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books01.gifENW's Emergi-Lexicon

A Compendium of those pithy phrases of Emergency Jargon
and regional variations of terminology!

Send contributions to: ENW Lexicon   You will be listed as the contributor.
While ENW does relish those slang terms that aptly characterize patients or situations not otherwise easily described, we are wary of pejorative or denigrating terms.
We are especially interested in providing terms that clarify a clinical presentation, or in national or regional differences in nomenclature.

Authorship or authority will be cited where known. Those indicated"© Tom Trimble, RN" are authored and copyright by Tom Trimble, RN.
Otherwise, words are in public domain and the definitions are by Tom Trimble, RN.



ball_green.gif "Adios Yo-Yo": (phrase) "Goodbye, you're on your own!" Term contributed by E. Needham RN, CEN

ball_green.gif"Amp of "Holy Water'": (phrase) An irreverent but not meanly intended indication that in the failing resuscitation effort still underway past any prospect of actual survival as a sentient person, the next or last drug to give would be an ampoule of Holy Water as either a miraculous cure or as benediction for afterlife, and as a gentle suggestion that resuscitation efforts be terminated. © Tom Trimble, RN

ball_green.gif"Binky™-Test": (phrase) The ability of an infant to evidence basic stability and an interest in "the important things in life" by placidly sucking on a pacifier. [From an account by M. Borgeson, MD, of an infant whose over-hasty intubation for mere tachypnea without respiratory distress was averted by a nurse who placed a pacifier in the child's mouth, thus demonstrating the "positive Binky™--Test," and blocking an unnecessary procedure. ] The term is a salutary reminder to check the whole patient and not focus too narrowly upon a single finding.

ball_green.gif"Blue Bloater / Pink Puffer": (noun) Stereotypical descriptions of bodily appearance of COPD patients with (respectively) Chronic Bronchitis and Emphysema.

ball_green.gif "Bounce-Back": The patient returns with exacerbation of the problem for which he was diagnosed and treated, or because of treatment failure, within twenty-four hours to a few days duration.

ball_green.gif Box: (verb) "He's going to . . . " "He boxed" ---to die (from coffin)

ball_green.gif "Brutane": (noun) The putative name of a fictitious anesthetic agent used as an euphemism for the careful and scientific application of brute force to manually restrain the patient for a procedure, e.g., a wiggling child for repair of a laceration.

ball_green.gif Bus Unloaded", "The: (phrase) A cluster or "bolus" of patients has arrived in the ED, near-simultaneously or within a short period of time, causing a rapid increase or perhaps overstretching of the workload to the available resources.

ball_green.gif"~ Care Unit": (noun - euphemism) "Celestial ~ ", "Eternal ~ ", "Expensive ~ ", references to Death or to a moribund stay in Intensive Care.

ball_green.gif cart = cot = gurney = stretcher = trolley: (noun, & regional equivalents) The narrow movable bed typically used for transporting patients or caring for them in emergency or critical care settings.

ball_green.gif"Cellular Samaritans": (noun) The individual, perhaps hundreds of them, who call 911 to report a public safety occurrence without physically contributing any useful aid or information to the resolution of the problem who thereby assuage their consciences to "do something" without effort or involvement or direct assistance.
Term contributed by V. Rooker, EMT-P

ball_green.gif "Chandelier Sign": (noun) The intense amount of physical response including near-levitation from the bed to the chandelier on the ceiling induced by examining for cervical motion tenderness in cases of Pelvic Inflammatory Disease.

ball_green.gif "Chicken Spray": (noun) Nickname, as used by "oncology kids", for Ethyl Chloride Spray, the chilling evaporant liquid used for transiently numbing injection sites.

ball_green.gif "Circling the Drain": (phrase) The patient's future prospects of life are dim . . . (synonym for rapid deterioration or near-extremis) Other variations include "F.T.D. -- Fixing to die. Pre-code patient" (submitted by Jack Sheehan), "Trying To Die", etc.

