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getoverit 4,393 Views

Joined Dec 30, '07. Posts: 435 (51% Liked) Likes: 768

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  • Sep 11

    Quote from cfsleo812
    Can someone please break it down really simple, elementary my dear: what is cardiac preload, afterload? Feel free to give specific examples with drugs that affect each to make it crystal clear, thanks.
    Hey cfsleo812,
    So: really simple, elementary preload and afterload, huh? Good question.
    Basically, preload is stretch. The amount of volume being returned to the right side of the heart from systemic circulation. Afterload is squeeze. The amount of resistance the left side of the heart has to overcome in order to eject blood.
    Just look at the mechanism of action with different drugs to see what they do. e.g. a dilator will decrease, so the pressure comes down and the heart has less resistance to overcome, the catch is that it can also lead to less venous return, hypotension, ischemia. A pressor will increase, hopefully leading to better return to the heart. But it can also create too much resistance, which also can lead to problems.
    This is a very simplified definition, hope it helps. Sometimes the simplest things are the most useful.

  • Sep 1

    first, sorry that happened to you. second, yes, anyone professional with a conscience has felt similarly. you mentioned that you were having an awful day...think about what things contributed to your error. are they things that could be modified or eliminated? the answer might be "no" but at least you've examined it from that aspect, and I have a feeling you've probably already thought of that by now.
    My mom has been an RN for 43 years and she told me about her med error. She had been nursing for almost 2 years and she didn't notice that a heparin ampule had a different concentration from what she was used to. So inadvertantly she administered 10x the dose that was ordered. She felt so awful and tried to resign, but her manager wouldn't let her. It's a learning experience and you just need to make sure it's one of those things that only happens once.
    I knew an LPN who made several medication errors and I felt like maybe she would be better suited in a job not handling meds, but that was after 2 serious mistakes and being unable to crack an O2 cylinder during a code.
    You also have to let it go, there was no bad outcome and like you say, there could've been, but there wasn't. I bet you'll never do it again...I gave an incorrect med during a code about 10 years ago. Patient was already asystolic and I inadvertantly gave a bolus of Lasix instead of epinephrine. I felt terrible but the MD said "hey, absolutely no harm done and if he had been successfully resuscitated, then we'd already be on the road to diuresis". It made me feel better about it and I've never lost the caution I gained from that experience.
    Hope some of this helps a little bit, just don't beat up on yourself!! Hope you have a better day with lots of sunshine!

  • Jun 29

    a woman had wrecked her car into a tree. when we arrived the police and firefighters had formed a cordon around the victim, who was on the side of the road, ambulatory and completely naked. She kept pointing at the tree and yelling "I want that man arrested!" (minor damage, subsequently was found to have no closed head injury and extensive mental hx) When we were immobilizing her, I asked if she had any ID and she put her fingers into her vagina, producing 23 cents in change. I said "thank you" and put it in a specimen bag. We tried to get the security guards at the hospital to log it but they would have NOTHING to do with it!!
    that's about the weirdest thing...but I have heard a radiography student ask how a man had "sat on a pickle".
    another time a man at a frat/keg party put his penis through a ribeye steak bone on a dare, where it became engorged and trapped. He showed up at the ER with a pitched tent and about 100+ onlookers, the MD took one look at it and requested the bone saw. The man freaked and thought they were going to cut his penis off, he started running around the ER with the steak bone still stuck. Eventually he was restrained by some unhappy security guards and it was explained that the saw was for the bone and NOT him.

  • Jun 27

    Quote from cfsleo812
    Can someone please break it down really simple, elementary my dear: what is cardiac preload, afterload? Feel free to give specific examples with drugs that affect each to make it crystal clear, thanks.
    Hey cfsleo812,
    So: really simple, elementary preload and afterload, huh? Good question.
    Basically, preload is stretch. The amount of volume being returned to the right side of the heart from systemic circulation. Afterload is squeeze. The amount of resistance the left side of the heart has to overcome in order to eject blood.
    Just look at the mechanism of action with different drugs to see what they do. e.g. a dilator will decrease, so the pressure comes down and the heart has less resistance to overcome, the catch is that it can also lead to less venous return, hypotension, ischemia. A pressor will increase, hopefully leading to better return to the heart. But it can also create too much resistance, which also can lead to problems.
    This is a very simplified definition, hope it helps. Sometimes the simplest things are the most useful.

  • Mar 6

    Quote from twinkerrs
    Necrotizing Fascitis of the scrotom.
    I"ve seen this one too, the poor guy died from complications. we had to put him in the hyperbaric chamber 2hours/day for several weeks before he finally passed.
    these are all interesting cases. i had a guy one time who was shot in the occipital skull with his left eye blown out, result of a drug deal gone bad (do they really ever go well??). We inducted him, intubated, etc...the whole 9 yards and flew him in to the trauma center. the surgeon called the flight office a few days later to tell us he had been discharged home. turns out the bullet ricocheted off his skull and travelled the length of his scalp, exiting from his left orbit. he got some stitches, abx and a glass eye!! but i'm here to tell you....from first glance at the guy I thought "how in the world do you still have a pulse!!??"

  • Feb 26

    I've only seen one patient live with a glucose >1500.
    Had an Na+ of 108. That's mighty low but a several days on 3% salt and he ended up walking out with his family.
    I"ve seen many ABGs with a pH <6.9, various respiratory and metabolic problems. A little over half survived.
    Of course the ubiquitous BAL .647, we thought it was in error so we re-drew it and it was .613. He was a dump job outside the ER door, found by a security guard.

