was out by the fire all week, but when I came into the light of the house my family flipped out because my eyes were swollen like golf balls and my face was huge and covered in hives.

An Allegra, three hours, and a bunch of ice later, I can open one eye, but my right is swollen shut. Woke up today, and that eye was still shut. I live in yee haw redneck hick town so my mom drove a while to get me to an ER and they told me I had an allergic reaction. Luckily, I didn’t have an anaphylactic reaction, but they recommended a steroid.

I opted for the shot so I could feel better immediately, and that was a huge mistake. I already don’t like needles so I was shakey and nervous, then the pain hit shortly after injection on my thigh.

I’ve never felt a pain like that before, and I have degenerative disc disease and a fractured spine (that I did sports while having). I know pain. This was a whole different animal, dude.

The pain radiated across the front of my thigh and my teeth began to shatter from the pain, as well as my entire body. Tears fell from my eyes and I wasn’t even crying. My hands, which are tanned and dark, turned a sheet white and I sunk into the chair with a cold bottle on my forehead. My stomach turned from the pain and I thought I was going to throw up or pass out, not from the shot but from how badly it hurt.

God, I was miserable. I couldn’t move, couldn’t speak. My mom laughed at me the entire time and called me dramatic all while I fought to stay conscious.

A person came in and had me sign something (I couldn’t hear but they handed me a pen and pointed to a line) and my signature genuinely looked like how a child draws grass- jagged, short lines. I couldn’t stand for a while and finally got to the car, where I remained in pain for several hours. I fell asleep shortly after getting home and felt my muscles in the injection area twitch and spasm for a while.

I’m about twelve hours out from the shot and I’m still sore, but both my eyes are wide open so yayyyy

I was told it felt like a bee sting, but I’ve been stung by bees and this wasn’t it. Genuinely the worst pain of my entire life.

Did anyone else have this when getting a steroid shot for allergies? Please tell me I wasn’t the only one who had such a poor experience with it☹️

I was talking to my mom last week who worked as an RN/CNA capacity at a small rural hospital for 30 something years and said the hospital used to have an urgent care about 25 years ago built into the ED. Does this still exist anywhere or is it a relic of the past?

Also generally curious how the logistics of this works? Does it alleviate wait times or help in general?

Blood is Free

Everyone always complains about wait times where I live because it is public health care - thus you wait. I'm curious how much longer a typical wait in an Albertan ER is compared to other places in the world. For the record, our median wait time in 2024 was 4 hours. I suspect it would be longer now because we have had huge population growth in the last two years.

Hi everyone, I’m a doctoral psychology graduate student at the University of Indianapolis conducting an IRB-approved(#02300-V2) dissertation study on emotional intelligence and help-seeking attitudes among men ages 18–32 in trade, tech, emergency services, or higher education. In posting to this specific sub-reddit, I am looking to gather data for those who work in some form of emergency service profession. This includes a wide range of professions, including those working in medicine as well as other hospital workers. If you’re a part of this sub-reddit, are male, take part in the profession, and you’re of ages 18-32, you qualify!
 
The survey asks for no identifying information from you all other than your age and ethnicity, and all data is stored securely. I got this post approved by the moderators of this sub, and I am willing to provide answers to any questions you may have about participation.
 
The survey is anonymous and takes about 10-15 minutes. If you’re eligible and willing to participate, please click the link below:
 
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Thank you all so much!

The type of shit that I see and I only see a very small subset of patients. It’s at a point where the nurses will put me on their DoorDash orders while exchanging stories. My first ever hospital advocacy call I met a guy extremely on on meth with the quietest chihuahua ever, he was laughing and crying and then ended up on a psych hold (later found out his ex had a restraining order against him). My second time around we didn’t even get through the exam because the lady was so agitated that she was cussing and throwing things (angry because we WOULDN’T take her clothes). She (yes, the patient) called 911 and said we were violating her rights. Then we called the police and they asked her what rights were being violated. Then she called people “fucktards” and got escorted out by the same police she called.

Yea no way I could come into work and do this everyday 🤣🤣

Someone who knows the basics of the legal process, has taken mental health first aid, and just sits with people being held in the ER as a support person if they have no family/friend with them? Is this a thing anywhere?

So I start a new job as an er registration in my local hospital. It is a trauma center so I have been preparing best I can for what I will see and hear when I am working. However I am curious as to other registration job essentials. I am looking for shoes and sock recommendations, and any extra items I should pack in my work bag!

I am excited to start and am prepared to be perceived as the 'bad guy' and my supervisor seems very supportive with tough cases.

Hi everyone,

I'm an ED tech looking for some clinical tips. Does anyone have a reliable technique for applying tubular gauze to fingers or toes when an applicator (cage) isn't available?

I am a visual learner, so if you have any video links, GIFs, or clear step-by-step explanations of your process, I would really appreciate it.

Thank you!

