You're in the bay. Once you get over to the bed,
we'll give you the story. Everything's going
to happen super fast. Welcome to the emergency
room. Pulse check no pulse And her blood pressure
is off Hey guys This right here is going to be
a non educational episode It's just going to
be me talking really about my very first level
one trauma as an LVN or an LPN if you're in a
state that does not recognize LVN and Just kind
of the importance of your basic nursing skills
So a lot of us, when we're in school, we discount
the manual blood pressure or we discount, you
know, I guess methods of attaining a temperature
or assessing pupillary reflexes or a cap refill
or anything like that, right? uh because like
you're probably sitting there thinking to yourself
oh i'll never use this a day in my life um when
was the last time anyone's ever taken a manual
blood pressure right and i can tell you right
now that in the level one trauma center setting
or in trauma settings period a manual blood pressure
is usually taken before you hook them up to the
monitor that right there is like number one right
Um, so if you're going to be working in emergency
medicine at any given point in your career as
a new nurse or as a nurse period, knowing how
to do a manual blood pressure will be of the
utmost important, um, thing for you because let's
just say that, um, you have you, you got a blood
pressure off someone and it was like, let's say
something stupid or something retarded. Right.
You call the doc because you're looking, you
know, for like rapid IV, push the beta wall.
Like you're going to do that. If you do do that,
let me know. I want to be there when you do it.
But you're looking for some type of like anti
hypertensive medication to give your patient
that way you can get their blood pressure under
control. Right. Because you can't really sustain,
you know, life with the diastolic blood pressure
of Snoop Dogg. Right. It's just something you
can't do. So they're going to want to know, hey,
did you get a did you get a manual? You know,
is the is it the machine or is it, you know,
is it them? And so you have to be able to go
to them and be like, hey, like, this is the manual
that I got, you know? And so like, that's also
another thing. So even if you're working on the
floor, you know, like you won't encounter many
traumas that where you'll have to. get a blood
pressure you know but if you do get something
that's like 250 over 130 you know like you're
going to want to take that with a manual cuff
just that way you can verify that this is legitimately
this high which if you don't know that is pretty
high. The highest blood pressure I think I've
seen was recently and it was an art line and
I think the highest the blood pressure got was
like 330 or 350. over like 120, 150 or something
like that. Naturally, they were unconscious,
unknown downtime, but yeah. Anyways, so yeah,
man, take your nursing skills very seriously
because if you're going to be getting into emergency
medicine, your basic nursing skills are going
to be part of your primary survey, listening
to lung sounds. That's like right off the rip,
you know, like primary survey. right off the
rip, you're going to be getting a lung sound.
You're trying to find out, hey, there are atelectasis
here, there are atelectasis there, you know,
tracheal deviation, obstructive shock, whatever,
you know, like all your basic nursing skills
are going to come into play like immediately
in emergency medicine. You're not going to be
doing something special. Like you're not going
to be the nurse that's inserting an auto line.
you are not going to ever do that. You might
be a nurse that's going to be doing an intubation
and so knowing how to do a simple jaw thrust
like they teach you in BLS that's going to be
something you're going to need to know and you
want to know how to do it well you know or if
you're like oh we don't really need to know how
to use a bag mask you know so let me just bullshit
my way through you know BLS and when in reality
like as soon as you tube someone after you pull
out the bougie, what the first thing you're going
to do, you're going to put the bag mask on and
you're going to you're going to bag them for
a while until RT can get the vent set up. So
knowing your respirations and how to use the
bag mask and how to seal it properly is going
to be of the utmost importance as well. I'm saying
this because like if you are a new nurse or if
you're just going through RN school and you're
like, oh, this is just. bullshit like I'll never
use this or whatever I promise you if you in
a lot of new nurses are like this they want to
get into emergency medicine they want to get
into the IQ for whatever reason you're going
to need to know your basic nursing skills like
hey when I shine this pin light into your eyes
do they respond you know like basic nursing skills
so knowing stuff like that you know is going
to be of the utmost importance and so Me being
me, I didn't really know like how important this
was. I was new to emergency medicine and naturally,
you know, like I got into a level one trauma
center as an LVN and I got cut free, got cut
loose from my preceptor. I had my first swing
shift because I worked the swing shift from 11
to 11. and I'm working the swing shift and, um,
it's nighttime. And if you don't know, man, like
all this stupid shit happens at night. And so
we get a level one activation, right? Level one
trauma. It was probably bed three, you know,
ETA five, you know, that was the, that was the
page. And so typically OSHA requires you to,
you know, have a gown, booties, bonnet, or bouffant,
whatever they call it, and some type of eye protection,
and naturally some gloves whenever you're going
to be exposed to some type of body fluid. Me
being me, I hung around. for a little bit, you
know, watch some people enter these level ones,
you know, some people were led, some people didn't.