  • Feb 18

    Quote from cfsleo812
    Can someone please break it down really simple, elementary my dear: what is cardiac preload, afterload? Feel free to give specific examples with drugs that affect each to make it crystal clear, thanks.
    Hey cfsleo812,
    So: really simple, elementary preload and afterload, huh? Good question.
    Basically, preload is stretch. The amount of volume being returned to the right side of the heart from systemic circulation. Afterload is squeeze. The amount of resistance the left side of the heart has to overcome in order to eject blood.
    Just look at the mechanism of action with different drugs to see what they do. e.g. a dilator will decrease, so the pressure comes down and the heart has less resistance to overcome, the catch is that it can also lead to less venous return, hypotension, ischemia. A pressor will increase, hopefully leading to better return to the heart. But it can also create too much resistance, which also can lead to problems.
    This is a very simplified definition, hope it helps. Sometimes the simplest things are the most useful.

  • Jan 29

    Quote from cfsleo812
    Can someone please break it down really simple, elementary my dear: what is cardiac preload, afterload? Feel free to give specific examples with drugs that affect each to make it crystal clear, thanks.
    Hey cfsleo812,
    So: really simple, elementary preload and afterload, huh? Good question.
    Basically, preload is stretch. The amount of volume being returned to the right side of the heart from systemic circulation. Afterload is squeeze. The amount of resistance the left side of the heart has to overcome in order to eject blood.
    Just look at the mechanism of action with different drugs to see what they do. e.g. a dilator will decrease, so the pressure comes down and the heart has less resistance to overcome, the catch is that it can also lead to less venous return, hypotension, ischemia. A pressor will increase, hopefully leading to better return to the heart. But it can also create too much resistance, which also can lead to problems.
    This is a very simplified definition, hope it helps. Sometimes the simplest things are the most useful.

  • Dec 27 '15

    I hear you, and all the posters who said you have to set limits and demand the respect you deserve are exactly right.
    We had a lady on the vent for 60+ days with pulmonary fibrosis, and every day you could tell what her family had looked up on WebMD the night before. Asking detailed, questions about vent setting trivia, acting angry the split second it seemed like she wasn't the center of attention at all times. Her husband yelled at one of my co-workers one afternoon about how "no one has been taking care of her". I went in the room and told him to google pressure ulcer when he got home and then ask himself how she had been laid up here for 2 months without having one....then see if he still thinks no one's been taking care of her.
    He must have done it because the next day he apologized and that was the end of them acting like that. Miraculously, without us ever taking care of her, she managed to survive her admission and went back home.

  • Dec 8 '15

    Quote from cfsleo812
    Can someone please break it down really simple, elementary my dear: what is cardiac preload, afterload? Feel free to give specific examples with drugs that affect each to make it crystal clear, thanks.
    Hey cfsleo812,
    So: really simple, elementary preload and afterload, huh? Good question.
    Basically, preload is stretch. The amount of volume being returned to the right side of the heart from systemic circulation. Afterload is squeeze. The amount of resistance the left side of the heart has to overcome in order to eject blood.
    Just look at the mechanism of action with different drugs to see what they do. e.g. a dilator will decrease, so the pressure comes down and the heart has less resistance to overcome, the catch is that it can also lead to less venous return, hypotension, ischemia. A pressor will increase, hopefully leading to better return to the heart. But it can also create too much resistance, which also can lead to problems.
    This is a very simplified definition, hope it helps. Sometimes the simplest things are the most useful.

  • Dec 2 '15

    we were loading an elderly woman into the helicopter during an interfacility transfer when she grabbed my collar and asked if either me or my partner would "please ride with me". I told her that we both would probably get in if that'd make her feel better!
    I felt so bad because it never dawned on us that she thought we'd just shove her in there and then leave her alone!
    another time a woman had wrecked her car into a tree. when we arrived the police and firefighters had formed a cordon around the victim, who was on the side of the road, ambulatory and completely naked. She kept pointing at the tree and yelling "I want that man arrested!" (minor damage, subsequently was found to have no closed head injury) When we were immobilizing her, I asked if she had any ID and she put her fingers into her vagina, producing 23 cents in change. I said "thank you" and put it in a specimen bag. We tried to get the security guards at the hospital to log it but they would have NOTHING to do with it!!

  • Nov 21 '15

    Saw a person OD on Tylenol and then attempt to OD on the Mucomyst too. Can't doubt their intent but dang.....Mucomyst??

  • Nov 20 '15

    Quote from cfsleo812
    Can someone please break it down really simple, elementary my dear: what is cardiac preload, afterload? Feel free to give specific examples with drugs that affect each to make it crystal clear, thanks.
    Hey cfsleo812,
    So: really simple, elementary preload and afterload, huh? Good question.
    Basically, preload is stretch. The amount of volume being returned to the right side of the heart from systemic circulation. Afterload is squeeze. The amount of resistance the left side of the heart has to overcome in order to eject blood.
    Just look at the mechanism of action with different drugs to see what they do. e.g. a dilator will decrease, so the pressure comes down and the heart has less resistance to overcome, the catch is that it can also lead to less venous return, hypotension, ischemia. A pressor will increase, hopefully leading to better return to the heart. But it can also create too much resistance, which also can lead to problems.
    This is a very simplified definition, hope it helps. Sometimes the simplest things are the most useful.



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