Ryan Thompson

1/31/23

Emergency Room Visit

Overall, I had a very good day observing in the Emergency Room. I got to perform a few

skills, first by inserting a catheter. The patient had a catheter previously for 2 weeks and it got

pulled out of place and was no longer working correctly. They tried to reinsert it but there was

still bleeding around it and urine was leaking out. So, we pulled the foley, and inserted a coude

catheter, because the patient had BPH. I also had an IV insertion on a patient which went very

well. The last situation that was very interesting was we had a stroke patient come into our

section. This patient had a stroke and fell on the ground 18 hours prior. EMS was called and was

brought into the ER. Upon arrival the patient had black vomit on herself and was flaccid on the

left side. Zach RN and I took the patient back to CT and even without knowing much about

imaging it was very apparent the patient had an ischemic stroke on the right hemisphere and a

hemorrhage on the left hemisphere. My reading of it was then confirmed by the radiologists note

in the chart. I was also explained on the reasonings of not giving TPA because it was not within

the time frame and because of the active bleeding would make it even worse. I left before the lab

results came back but it was also suspected the patient had an active GI bleed so I assume the

Hgb and Hct would both be low.

The roles in the emergency rooms vary there was at the time 3 RN’s on the floor and a

triage nurse roaming and doing admissions. The charge nurse was also there to understand all

patients and any urgent situations were addressed. Triage is very important because it bases who

needs treated first based on their level of acuity. I also got to witness Zach RN give report to a
floor nurse about a patient who was an ER hold. Report was given in SBAR format and was

presented in a very organized manner. Bed assignment is given based on acuity, but since the ER

at the time was not very busy, everyone at the time got a bed.

One ethical concern that everyone knows about emergency medicine is the long wait

periods. No matter what is done somedays people will be waiting for care. That is why it is very

important to triage patients appropriately so that we know who needs treated first.

I enjoyed my time in the ER and I look forward to going back and using my critical

thinking skills as well as my hands on skills.