ball_green.gif "Code Blue-->Code Purple-->Code Yellow-->Code Brown-->Code Rock": (phrase) Description of the pathophysiologic sequence often encountered in the process of death or responding to a person in some phase of the same. e.g., cyanosis, intense cyanosis or post-mortem lividity, loss of urine from the bladder from sphincter relaxation, loss of stool from the rectum due to sphincter relaxation, rigor mortis. © Tom Trimble, RN

ball_green.gif Crock: (noun) The patient whose physical complaints are without organic or discernible basis, or frankly bogus. Often resented for the "wasteful" amount of work necessary to prove non-validity. If one might be overheard, reference might be made less plain by the pseudo-scientific "high Serum Porcelain Level" or to putatively send such a test to measure the degree of falsity.

ball_green.gif Demerol® Sponge: (noun) The great capacity and tolerance to, and desire for high doses of narcotics by patients with chronic pain management problems, often further compared to "if you or I had that much we'd be comatose or dead!"

ball_green.gif"Didivoid":   (phrase) Question of apparently high importance regarding the patient's history almost invariably  asked by ward nurses taking report: colloquial translation of "Did he void? (empty the urinary bladder).

ball_green.gif"Diffusely Positive 'Review of Systems'": A patient who reports findings or complaints broadly through each system of the body during the history interview of formal examination; may be an unfortunate who has truly had many ailments, may be vague unorganized or psychosomatic complaints; may represent suggestibility on the partient's part who tries to give some information on everything to please the doctor.

ball_green.gif"Diplomat Nurse": (noun) The Clinical Nurse Specialist attached to a hospital service or to a private practice group of physicians who operates not only as the problem-solver and preventor but also as the "polisher and smoother" and intermediary for the practice in many matters.

ball_green.gif "DFO" or "Done Fell Out!": (verb) A dialectical expression of syncope.

ball_green.gif "Duck": (noun) Obsolete slang for a male urinal from its (former) typical white enamelware construction and its similar silhouette to the bird.

ball_green.gif DRT -"Dead Right There'': (phrase) [field usage} "The patient has been deceased long enough to greatly decrease the probability of resuscitation." Submitted by [email protected] {Editor's Note: Implies meeting of criteria for field reporting of Death or to Withhold Resuscitation Efforts, includes non-transport of dead body by an EMS}

ball_green.gif Dwindles, the: (noun): the slow vague "failure to thrive" of senile physical deterioration.

ball_green.gif"Epi-Sick": (noun): The pale, "green", nauseous, chest-pounding, tachycardiac, appearance of the patient who has received aggressive subcutaneous epinephrine (Adrenaline) therapy in anaphylaxis or status asthmaticus as distress resolves and the patient awaits the resolution of his circulating exogenous catecholamines. © Tom Trimble, RN

ball_green.gif Face-Plant: (noun) Victim fell forward injuring face against floor or other object seemingly without effort to save self or associated injury.

ball_green.gif "Failure To Fly": The patient fails to achieve the hoped-for discharge criteria, cannot pass his "roadtest" (q.v.), doesn't make it out to the family car in the parking lot without fresh exacerbation, or "bounces back" shortly after discharge; reminiscent of fledgling birds that can't yet leave the nest.

ball_green.gif "Failure To Thrive": (phrase) The diagnostic omnibus for the global physical, mental, social deterioration of the patient in his own milieu. May be the first official recognition of the patient's terminal spiral.

ball_green.gif Fascinoma: (noun) An obscure, curious, or medically exciting condition which incites a great deal of attention, often from many doctors ("hey, look at this"), to the process rather than to the human concern for the patient afflicted with the problem. Also known as a "Great Case."

ball_green.gif"Flail": (noun) A tense, difficult, clinical effort, chiefly characterized by elements of confusion and chaos, perhaps due to "high Atmospheric Adrenaline Level", As in the description, "they were flailing around." "That Pedi Code was a real flail!" Similar to "SNAFU" and other unprintable expressions of other generations.

