Biffbradford 7,301 Views
Joined Sep 23, '10.
Posts: 1,118 (48% Liked)
The place to start is with the emergent:
Ventricular tachycardia (VT, Vtach)
Ventricular fibrillation (VF, Vfib)
3rd degree block
Superventricular tachycardia (SVT)
Atrial fibrillation with rapid ventricular response (Afib w/ RVR)
Don't get too hung up in all the details. Be able to spot these and know the treatments and you'll cover >95% of the cases.
And recognize that the monitors have pretty good algorithms to spot the lethal rhythms.
If the rate is greater than 50 and less than 110, it's not likely to be an emergency.
Start with Thaler's book and go from there.
How much do perfusionists make compared to ICU RNs. You want me to do their job too? Show me the money.
Scary? After you've been in the game so long, I think you become desensitized to stressful situations and it takes a real bad threat to be 'scary'. However, one time we did have an angry husband barricade himself in a patient's ICU room (with glass doors), not letting anyone come near the patient. She had been there for a few months, but was still quite sick, so when we saw her EKG go flat line, we became 'concerned'. Maybe it was just a lead that fell off, but we didn't want to wait 15 minutes for the next automatic blood pressure reading to confirm it or not. Oh, we had security and the local police there too. It was quite the scene. In the end, everyone was fine and he was escorted away. Most importantly, I was just beginning a weeks vacation, so I didn't have to deal with it the next day.
Talkers: "Gotta go!" then exit stage left.
I guess my concerns are that
a. This is outpt dialysis - the pts come by themselves - no family/caregivers present.
b. This is rural area - transplant center is 200 miles away in Chicago.
c. There are only 2 RNs present in the building for 32 pts.
d. By the time they get too dry and pass out, it could be a little late to start thinking about "what we should do."
I don't remember what they all were, but I recall an ECMO patient that had 4 stacks of Baxter double pumpers. (not the official term) Two stacks on each side of the bed and prob. 4 high (you could go more but the pole got real unstable) so that would make 16 if they were all used (I don't recall) and prob. included a couple pressors, one or two for heart rate, sedative, analgesic, back up fluids, a paralytic, TPN, citrate for CVVH, you name it. That's one of those 2 nurses to 1 patient deals where you need a nurse functioning as a 'mechanic' to keep up with the chores. 12 running would certainly be possible. That's a lot of fluid!
The ICU isn't all sedated and intubated patients believe me. You'll get the 27 yo woman with 3 kids and a very complex family, who's dying and knows it but who get's the kids? (and more) So you're dealing with the physical problems, psychological, religious, family dynamics, juggling MD's, consults, social services ... and don't let those drips run dry! Plenty to keep you busy just in that one patient plus it doesn't get more holistic than that.
I've given up trying to figure out the hiring process. It makes no sense at all.
If you have worked in a hospital, then you have been colonized. Indeed.
Once had a VAD pt in slow VTach for a WEEK. Rhythm was unresponsive to all therapies, but the VAD still kept pumping so BP was fine. Final outcome not good. Crazy stuff.
How would you like to have your family member experience a life threatening heart attack so bad that they have to sedate and cool you down to unnatural levels, yet the nurse has OTHER chores that may have priority? Isn't that crazy??
How closely are your 12 hour shifts usually? Do people usually do 3 straight 12s and call it a week? I'm planning to be a new RN in the future and trying to figure out how my life working nights may be, as far as sleep, family, social life.
Photographer. But NOT weddings. Guess I'd have to win the lottery first.
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