Rachelle M.

Firman

Emergency Room Rotation Journal

Mrs. Georgia Kirby

11/12/20
 ER Rotation

During my rotation to the ER I saw many patients. Patients came in with the chief

complaint of chest pain, shortness of breath, low back pain, and slurred speech. My first patient

with low back pain had a known AAA and complained of severe nausea. We got blood work, a

CT, gave her pain meds, but other than an elevated BNP everything looked normal. A patient

came in with chest pain and shortness of breath; he was sweating profusely and was severely

dizzy. We took his blood sugar as he was a diabetic, tested him for covid-19, and ended up

admitting him on a BiPAP which decreased symptoms and improved his blood gases. Another

patient who had been “feeling funny” for a few days and passed out at home presented with a

heart rate of 40. After obtaining an EKG he was discovered to have symptomatic runs of v-tach,

we gave him amiodarone which seemed to decrease the occurrence of his arrhythmias. Only one

trauma patient arrived, but we was pronounced dead shortly after the EMT’s brought him with a

self-inflicted gunshot wound to the head. There were multiple stroke alerts called during the shift

but none on any of my patients.

The ER is set up in a rectangle and divided into sections. Each nurse gets four rooms and

a hall bed if needed. My nurse had section B 1, 5, 6, 7 and a hall bed. Rooms 2, 3, 4, 8 are trauma

rooms used for emergency treatment and stocked with vital supplies. The sections are meant to

separate and organize patients by severity and symptoms (section G is for psych patients only) .

However the ER is overpopulated recently and the patients tend to go where there is an empty

bed. In the ER there are scheduled Nurses, Float nurses, the charge nurse, respiratory, trauma

team, and the ER doctor or doctors; however other specialties may be called for consult.

In the ER it is the nurses job to prioritize a patient's needs with triage level 1, 2, or 3 with

level 1 being the most important one to assess. The nurse evaluates symptoms and history,
obtained Labs, vitals, screenings, tests and convenes with the doctor to make a plan. The patients

are either admitted to the unit or discharged home with education, information, medication, and a

home plan of care. One potential ethical concern is the 5:1 patient to nurse ratio. For example my

nurse and I walked on shift to a flash pulmonary edema patient and a possible ruptured AAA

plus had two other patients with cardiac symptoms and no way to treat and assess all of them at

the same time. The ER is being overrun during the pandemic and the ER needs to stock more

nurses, because although all of our patients made it out okay the workload itself was too much

for one nurse.

Overall I really enjoyed my time in the ER. I learned a lot about triage and quick

assessment. In the ER you need to think fast and act fast while being careful not to miss anything

pertinent. I did a lot of Hands-On things for the first time. I put in IVs in my patients, which I’ve

only done once before. I put in my first catheter. I drew blood gases and Labs. I hung IV meds

and pushed morphine and Lasix. Overall it was a great experience and I would definitely

recommend clinical groups continue the rotation even if they are not interested in the ER.