Anyone else studying for CCRN exam? - page 8

Is there anyone else out there who is currently studying for the CCRN exam and would like to start a thread as perhaps a study and support group? I have just applied for the exam and have not yet... Read More

  1. Visit  deeDawntee profile page
    0
    Hi everybody!
    How was the weekend? How is studying going? I have to share with you all a patient I had this weekend. He is a 55 yo 3 ppd smoker who came in with pneumonia and was intubated. This man's lung's are so tight and his COPD so severe that he has an internal PEEP of 30 (without being vented). OK, I don't understand how that is even possible? I just don't get it. Air is constantly trapped in his lungs.
    Has anyone heard of that before? This is the first time for me!
    The guys fingers are clubbed, obviously he's been in bad shape for a long time. Very sad. They have his vent set at a PEEP of 8. (Why?)
    I'll have to try to google this and see if anything comes up. Very strange. I know that COPDers are CO2 retainers, but I thought that meant in the blood gasses. I am confused. No one last night at work seemed to know either.
  2. Visit  cjmue12 profile page
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    Quote from Burnt2
    I have such a tiny brain though....oh well, you're right....I tend to have a negative attitude sometimes


    does anyone here do cvvh/prisma? I'm looking for some kind of online ed thing
    We do CVVH/CVVHD. Our current machines are through Baxter but we will be changing to Nexstage soon. Try searching for CRRT (continuous renal replacement therapy).
  3. Visit  Burnt2 profile page
    0
    Quote from deeDawntee
    Hi everybody!
    How was the weekend? How is studying going? I have to share with you all a patient I had this weekend. He is a 55 yo 3 ppd smoker who came in with pneumonia and was intubated. This man's lung's are so tight and his COPD so severe that he has an internal PEEP of 30 (without being vented). OK, I don't understand how that is even possible? I just don't get it. Air is constantly trapped in his lungs.
    Has anyone heard of that before? This is the first time for me!
    The guys fingers are clubbed, obviously he's been in bad shape for a long time. Very sad. They have his vent set at a PEEP of 8. (Why?)
    I'll have to try to google this and see if anything comes up. Very strange. I know that COPDers are CO2 retainers, but I thought that meant in the blood gasses. I am confused. No one last night at work seemed to know either.
    Man that's alot of physiologic PEEP. PEEP of 8 seems entirely insufficient - did they have him set on some kind of pressure support mode with target volumes? Maybe they loaded him with so many beta agonists that it opened him up a little

    I may be wrong, but i think an inverse I:E (like 3:1)sometimes helps with those people with wicked stiff lungs
    ............this is a great ccrn thinking type scenario right here
  4. Visit  Burnt2 profile page
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    Addendum: what was his blood pressure with that kind of peep? talk about putting the squeeze on the heart
  5. Visit  deeDawntee profile page
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    Quote from Burnt2
    Addendum: what was his blood pressure with that kind of peep? talk about putting the squeeze on the heart
    He was on Vt of 580, his systolic pressures were 130-150's. How does that kind of physiological peep develop? The vent was IMV at 22. There was no overbreathing the vent. I had him on Diprivan at 90 mcgs for the night. When I came on he was diaphoretic, although afebrile. I stripped him down, gave him a good bath, got him a fan. He seemed much more comfortable with the cooler temp and the higher sedation (for the night anyway). This poor man at only 55 had been living in a VA home. Estranged from his family and had some severe OCD.
  6. Visit  stressgal profile page
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    Are you talking 90 mcg/kg with the diprivan? I haven't gone that high unless someone is ETOH dependent.
    Sounds to me link emphysema, not just pneumonia. I have a pt. curently that is end stage emphysema, yet the family is just accepting the dx. So sad. Mom (patient) is an emaciated 60+ year old barrel chested COPD pt. You know.... Yet the family just now realizes the extent. So SAD. There is truly nothing worse than watching a loved one "struggle" for breath. Say a prayer please.
    Thanks!
    Stressgal
  7. Visit  deeDawntee profile page
    0
    Yep 90 mcg/kg, that is up from 80-85 during the day. Not that unusual really for large people. This guy definitely has SEVERE emphysema with a physiologic peep of 30! VERY stiff lungs. I doubt that he really wants to wake up or get better, to tell you the truth. Looks like a case of slow, deliberate suicide. Very sad.