So I was just kind of watching and seeing kind
of like what I could do. And then one night it
came in that level one activation, 20 something
year old dude got shot in the chest. I've been
at this trauma center going on a year and some
change now. And I have yet seen a clamshell thoracotomy.
And that's like one of the things that I'm like
dying to see. I mean, we can be morbid about
it all you want because like the clamshell has
like a less than a one percent chance of success.
So I mean, sadly, someone someone's going to
have to get it done. And I would just like to
be there when they get it done, not just a normal
thoracotomy, like a like a clamshell, like I
want to see a clamshell. And so I was excited.
So we had a chest, a gunshot wound to the chest.
And so I was excited. So I was like, you know
what, like if I'm going to get over my fear of
being a level one traumas today is going to be
the day I get in there. I get the monitor set
up there. I'm getting ready. Surprisingly enough,
no one was responding to this level one. And
usually at my facility, we're the busiest level
one trauma center in the United States. And that's
by Google. And when usually when a level one
trauma is being activated, like the room is packed
full. I mean, you can Google level one trauma
on Google and like you'll see how packed the
rooms are because the residents need to get hands
on experience. And so everyone's trying to get
a look. Everyone's trying to take a turn. You
know, so the room gets packed like relatively
fast. I'm in there. I got the monitor set up.
No one's in there. So I'm like, oh, shit, we
need someone to get the manual because that's
part of the primary survey. And so I'm fresh
out of TNCC. You know, like I am an LVN. So I
hold a letter of completion when it comes to
TNCC. I got fresh out of TNCC and I'm like, OK,
let's do this. Like, I'm super excited to do
this. All right. This is going to be this is
it. You know, this is what I've been wanting
to do. Homeboy rolls in gunshot wound to the
right side of his chest, kind of like in the
axillary area. And they weren't going to do a
clam shell. I was kind of bummed. I wanted to
be part of the team. So I wanted to take a bite
and see what I can do with it. Put my ears in,
you know, the stethoscope. I cranked that bitch
all the way up to like 300 and homeboy is sweating.
He's throwing up. He's showing signs of decompensated
shock. And so like we're like racing at this
point, right? and I can't hear the blood pressure.
I sit there and I like turn around and I look
at the nurse that's behind me and I'm like yo
man I can't hear this I can't hear the blood
pressure and they didn't acknowledge me or they
didn't respond to me because they were too busy
setting up the massive transfuser or they were
doing something else and so I try again right
and I turn back around I say yo man I can't really
hear this and they were still messing around
with the with the massive transfuser we have
the brand Belmont so if you hear me say Belmont
They're not endorsed. They're not endorsing the
episode. It's just our particular equipment.
They were messing around with the Belmont still.
I tried again for the third time. And by this
time, the trauma surgeon is like, hey, what's
our manual? And I didn't hear it. And so I looked
at the nurse behind me and said, hey, do you
want to try? And they were like still messing
around with this fucking Belmont. you know, because
if you know anything about the Belmont or any
type of massive transfuser, they they malfunction
regularly. And if you get the smallest air bubble,
they're not going to they're not going to work
rightfully. So and so, like I said, hey, I can't
get it. They I guess he didn't hear me. So he
called out again. I was like, hey, I can't get
it. They acknowledged it. We put the monitor
back on and his blood pressure was like like
50 over 30, 50 over 20, something stupid low.