ball_green.gif F.L.B.: "Funny Looking Beat" (noun) Indeterminate or chaotic abberancies on the cardiac monitor that are not well or quickly described or not well seen as the tracing went by.

ball_green.gif F.O.F.: "Found On Floor".

ball_green.gif "FOOSH": (noun/verb) "Fall Onto Outstretched Hand" as mechanism of injury.

ball_green.gif"F.O.S": (phrase) The clinical or radiographic determination that the patient's intestinal tract is "full of (ahem!) stool"; sometimes used to point out that the patient's story or character do not entirely hang together as they should. Also in field use to mean "found on sidewalk."

ball_green.gif "Four 'B's": (phrase) No, not Brahms, Beethoven, Bach, and Bartok, but how I characterized the hectic hours of 0500-0700 when I worked on a ward: "Bells, Bowels, Bladders, and Big Shots!" of patients and their organ systems awakening, requiring service and documentation, pre-rounds of junior physicians and Rounds with Attending Physicians with an entire entourage of team and students. © Tom Trimble, RN

ball_green.gif "Four 'B's": (phrase) The post-all-night-shift version: "Breakfast, Beer, Benadryl™, & Bed", i.e., that which is to be sought for restoration of the physical and mental self. © Tom Trimble, RN

ball_green.gif"Four 'H's": (phrase) Four causes of unexplained restlessness, agitation, or combativeness in patients with altered mental status which must be investigated and treated: Hypoxemia, Hypoglycemia, Hypovolemia, and a "High" Bladder! © Tom Trimble, RN

ball_green.gif "Frequent Flyer": (noun) A well-known patient who is seen often in the Emergency Department.

ball_green.gif "Frog, Doing the": (phrase) The arching and tetanizing electrogalvanic effect upon skeletal muscles that occurs at discharge of a defibrillator (similar to classic laboratory experiments). © Tom Trimble, RN

ball_green.gif "Good Intern Case":(noun) A routine case of some complexity, tediousness, or disagreeable aspects of no interest to the senior physician that can be palmed off on an underling to do the interview, examination, and scut for its putative "educational value." A pecking order in action.

ball_green.gif "Great Case: c.f. Fascinoma, q.v., (noun) such a case, as in the phrase "I never want to hear doctors outside my door saying "Wow, what a great case!" believed to augur poorly for the patient's health and life.

ball_green.gif"Green Poultice": (noun) The object of eventual desire for a patient who is "improving his case" ,viz., the soothing warm application of a substantial sum of money (American currency is green) to be derived from a financial settlement of a lawsuit.  Suggested by Charles S. Krin, DO FAAFP who states that "the originator of that particular term, . . . as far as I know, (is) lost in the mists of antiquity...or at least the last 30 years."

ball_green.gif H.O.D.: (noun) Heroin Overdose.

ball_green.gif "Improving His Case":   Self-alleged victim of a minor motor vehicle accident or workman's compensation injury who wishes and requires no or little other care than documentation of aches and pains for the purpose of a legal claim or lawsuit. May state that he is here now because his lawyer or a friend advised that he should be seen by the doctor. May request a copy of "my medical record" or to be given a cervical collar or sling. If one wishes to obscure one's meaning if there is a chance of being overheard the pseudo-diagnosis of "subluxation of the ligamentum litigationii" might be used, particularly if spoken softly  and rapidly but might not fool the well-educated. © Tom Trimble, RN

ball_green.gif "JIC" tube: Submitted by Andrea Novak: "When drawing blood for lab studies, a "JIC" tube is drawn for "just in case" the doc adds more to the lab order later on."

ball_green.gif "La Malade du Petit Papier": The patient who brings in a list of his purported ailments, excessively extensive documentation of each bowel movement or sip of water, and persistently recounts them from point to point. This is in contradistinction to the non-neurotic patient with lengthy and complicated history, well elders who may need an aide-memoire, or bring in the requested self-monitoring notes of their diabetes or peak-flows.