    You are right, I think dying of COPD is the worse death.
  8. Visit  cjmue12 profile page
    0
    In our institution we we get that high on Diprivan, its time to start a different drug (Ativan Versed, etc). Diprivan at 100 mcg is considered anesthesia, not to mention the astronomical cost, around 150.00/ 100 ml bottle. At that rate and with a large person you are probably hanging a new bottle every 2 hours. Plus dietary hates when we keep people on Diprivan for more than a few days with all the lipids and empty calories.
  9. Visit  deeDawntee profile page
    0
    You are right about the Diprivan, but at the hospital I work it is not uncommon to see doses that high for no more than a week in most cases. It is anasthesia, in people who are hypoxic, at times we use paralytics to keep their O2 consumption at a minimum as well, but that is far less common. Is that an unusual practice?
  10. Visit  ElizabethJRN profile page
    0
    No Dawn it's not that unusual a practice. I have seen a lot larger doses than that of Propofol, but we dose in mcg/kg/min. Propofol is a great drug because of it's half-life, can wake them up real quick and then get them back under if needed! And they are always on the vent...so no need to worry about some of the anesthesia effects. A lot of times on our unit we can't use it though due to hypotension...we have a lot of septic patients here.

    Ha, we are hijacking our own thread! Oh well, I suppose any ICU case could be used in our studying
  11. Visit  deeDawntee profile page
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    Of course!! That is what we're doing right!!? hehe

    But seriously, have you ever had a pt with a physiologic peep of 30?! You know, I am not even sure if I believe it, how is that even diagnosed? I am a bit befuddled by the whole matter!!!
  12. Visit  Burnt2 profile page
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    Yea I had an 18 year old huffer who went through a 100ml bottle of propofol every 2 hours and still managed to get out of his restraints and yank his tube out. I think there's a correlation between heavy drug users and propofol tolerance - even though propofol isn't an opioid.

    Quote from deeDawntee
    But seriously, have you ever had a pt with a physiologic peep of 30?!
    What are his peak pressures? It seems odd that they'd have him on a volume controlled mode with that kind of COPD nastyness (sounds like ARDS?) His lung compliance and alveolar recruitment must be in the toilet - I can't imagine needing 30 PEEP off vent and spontaneously breathing; I mean --- needing that kind of peep just walking around means your lungs would collapse every time you exhale, and then would be nearly impossible to reinflate....right? Or does the COPD autopeep come into play here?


    STUDY UPDATE: I'm taking the GRE tomorrow (wednesday), then I'm doing a PALS cert course (thur-fri), then I'm ramping up CCRN study full time. I'm shooting for 4 hours a day on my days off.

    How's everyone else doing with studying? lets hear some updates!:biere::roll:roll
    Last edit by Burnt2 on Jul 17, '07
  13. Visit  deeDawntee profile page
    0
    Oh My Gosh Burnt2 (I get the screen name now) is the rest of it:
    a crisp? You are something else. That is an incredible amount of testing you are doing!! That is amazing and I am sure it will lead to great things.

    As far as studying is concerned, I have stepped back and tried to stay concentrated on the core content of Laura Vonfrolio's course and of David Woodruff's course. I was told that is enough to pass the test. The questions in Laura's Review book are very good but are far more detailed than most of her core material in her DVD course. (Has anyone noticed that?) I suppose it is the difference between passing at 70% and getting closer to 100%. Personally, I will be happy with about 85%!! I want to have that core stuff down so well that I never forget it. The rest that I can memorize before the exam will just help with the score. I tend to be the type of person who tests well, but most of the detailed material is gone from my mind in a short time. Anyway, that is my new strategy. Anyone else have any suggestions? It helps so much to have a patient with some of this stuff and see it first hand.

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