[ElizabethJRN]

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

[deeDawntee]

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!!!

[Burnt2]

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.

Originally Posted by 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:

[deeDawntee]

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.

[ElizabethJRN]

Originally Posted by deeDawntee

It helps so much to have a patient with some of this stuff and see it first hand.

I couldn't agree more! I have found almost everyday that I can correlate something that I was studying, to a patient I have had in the last few weeks!! For example, I have been studying a lot of cardiac lately since we don't see it as much in the MICU. Well, I've got a super septic pt right now, maxed out on vasopressin and levophed, but also on milrinone because he has such an extensive heart history and they are thinking there's a little bit of cardiogenic shock going on. Yesterday before the milrinone was started, I was thinking: hey, this pictures looks a little cardiogenic also, we may need something for contractility or cardiac vasodilator. Oh how fun it is to learn!

He's also on Xigris (among many other gtts), anyone know the cost of that one? I heard along the lines of $1000 a bag !!? Great med though!!

Happy studying everyone!

[ElizabethJRN]

Originally Posted by Burnt2

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.

Good Luck!!!!

[Burnt2]

Originally Posted by ElizabethJRN

He's also on Xigris (among many other gtts), anyone know the cost of that one? I heard along the lines of $1000 a bag !!?

I had a patient on Xigris last december.....

the pharmacy accidentally sent me the bag via the tube system and we had to throw it away (Xigris has to be hand delivered to avoid shaking).

expensive mistake!

[deeDawntee]

Originally Posted by ElizabethJRN

I couldn't agree more! I have found almost everyday that I can correlate something that I was studying, to a patient I have had in the last few weeks!! For example, I have been studying a lot of cardiac lately since we don't see it as much in the MICU. Well, I've got a super septic pt right now, maxed out on vasopressin and levophed, but also on milrinone because he has such an extensive heart history and they are thinking there's a little bit of cardiogenic shock going on. Yesterday before the milrinone was started, I was thinking: hey, this pictures looks a little cardiogenic also, we may need something for contractility or cardiac vasodilator. Oh how fun it is to learn!

He's also on Xigris (among many other gtts), anyone know the cost of that one? I heard along the lines of $1000 a bag !!? Great med though!!

Happy studying everyone!

Good job!! I've hung Xigris a couple of times. Pretty amazing med.
I've always really liked milrinone, in my limited experience, it has been more effective that dobut.

[Burnt2]

GRE: 1350! (700 Verbal, 650 math - 1600 possible). Yay!

Now to study the pals stuff

[Hoozdo]

Hey, what's a GRE?

Well, I am still on schedule to test on 7/25. Studying full time since this Monday. First I started off with a Pass CCRN DVD Post test to see what my major weaknesses were. As expected, they are cardiac and hemodynamics. Most of my experience has been in MICU and I have only dealt with Swanns a GRAND TOTAL of twice. My 12 lead EKG interpretation on the different areas of infarct needs lots of work too.

So, I opened up my current Thelan's Critical Care Nursing textbook and am going through all 300 pages of the cardiac/hemodynamic section and making notes. I am almost done with that.

Then I am going to retest just the cardiac section with Pass CCRN and see how I do. Once I am happy with that, I will watch all of Laura's tape (have only watched 5 so far) and reinforce with Pass CCRN questions.

Whew, this is a lot of work......but to my surprise, I am enjoying it. Seems like old school days.

I am also off of my night shift hours and on a quasi dayshift schedule for studying. The testing times are either 9:00 AM or 1:30 PM in my area, neither of which are my prime time working night shift!

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