ball_green.gif"Landmark-Walking": (phrase) The practice of the ataxic, infirm, sea-sick, drunk, and others of un-confident stability and gait, of walking (and looking to find) from one object to another to steady oneself or rest before moving on to the next; intervals without a steadying object or hand may resemble a lurching, festinating, or semi-controlled fall. ©Tom Trimble, RN

ball_green.gif "Lipstick Sign": As a patient rouses from earlier misery, the first application of lipstick or hairbrush indicates a sense of future, self-perception, self-image and esteem, and a willingness to leave behind the sense of illness.

ball_green.gif"LOC": At a paramedic tape-review session, discussion to clarify communicated meanings revolved around "LOC". I was asked what it means. For some reason, hilarity ensued when I explained that "where I work, "LOC" can mean Level of Consciousness, Loss of Consciousness, or "Laxative of Choice!"

ball_green.gif" LWBS": (acronym) Left Without Being Seen, abbreviation placed upon charts to account for patients who no longer can be accounted for, i.e., patient discouraged by wait- changed his mind - departed without examination or treatment.  Term contributed by Scott G. Shelp, RN AAN CEN AASc AA

ball_green.gif"Main d'Accoucheur, La": (noun), from French, literally "the hand of the man who assists women with childbirth". The "obstetric hand" describes the cramped and "coned" posture of the hand and fingers that occurs with carpal tetany as found in Acute Hyperventilation Syndrome with Tetany.

ball_green.gif"Meet'em, Greet'em, Treat'em, & Street'em": (phrase [and philosophy]) The aphoristic admonition to rapidly evaluate the patient in problem-oriented fashion with expeditious discharge avoiding the trap of a "Million-Dollar Work-Up" (q.v.). Implied is the goal of providing care only for those current complaints that actually require treatment now, rather than addressing all comprehensive health maintenance issues, and urging patient self-responsibility for follow-up, as arranged, and obtaining a primary health care provider. ENW has received reminders to include this prevalent phrase from: Angel Bumpers, Tracy E. Ward, Terri Kushner

ball_green.gif"M.T.F.": "Metabolize To Freedom" Worked-up sufficiently to exclude other diagnoses than alcohol intoxication, disposition/discharge planned when achieves safe functional level. Source = Highland General Hospital, Oakland, CA

ball_green.gif "Million-Dollar Work-Up": (noun) The lengthy, extensive, expensive, labor-intensive, sometimes painful, process to seek a diagnosis or to rule out more ominous differential diagnoses. This may have initiated due to patient complaint [e.g., "worst headache of my life"], patient request [e.g., comes unannounced with x-rays in hand from another hospital and wants a "second opinion"], physician fear of lawsuit, or attempt to achieve a definitive diagnosis of a fascinoma, q.v.

ball_green.gif "Nose-Hose": (noun) Nasogastric tube.

ball_green.gif "O - Sign": The open-mouthed slack-jawed appearance of the narcotized, unconscious, stuporose, and dead-drunk. c.f. Q - Sign q.v.

ball_green.gif OTD: (phrase) Out the door. {as in, "Don't erase Room 5 until he's really OTD."}
Term contributed by E. Needham RN, CEN

ball_green.gif"Perineal Towel Sign": (noun) refers to the panty liner, sanitary napkin, tissues, incontinence diapers, washcloths, or towels worn in the underwear of elderly women with urinary incontinence which, in the context of otherwise unexplained illness or early urosepsis, has positive predictive value for diagnosis in view of the high potential for seeding of the urinary tract with e. coli bacteria.

