Biffbradford 9,527 Views
Joined: Sep 23, '10;
Posts: 1,117 (48% Liked)
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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.
Congratulations. I went the other route ... started in a CVICU and moved to step down. Like you said, crazy busy but now I'm not worrying about someone crashing every day and if they do begin to go sour, it's not up to me to fix 'em. Did that for > 10 years. Nice sending people HOME for a change. You'll do fine. Good luck!
Best ICU (CVICU) I worked in had a clip board for each room, so each patient had their own report sheet. It was re-writen on NOCs and updated throughout the day. Format and content was determined by a committee of nurses. Report was easy, you went from box to box and it covered everything from history to drips to skin, labs, the works and you didn't have to worry about scribbling it all down over and over. It was already written down for you, and you could add or change as needed. This unit was run as a very tight ship and it worked. Even the docs would refer to the clip board from time to time. While it was a very hard unit to work in due to the sheer high acutity of patients, I do miss that report system.
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.
Yeah, I refrain from 'stripping' but will resort to that if it means getting a big honking clot out of there and preventing sending the guy back to surgery for tamponade! I remember one nurse that spent her whole 12 hour shift milking and stripping chest tubes with due diligence trying to keep them patient, grabbing anyone she could to help out. What a nightmare! OP: check them frequently looking to make sure they still draing 'something', if not, then 'milk' it to see if there's a clot that can be worked free and out.
From what I have read about acute dialysis - ON CALL. Some times >100 hrs/week. Even docs will say that it can suck the life from you. Clinic dialysis schedules would be more structured of course. Could be good or bad considering your point of view.
Boy, if I ever face some time on the table, CUT ME OPEN. I want that surgeon looking and smelling with his own eyes and nose, cutting and sewing with his own talented hands.
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!
More like 'fight' the Grim Reaper, if he really want's 'em, he'll take 'em.
Hard to say. Be courteous but curt with your time. Get in, get it done, and get out. Even in the ICU where you 'only' have 2 patients, you have to pick one to start with. Do you see the 'easy' one first? Or the 'hard' one? I usually go with the sickest, or busiest first so I don't get bit in the *** by something small now that can grow to major trouble later. Nip it in the bud! Then you can relax and get to the 'easier' of the patients.
Nothing earth shattering to share from here. Stay on top of a spare bottle for the on coming shift and I'll change the tubing a little early if it's going to be due on the next shift (usually Q12hrs). Love it though!
Welcome to Allnurses! Where do YOU feel that you can make some improvements? That would be a good place to start.
Have done it both ways. In a code situation we've even 'squeezed in' fluid or blood.
Can you actually *FEEL* a pulse? Art lines are great, but they do go bad.
His family will just have to corner the attending physician and bombard him/her with questions. Perhaps it's time for a family conference where you gather the docs and a nurse and talk about his current treatment and future plans. In 15 years of ICU care, I've seen people who we thought would fly through treatment, only to not make it one night ... and others who we thought would never make it, end up walking out of there. Sometimes we tune 'em up as best we can, looking pretty good, send them to LTAC (long term acute care) and they bounce right back to the ICU next day, or they die. Yet others you never hear about again. It's very hard to predict outcomes and you just have to take the ups with the downs, take it step by step. Hope that helps. Best of luck.
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