Latest Comments by Anna Flaxis

Anna Flaxis, ASN 26,606 Views

Joined Oct 15, '10. Posts: 2,867 (67% Liked) Likes: 8,635

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  • 0

    What did the OB-GYN have to say about this?

  • 0

    Gero-psych certainly wouldn't hurt anything. We see a ton of that in the ED, so having some experience with it wouldn't be a bad thing at all. But to be honest, if your passion is ED, then go for ED-with one caveat... if you don't expect much more than a sink-or-swim orientation and you are a person who can deal with that, then go for it. If you need a lot of hand holding, then please don't. The ED is a busy place, and if you don't have the ability to pull up those hip waders and wade right in, then it may not be a good fit.

  • 2
    AJJKRN and nursiebean like this.

    Depends on the clinical picture.

    Is this a new medication for the patient, or have they been taking it for a while?

    If it's new, I agree that it would be safest to have them on the monitor for at least the first few doses.

    If they've been on metoprolol for some time, and it's simply a route change due to NPO status, it is important to avoid abruptly discontinuing the medication, as this can lead to a whole host of problems, such as Acute MI. It would be of great import to make sure they get their dose. If you're not comfortable with an IV push, then mixing it in a mini-bag and infusing over 10 minutes would be a good compromise.

  • 0

    Quote from caalvarez3
    Can a patient be alert and oriented but drowsy?
    What are your thoughts?

  • 5

    The doctors do it where I work.

  • 0

    Quote from chare
    And thus the intent of my previous post. Don’t you think that there should be some evidence behind what we teach and practice?
    Of course, just as I think that when citing evidence to make a point, one should verify that such evidence is reliable. :-)

  • 5
    bellakat, datalore, kakamegamama, and 2 others like this.

    Why should any further study be done?
    Assuming this is not a rhetorical question, to put it simply, the smaller the sample size, the less precise the information is.

    Say, for example, you receive a shipment of 500 widgets, and the supplier guarantees you that no more than 10% will be defective. You can't check every single widget, so you take a sample of 10 and find two defective widgets. You could conclude that 20% of the entire shipment of widgets is defective, or you could understand that perhaps you just happened to pull out 2 defective widgets when selecting your sample.

    Now, what if, instead, you select 50 widgets as your sample, and 2 of them are defective? That would be 4%, and consistent with your supplier's guarantee of 10% or less.

    You can apply this principle to individual experiments as well as what we call the "body of evidence". Two studies (with small sample sizes, no less) is not a large body of evidence upon which to form a strong conclusion, it is merely a starting point for further research.

  • 0

    Quote from chare
    The old “rule of thumb” that a radial (femoral, carotid) pulse indicates an SPB of ≥80 (70, 60) mmHg originated from the ATLS course. This is not accurate, and using this method is generally an overestimation of the actual SBP.
    First, please note that this is a single study with an n=20. This is not a large enough sample size to be statistically significant. Second, please note that in Group 1, the group in which radial, femoral, and carotid pulses are present, 8 out of 12 patients (67%) had an SBP >/= to 70, and 11/12 (92%) had an SPB >/= to 60.

    We would need to conduct more experiments with greater sample sizes to be able to draw a reliable conclusion.

    Also, please see: Accuracy of ATLS guidelines for predicting systolic blood pressure

  • 0

    In my experience, a Code Blue is for a cardiac or respiratory arrest, and I'm not sure why one would perform chest compressions on an adult with a pulse.

    It is reasonable to call for assistance if your stable patient suddenly begins seizing.

  • 2
    poppycat and PsychGuy like this.

    I don't understand. If they're not on a hold, they have the right to leave.

  • 10
    LadyFree28, klone, brownbook, and 7 others like this.

    Quote from Been there,done that
    Per NIH "no compelling evidence for routine cultures or empiric treatment with antibiotics. Further research is required." This is my kid we are talking about. Use sterile procedure, culture that green and yellow stuff, determine if and what antibiotics are necessary. I would expect the same for my patients.
    Everybody is somebody's kid. Doesn't change anything.

  • 8
    My_toe_sis, iluvivt, brownbook, and 5 others like this.

    Quote from feelix
    This should be an incident report. Don't let doc get away with it. He is supposed to know more than you do.
    He does know more than you do, and I&D is not a sterile procedure.

  • 3
    cocoa_puff, BSNbeDONE, and BSN16 like this.

    I work PRN exclusively. My orientation was as brief as I could possibly make it, as I am an experienced RN and have little tolerance for having my hand held.

  • 9

    I&D is a clean procedure. C&S is unnecessary for simple abscesses, as most abscesses heal without antibiotics.

  • 0

    Hmmm, I've gone as far as I wanted with my ADN. I've worked in cardiopulmonary/post-interventional/telemetry, emergency, infusion services, and administration. I've been approached for peri-operative services, but declined because I don't want to take call. I value my free time too much for that.


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