ball_green.gif"PID Shuffle": (noun) clinical slang for the characteristic mindful and uncomfortable shuffling gait and flexed posture of the woman with significant Pelvic Inflammatory Disease. Term contributed by Scott G. Shelp, RN AAN CEN AASc AA

ball_green.gif Pimp: (verb) To interrogate another mercilessly regarding knowledge of a subject so as to derive personal benefit from another's study without doing so oneself, or for the purpose of embarrassing that person and to display one's own superiority.
(c.f, also http://www.neonatology.org/pearls/pimping.html
"The Art of Pimping "by Frederick L. Brancati, MD, Department of Medicine, University of Pittsburgh. From JAMA 262(1):89, July 7, 1989 reproduced on "Neonatology on the Web")

ball_green.gif"Pothole Sign": (noun) Ask someone who may be having an acute appendicitis attack how the drive was to the hospital. If every little bump was felt, they displayed a "positive pothole sign". From: Yvonne Harris

ball_green.gif "The Progressive Purple Mask of Death": (phrase) Deep anoxic cyanosis of the face extending to the earlobes, the entire ear, the neck, and proceeding to include the chest associated with progressively diminishing possibility of resuscitation from cardiopulmonary arrest. In my experience, the patient may sometimes be resuscitated from cyanosis of the pinna or even the upper neck more rarely, but have not encountered any who have been resuscitated from thoracic cyanosis. © Tom Trimble, RN

ball_green.gif"Prolixin™ Shuffle:  (noun) Characteristic shuffling gait and bradykinesia of patients on high doses of this potent anti-psychotic drug.

ball_green.gif "Q - Sign": (noun) The more advanced and severe form of O - Sign, q.v., wherein the tongue lolls protruding from the mouth like the tail of the Q.      ball_green.gif "Dotted-Q Sign": One or more flies resting on the tongue. From: Geoff Pangrac RN

ball_green.gif "Road-Test": (noun) The attempt to establish discharge suitability criteria by testing arousal (compelling the patient to waken and bestir himself to some level of self-sufficiency), neurological cerebellar testing of station, gait, ataxia, ambulation, etc., give discharge instructions, and promise or threaten whatever incentive is necessary for the patient to depart and stay gone without falling down in front of a bus or other misadventure.

ball_green.gif "The 'S'-Word"/"The 'Q'-Word"/ "The 'B'- Word": (noun) The most prevalent and accepted folk-custom in the ED culture, ---nay, even pandemic, perhaps second only to the belief in the malevolent effect of the full moon upon workload and weirdness, is the practice of avoiding (and castigating any usage thereof) the words "S**w" (antonym of "fast"), "Q***t" (antonym of loud or peaceful), or "B**y" (antonym of inactive), in reference to the workload or activity level. For surely, as the night must follow day, there is a direct causal relationship to the adverse changes and bad karma which follow.

ball_green.gif Scut: (noun) The clinical chores and tasks involved in examining and treating patients.

ball_green.gif Shoot and Boot: (phrase) Medicate and discharge. Term contributed by E. Needham RN, CEN

ball_green.gif "Shooter": (noun) A user of injected illicit drugs, e.g., "shooter with fever", needs "million-dollar work-up". q.v., and admission for presumptive endocarditis.

ball_green.gif "Spooge": (noun) describes ANY fluid once it has escaped from the body......usually onto the patient's freshly changed bed. Term contributed by Tracy Emery RN

ball_green.gif"STAT": (abbreviation of Latin "statim" = now, or immediately) jocularly, "Some Time After Tomorrow" is offered as the "real" probable likelihood of having the event occur within the desired timeframe. Suggested by Geoff Pangrac

ball_green.gif "Suitcase Sign": (noun) The patient arrives with a packed suitcase with clear and evident intent or expectation of being admitted, perhaps regardless of any merit to their complaint. [email protected] reports that '''suitcase sign' is commonly called a 'positive samsonite sign' in my area."

ball_green.gif "Sundowner" or "Sundown Syndrome": The well-known tendency for senile or demented patients to have a nocturnal worsening of their mental status and confusion; may also be caused in such patients by even relatively small doses of sedatives, analgesics, and hypnotics, or to have nocturnal paradoxical effect of such agents.

