A Day in the Life of an Emergency Room Nurse

Sarah Carlson – a 28 year old Critical Care Nurse from Boston

Four years of nursing school, textbooks and classroom lectures have failed to fully calm my heart, mind, and spirit as our next trauma patient is rushed through the double doors of the emergency room on a wobbly six foot stretcher. Injuries uncertain, responsiveness still to be determined, vital signs unknown.

	Sarah Carlson. (Photo: Eugene Adams) Click here to see more photos of nurses featured in this documenary.

"CODE TRAUMA NOW" resounds throughout the department on the overhead pager. MD Attending, MD Resident, OR Residents, Respiratory Specialists, Nurses and Emergency Service Assistants arrive in the trauma room of the ER. Each clinician dons gowns, gloves, and glasses and the patient is methodically moved from the Paramedic's stretcher to the hospital stretcher. Like clockwork, the Paramedic begins to report, as all eyes in the room are on the pale, female, approximately 19 years old, lying before us covered in blood under a white blanket. Both her arms appear broken, glass is strewn in her hair, deep cuts line her face along her eyes and nose. Her head is swollen, bloody and bruised. The room is silent as the paramedic describes what happened. While we try to stabilize the patient I hear bits and fragments of the paramedic's report.

High-speed motor vehicle accident?… What?… Unconscious at scene?… I think to myself, is that what I just heard?

Then the doctor's trauma assessment begins. The MD Resident, a tall dark haired 29 year old woman takes charge. The attending faculty physician looks on—as the young doctor begins her verbal full body assessment of the young motor vehicle accident victim. While the team listens—they work quickly to get the young patient's clothing off and bring the necessary equipment to the bedside to perform emergent imaging to make sure there is no damage to her internal organs. One of the nurses in the room begins to document all trauma findings on the trauma flow sheet as the MD Resident dictates. An Emergency Service Assistant hastily places the cardiac monitor on the patient to get a current set of vital signs. Blood pressure: 82/54, heart rate: 130's, respiratory rate: 26.

My role as the trauma nurse is to find intravenous access to immediately begin administering fluids, medications and blood products. I look at the bloodied, severely injured patient to find a place where I can access a vein with an IV catheter. My first attempt to place the needle in a vein in her left forearm fails because her bones are broken and her veins there are weak. I look for another vein and easily place a large IV in her right wrist, followed by a second large IV in her right anticubital area—inside her elbow. I am successful and the IV fluids are running through the patient as the MD resident continues her assessment. The resident has ordered me to begin administering blood products because the patient's blood pressure is low which can indicate she has lost a lot of blood from her motor vehicle accident. I grab a bag of blood from the coolers that are in the trauma room and start giving it through the IV's.

Thoughts continue to rush through my head. Is the patient breathing on her own? Are we going to need to intubate her and should I begin to draw up the necessary medications to perform this procedure? What are her current vital signs? What is her respiratory rate, heart rate, blood pressure, and temperature now? Are these stable? Are my IV's working and running? At this point I only have visual clues as to the status of my patient. I see blood coming from her legs—how deep are the cuts? Is her leg broken? There is bruising around her abdomen—is she bleeding internally?

The MD resident states that because the patient is loosing a lot of blood, her injuries are not completely known at this time, and her blood pressure is low, heart rate is fast, and she is breathing at a rapid pace. We need to place a breathing tube down her throat to allow a ventilator to breath for her. The resident yells out the dose and medications she wants to use for the intubation and I quickly draw them up in a syringe ready to administer them. Respiratory personnel are present in the trauma room and have the ventilator ready. With encouragement and cooperation from the emergency medical team the resident asks me to administer the medications to paralyze, sedate, and take away all feeling of pain the patient may be experiencing. Easily the tube is placed down her throat and her chest starts to rise with the breaths given to her body by the ventilator.

The patient is then moved to radiology for x-rays and CT scans. It turns out she has a broken left arm, broken right femur, multiple facial fractures around her eyes and mouth, two broken vertebras in the middle of her back, and a cut on her liver causing her to lose a lot of blood.

Through all my emotions and through quick thinking and using my knowledge to help perform the necessary interventions to help save this patient's life, I am able to stay calm, for I see that everyone in that room is working as a team, an Emergency Medical Team, and together we are delivering the best care we can for this patient.

I chose to become an ER nurse because I thought it would be a job where I would never get bored. The energy, excitement, teamwork and the goal to save lives and the knowledge needed to do this is what continues to drive my daily passion for Emergency nursing. Whether I am the trauma room nurse or taking care of patients suffering from chronic illnesses, whether I am helping alleviate someone's pain from a broken bone or cut hand, whether I am sitting and talking with someone who does not feel safe to himself or to others around him, I desire to pour out comfort and compassion to those around me. I want to be a calming voice in the time of chaos and uncertainty. In the ER I never see the same thing that I saw the day before. Each patient is unique and the knowledge needed to assess every new patient is something that I know I will learn better through time and experience.

Some days are harder than others for me to care for my patients but this is my greatest challenge to come here every day ready to work and give of my time, knowledge, caring, calmness, and love to those who are often facing major turmoil.

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