And so we're like, oh, shit, we really need to
get this blood in. And so they get the blood
going. And this was like right at my shift change.
Like for me, it was right at the end of shift.
And so we get the guy to the scanner and then
the charge nurse pulls me out to the side. you
know, a little bit later, right before I'm getting
ready to clock out. And he was like, hey, that
patient was really young. Maybe I need to talk
to management with getting you more exposure
to level one traumas. But if you can't hear the
blood pressure, you need to let someone know
because you held up, you know, the whole process
and we almost lost that guy, you know, blaming
me for this kid that got shot and almost died.
And so I took it in stride, man. Like I looked
at him and I said, you know what, ma 'am, thank
you for the criticism. Thank you for pointing
that out to me. I know now and I will be better.
And so before I left for my shift, before I clocked
out, I got online and I bought one of those echo
core attachments that you can put onto your stethoscope
to amplify the sounds in your stethoscope. You
know, like I was like, this will never happen
again. This is never going to happen to me again.
I get the new stethoscope. You know, I have I
rotated out of trauma quite a bit. Back then
I had this new stethoscope and so I wanted to
do all the blood pressures You know in these
level one traumas and I will say this man Like
if you if you find yourself in those situations
where you are Scared, you know or something like
that, you know, at least you're not an LVN In
a level one trauma scared to get a blood pressure
And so my only critique with that is the attachment
works a little too well. Found out really quickly,
like in later level one traumas, it picks up
and amplifies every sound. It's not just heart
sounds. When you're in level one traumas, like
everyone's moving, everyone's moving something
like someone's getting a primary survey done.
Someone's cutting off clothes. Someone's starting
an IV. someone's grabbing x -rays, someone's
trying to turn on someone's, you know, someone's
always doing something, right? Someone's grabbing
labs. And so it's hectic and it's loud. And so
I thought like legitimately this stethoscope
would be good. And it turned out it's a little
too good. So if you find yourself wanting to
get one of these high powered stethoscopes i'm
not saying don't get them because the echo core
series whether it be the echo core itself or
the echo core 500 which is the one that gives
you the three lead ekg they have their place
in medicine i think they're great tools but they
are not good for level one traumas or in a trauma
setting or an emergency room type setting where
the patient is actively trying to die on you.
Because when that shit starts happening, like
everyone's trying to get a turn. Everyone's trying
to get in and trying to save someone. Stick to
your regular stethoscope. I promise you that
like you'll get the blood pressure. And if you
don't get the blood pressure there, it's probably
because the fucking blood pressure is that soft.
You know, it's going to be 50 over 20. You know,
so you're knocking on death's door quite literally.
And when I tell you, man, like this kid was off
in a bad way, just like sweating profusely, bleeding
profusely. We couldn't get the blood in fast
enough. You know, and I like stuck a chest tube
in. It was a ride. And then I will tell you this.
I'm like, if you are a new nurse and you're thinking
about getting into emergency medicine, like you'll
know really quick if it's for you or if it's
not. And I promise you, if you're going to be
timid and you're going to be weak about it. Not
weak, but if you're gonna be timid, it's probably
not gonna be the right fit for you. Because us
ER nurses, man, if we see you fucking up, we're
gonna let you know, hey, you're fucking up. And
you have to be able to take that criticism and
you have to be able to take it in stride and
keep moving. Don't take it hard or anything like
that. Like, yo, we're trying to literally do
what's best for you, the new nurse, and then
be the patient that is dying in front of you.
It might come out. a certain way, but it's legitimately
trying to just be like, hey, we're looking out
for you and them. So get it together. So that
right there was the episode, man, I was just
trying to let you guys know how important your
basic nursing skills are. And a little bit of
story time with my first level one trauma. A
lot of fun, a lot, a lot of fun. But yeah, thank
you guys for listening.