ShaunES

ShaunES has 1 years experience and specializes in ICU.

Latest Activity

1. Therapuetic Hypothermia

   ShaunES replied to kaiser0926's topic in MICU

   We cool for ~24 hours, then passive rewarm with space blanket aiming for 0.5 degree celcius/hour. We remove blankets and recommence cooling if they exceed this. We've had several successful cases, but we've also had several unsuccessful cases. Have t...

2. Cath Lab

   ShaunES replied to wrenRN06's topic in Cardiac

   If you're applying to ICUs why are you getting nervous about going into the cath lab? Just go, it sounds like a good job with a good orientation and it will certainly get you in the door.

3. Temperature. Where do you go?

   ShaunES replied to MLB55's topic in Critical

   Bottom is worst. Properly positioned esophageal probe (at the aortic arch) will give you the closest match and the fastest response to blood temperature changes.

4. Multiple drip administration

   ShaunES replied to Sugarcoma's topic in CCU

   cvp is useless to assess volume status and you should ignore it; better yet, put your vasoactive medications on the distal lumen and you have another free lumen. last or first it doesn't matter, there's going to be a good whack of medication in the a...

5. Multiple drip administration

   ShaunES replied to Sugarcoma's topic in CCU

   Seems much simpler to just use a bag and then you never have to stop it.

6. Should CVVHD be 1:1

   ShaunES replied to kristenallene40's topic in Critical

   If the argument is that it's time consuming, then I agree, it can be time consuming. On the other hand, changing bags takes a minute or two at most, and fluid removal is simple. As for charting, I'm not sure how you guys do it, but it's pretty simple...

7. Should CVVHD be 1:1

   ShaunES replied to kristenallene40's topic in Critical

   That's why they're 1:1. What's the difference between an intubated patient and someone on CRRT? If you lose an airway that's a lot bigger deal than your circuit clotting. I don't understand.

8. Nitro vs Morphine

   ShaunES replied to moidla's topic in CCU

   CRUSADE is demonstrating that those treated with Morphine have double the mortality rate than those not given morphine. If one were to use opiates/opioids, I would suggest fentanyl - faster, nicer and an all around better drug.

9. Do you get a lunch break?

   ShaunES replied to beccainabox's topic in Critical

   I work in a large ICU in Australia. We're 1:1, and work 12 hour shifts. We get a 20 min morning tea, 30 min lunch, 20 min afternoon tea, 30 min dinner. We do break with our neighbour; our bedspaces are separated by curtains and benches, and you can s...

10. Intubated Pt's Using Bedside Comodes

    ShaunES replied to EDrunnerRN's topic in Critical

    I've walked intubated patients around the unit with a transport ventilator, so no, using a bedside comode isn't that crazy an idea. Not every intubated is unstable, if you have the resources and time to do it safely, do it! (The procession for the wa...

11. Sedation..Your thoughts?

    ShaunES replied to Da_Milk_of_Amnesia's topic in MICU

    I just use the bolus feature in our pumps, saves me having to baby sit the pump, and I don't accidentally leave it infusing at 1200mL/hr.

12. Scrotal Edema leading to Breakdown

    ShaunES replied to dtbrn09's topic in Critical

    Our hospital has occupational therapists who do all our splints/etc, they provide scrotal slings to assist with reducing pressure, seems to work.

13. Moving Too Slowly in Emergent Situations

    ShaunES replied to LaurenBoog's topic in Critical

    Sounds like a problem with the system, not with you. In my ICU, all orders are entered onto our electronic system by the doctor requesting them, and show up instantly on our bedside computer. Similarly, lab tests are ordered the same way, but in addi...

14. When to call in sick to the SICU

    ShaunES replied to DuluthMike's topic in MICU

    When you're sick!

15. Vasopressin- Usage and dosing

    ShaunES replied to trvlnurs's topic in MICU

    http://www.srlf.org/data/Upload/Consensus/pdf/50.pdf This study has the patients in severe sepsis on an average of 0.45mcg/kg/min of noradrenaline, with a maximum of 1.06mcg/kg/min. While there is still a lot of mystery in when you should add more va...