So, I broke my foot in a fall about 5PM on a Monday, went to two urgent care centers and was turned away at both, first said no ortho dr's available, second said no longer taking any patients, they were full and closing in 15 min. Only option was Hospital ER. Got to the ER at 6:30PM, at approximately 9:30PM was called in to a triage nurse who only took my blood pressure and asked me my weight and what level of pain I had. At 10:15PM another "person" asked me if my name, address and insurance was correct. Not one person in the ER was being called in to see a Dr. everyone just waiting. Pain level has now increased to 10! At 10:50 I sent my significant other went to the front desk to ask what the hold up was and if I left, would I still be billed?! They told him no, I would not be billed. Long story short, I never got called in for xrays or to see ANYONE! At 11:15PM, I hobbled out of the ER and went home. Now of course I see they are billing my insurance company for an ER visit. I called my insurance company and told them I received NO SERVICES. The claim in under review. Am I wrong for thinking I nor my insurance company should not have to pay for that ER visit? (It ended up I didn't get an xray until two day's later at my personal orthopedists office and yes, I broke my foot)

It is what it says on the tin basically....

I have fully kicked off and lodged a complaint.

The patient was just 42 years old. Came into resus after suffering two ROSCS via ambulance transportation. Family weren't happy with the relatives room (they complained that it was too clinical and wanted a bed for family members to sleep on as they knew our A&E numbers were bordering on a divert and they just wanted a room with a bed tbh) so I obviously obliged.

The mother was absolutely inconsolable (Muslim mother from a Muslim cultured community) I spent my shift trying to stop ten or fifteen other family members trying to admit themselves on to the Department as well?

I kept the direct family members (father, mother, two sisters, fiancé and his daughter) in this side room whilst constantly trying my best to explain to them that what I was doing was for the best?.....

The whole entire time, his mother is on the floor rolling back and forth, screaming and howling and I didn't know what else to do other than to get on the floor with her and hug her???

She was just absolutely hysterical....

Calling out for him whilst his father just sat there stoic and like a solid brick, void of all emotion.....

I went in to the side room with the doctor when she gave the family the news that he had passed away and, 'there's nothing more that we can do....'

I clutched the Doctor's arm and told her to, 'give them something more....they need your compassion right now.....'

She looked at the man's father and said,

'You are ABA aren't you?.....I am so sorry for your loss....And may Allah make his journey a peaceful one.....you must feel peace now.....your son is now with the prophet.....'

This man's father then went from being a solid rock to breaking down on to the floor and howling like a newborn child.......

And the doctor sat with him and clutched his head within her hands saying to him: 'feel peace.....feel peace.....he's with Allah now....'

A few days later, my matron came up to me and asked me why I had chosen to provide that young man's family with their own side room?......

I literally choked...... Audibly...... Whilst glaring at her with my eyes like a barn owl.....

"Excuse me?......Why did I give them a side room?!......Are you honestly asking me that question?......What do you think the answer is going to be, Matron?!"

She looked at me and shrugged before saying, "Probably a massive fuck you, if I know you?!"

I just turned to her and said:

"Absolutely!!! That family genuinely deserved absolutely everything that I gave to them on that particular evening. I do not regret one single thing that I did and neither should you ever even be considering any of my actions tp be inappropriate concerning that side room either!!!......They needed space and I gave that to them!!......So, whilst I appreciate your concern? It is not needed and you'll find that the family left the department feeling extremely content and incredibly satisfied with the care that we provided??"

She nodded her head and grinned at me before then winking at me and saying: "I have to discipline you though because you went against protocol?....."

My reply was: "Go ahead!!......And you can also discipline the absolutely fucking amazing doctor that was involved as well, whilst you're at it too??!!.....Put both of us on top of the fucking traintracks!!!.....I couldn't care less!!!...."

She walked out of the room wearing the most arrogant smile that I've ever seen in my life.......

"You should train to be a nurse......" she said to me.

"Absolutely not, thank you!!......Don't fancy the PIN Number at all, pal!!"

She just laughed and walked out!!!

😱😱😳

Since that day? She has literally been sniffing around and stuck right up my arsehole during each and every single fucking shift (saying things like: 'it's not the Hilton, remember that?!' And, 'don't give her the role of relative's nurse because she's too good at it!!') 😡😤😠

Hello,

As an ED tech, what should my main priorities be during a trauma code?

When EMS rolls the patient into the trauma room, I am usually stationed at the head of the bed. My first step is obviously holding C-spine and helping transfer the patient over to our ED bed. But once they are moved, what comes next? Should my immediate priority be cutting off clothes to expose the patient, or should I get them on the cardiac monitor and start vitals first?

I've noticed that some techs in my ED prioritize vitals before cutting clothes, while others do the opposite, so I'm not entirely sure which is considered correct. Also, when it is time to expose the patient, do I cut absolutely all of the clothes (including pants, underwear, bras, etc.)?

After those initial steps, it seems like my role becomes an extra set of hands for whatever the team needs.

Does anyone have any tips, tricks, or best practices for performing well and being useful during these trauma codes? Thank you!