Emergency nursing isn’t all drama and adrenaline.

As any ED nurse knows, most of what a nurse sees in the ED is not what would classify as real emergencies—the kind of exciting, life-threatening situations that might have actually been the reason they chose emergency nursing. That’s how it was for me, and getting hired as a new grad to work at New York City’s Bellevue Hospital, one of the country’s premier emergency services, was a dream come true.

However, I quickly learned that most of the people who came through our doors did not have exciting, life-threatening emergencies but rather the more humdrum “urgencies” of life—gastroenteritis, a sudden high fever, a small laceration that needed a few sutures, sprains, and minor fractures. Minor, comparatively speaking, but certainly not minor to the patient, and all requiring attentive care. (For a vivid and poignant inside view of emergency nursing today, see the photo essay in the September issue; the essay is based on Carolyn Jones’s new film, In Case of Emergency, to be released this week for Emergency Nurses Week.)

When the ED doors slam open.

But then there were those sudden life-or-death emergencies that raised everyone’s adrenaline levels—a patient bleeding out was one of the more dramatic scenes. They usually arrived without warning, doors slamming open and a stretcher pushed in by paramedics and then quickly surrounded by nurses as someone paged the trauma team. There’s a visceral reaction to seeing blood pouring out of a massive abdominal injury or chest wound, but then training kicks in as you go through the mental steps and check vital signs, start IV lines and hang fluids, find and stop the bleeding.

What we’ve learned about treating hemorrhagic shock.

The thinking on resuscitation has changed over the years—from flooding the patient with fluids and plasma early on to boost blood pressure to whole blood as first choice and permissive hypotension. The wars in Afghanistan and Iraq have also spurred greater understanding of hemorrhagic shock; as the authors note, “Several procedures developed on the battlefield to treat this condition have been adopted by civilian health care systems and are now used in a number of nonmilitary hospitals.”

Read the comprehensive update from our September CE article, “Trauma-Related Hemorrhagic Shock – A Clinical Review.” Although this article is geared towards the ED setting, it’s also applicable to nurses in the OR/RR, labor and delivery, and med/surg areas who know all too well that there are many reasons a patient may develop acute and severe bleeding. We’re glad we could bring you this helpful article.