ball_green.gif "Tachy-Aye":(noun) (pronounced tackyeye) refers to a patient whose response to pain is to repeatedly yell "aye-aye-aye". Term contributed by Tracy Emery RN

ball_green.gif "Tape Boogers": (noun) Remnants upon the skin of old adhesive residue from tape or monitoring electrodes. May sometimes be of nearly archeological age. {I wish I had thought of this one!}

ball_green.gif "Three Hots & A Cot": (phrase) The food and shelter actually sought by homeless and socially dysfunctional persons who seek to use a hospital as an almshouse by either direct/indirect request or by simulation of illness.

ball_green.gif TBF: Total Body Failure: (noun) Used in describing a patient, usually the elderly, who are suffering from "failure to thrive". From: Cessford

ball_green.gif "TNTC": (abbreviation) From laboratory usage reporting "Too Numerous To Count". Can be applied to the patient's list of complaints.

ball_green.gif"Toxic Socks Syndrome":  (noun) The pervasive malodor emanating from the unwashed and unkempt when foot coverings are exposed or removed.  Other regional variants exist, e.g., "Mission Foot" as in Mission Emergency Hospital, San Francisco.

ball_green.gif "Train-Wreck": (noun) A patient with too many problems, perhaps in dire and desperate condition, as if he had "been hit by a . . . "

ball_green.gif "Trumpet": (noun) Nasopharyngeal Airway, said to be so due to the flared end that keeps the tube from slipping backwards.

ball_green.gif" Vapors, the": (noun) The vague somatization and physical, perhaps hypochondriacal, complaints, often flutteringly or histrionically displayed by the patient.

ball_green.gif"Velcro": (noun) The family or friends who brought the patient to the ED and are usually stuck to the patient's side when the patient needs to be brought to the patient care areas. As in." (I wish they would) leave the Velcro in the lobby." Term contributed by Tracy Emery RN

ball_green.gif (A) Wall: (noun) "Be a Wall, Man! This injunction by or to other house staff physicians is the imploring of protection from admission of patients, i.e., (I'm exhausted, or do not wish to be bothered, therefore protect me from admitting more patients; stonewall them; be an impregnable barrier.

ball_green.gif "Wastebasket Diagnosis": (noun) A diagnosis which is deemed to be faddish, not well proven to exist, or yet physiologically explained, or not described with great specificity, broad inclusiveness to the point of being scientifically useless. Notwithstanding, such diagnoses may be commonly spoken of, claimed by patients, or have many articles in the last three years in the journals and tabloids at the supermarket checkstand.

ball_green.gif" WNL": (abbreviation of "Within Normal Limits") jocularly, a false definition of "We Never Looked" is offered to cast doubt on the validity of the process by which the said datum was obtained. Suggested by Geoff Pangrac

ball_green.gif "Worst Headache Of My Life": (phrase) Chief Complaint of a patient that may result in a million-dollar work-up, q.v., of exam, labs, IV, CT Scan, Lumbar Puncture, Neurology Consult. Often referred to in staff conversation of things oneself does not wish to have happen, as in "I never want to be an ED patient and say that it's the "worst headache of my life"; too much can happen to you!"

ball_green.gif Zebras: (noun) Rare diagnoses, as in the classic aphorism to consider consider common diseases most probable: "If you hear thundering hoofbeats behind you, it's more likely to be horses than zebras!"

"ENW's Emergi-Lexicon"
is a webarticle presented by:
Emergency Nursing World ! [http://ENW.org]
Tom Trimble, RN
[[email protected]]

Internet Resources for Medical Language and Abbreviations

The TLA Web Page - A Guide To Medical Abbreviations
from National Center for Emergency Medical Informatics

Acronyms and Abbreviations
from World Wide Web of Emergency Services
at Rochester Institute of Technology

Humorous Run Report Acronyms
from National Collegiate Emergency Medical Services Foundation

flag-Belgium-vsmall.gifMultilingual Glossary of Medical Words
from Heymans Institute of Pharmacology, University of Gent, Belgium
at the direction of The Commission of European Communities

The WorldWideWeb Acronym and Abbreviation Server (a general source)



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