Latest Comments by MunoRN

MunoRN 43,468 Views

Joined Nov 18, '10 - from '.'. MunoRN is a Critical Care. She has '10' year(s) of experience. Posts: 8,042 (70% Liked) Likes: 20,318

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  • 2
    brownbook and Catticus11 like this.

    Lidocaine gtt is generally only considered effective for drug induced long-qt ventricular arrhythmias, it is of little benefit in congenital long-qt syndrome which is treated with magnesium and defibrillation and can be successfully avoided with intermittent overdrive pacing (typically with a paced rate of 120 or greater).

    Confusion is not uncommon with systemic lidocaine treatment, if that's what you mean by "weird", but delirium is not uncommon in patients having recurrent torsades due to congenital long-qt, due to the need for versed, shocks, stress, anxiety, etc.

  • 4

    Quote from SC_RNDude
    For most if us, our reasons for finding the idea universal healthcare to be horrific, have nothing to to with the constitution.
    Then why do you find it to be "horrific"?

  • 1
    herring_RN likes this.

    Quote from pmabraham
    "1. How would you fix the ACA?"

    By repealing it completely; government should have minimal involvement in health care.

    "2. What is the perfect healthcare system for the U.S?"

    EMBRACE Single System (not Single Payer) Healthcare System- An Introduction - YouTube might good if it grabs traction.
    The "EMBRACE" proposal is essentially identical to a "medicare for all" single payer system, it's only the semantics that are different.

    The EMBRACE proposal is a system overseen by a board that is subject to congressional oversight, just like medicare.

    The EMBRACE system board sets best practice guidelines and encourages/enforces compliance with those guidelines, same as medicare for all.

    The EMBRACE system funds healthcare with a dedicated tax revenue, same as medicare for all.

    The EMBRACE system covers all acute treatment needs, coverage of "luxury" care can be purchased separately, same as medicare.

    The EMBRACE system encourages a cross-compatible EMR system, same as medicare.

    It's functionally no different than the single payer "medicare for all" proposal that's been around for a while, it's carefully explained in a way that makes it seem different, and if that's what it takes for people to get on board then that's fine with me.

  • 9

    Quote from ella2990
    After that I was afraid to give her pain meds every hour.
    This seems to be the gist, by itself the frequency that a patient is receiving a med isn't really a useful predictor of overmedicating a patient. Giving a patient x dose of opiate A every hour is no different than giving them 4 times that dose every 4 hours. What you're evaluating is the patient's response to the medications regardless of the dose or how often they are being administered; are they lethargic, somnolent, obtunded? Are they not protecting their airway? CO2 level? Is their RR 6? etc. Is there a pain contract in place?

  • 36
    SobreRN, Kitiger, /username, and 33 others like this.

    If you're concerned about your license then you should be just as concerned about holding indicated meds without any apparent rationale other than what appears to be a personal bias. I get that it often feels like you're losing some sort of personal battle every time you give a patient an opiate where there is some component of seeking involved, but it's important to keep that separate from an objective assessment of whether or not the medication should be held, particularly in a post-surgical patient.

    It would be reasonable given that list to ask that it be condensed to a single long acting and prn order in addition to the toradol. but the doses are all relative and can't really be compared to every other patient, it's quite possible that giving a Norco or two to another patient is far more risky than giving an opiate tolerant patient 4mg of dilaudid.

  • 3

    Quote from SC_RNDude

    Let me ask you about your comments.

    You mentioned making any cuts to Medicare is bad. Immoral is the term you used. 25% of the population is on it, according to you.

    How I took it was that you think even more people should have to rely on the government for healthcare. Am I wrong?

    Or should we work to a solution where fewer people rely on the government?
    I think it's reasonable for the government to take responsibility for a service it requires to be provided. A solution to keeping people off Medicaid would be to no longer allow employers to leave the costs of their employees up to the government, which is something Obamacare at least takes a step towards. The republican plan moves us farther away from keeping our healthcare system dependent on government funding.

    Who should be responsible for keeping our healthcare system afloat?

  • 0

    Quote from SC_RNDude
    Is it moral to leave Medicare alone and simply let it go broke?
    Is the republican plan to cut medicare so that it goes broke sooner moral?

    Medicare was never intended to be left alone, it's a 'pay-it-forward' based system and a result the ratio of those paying in vs those taking money out is always changing and therefore always requiring adjustments. Ideally, when revenues drop the first response to make sure we've eliminated all possible waste, but after that we need to increase revenue, if we don't then those costs simply get transferred to other payers, in other words it increases costs to mainly those who are privately insured by the same amount that Medicare revenue decreased.

  • 6
    Ted, elkpark, Avid reader, and 3 others like this.

    Quote from SC_RNDude
    Generally direct measurements of all the data in question is more accurate than indirect measurements using an exceedingly small sample size.

    The "study" you're referring to was actually a poll with a sample size of 339 respondents who claimed to be non-citizens. Polls on how people voted are notoriously unreliable as there those who believe such polls should be misled.

    Luckily we don't have to rely in this information that is by basic statistical definitions unreliable, we directly audit whether each person who voted was allowed to vote and these more reliable numbers are closer to 3 digits than 7.

    Kris Kobach is well known for supporting the claim that voter fraud is widespread, which is why Trump appointed him to lead his voter fraud commission. Yet as secretary of state of Kansas Kobach has only been able to find 4 instances of provable voter fraud over a 6 year period, on a national scale, that rate would be about 175 illegal votes, far short of a few million.

  • 3

    Quote from SC_RNDude
    Several people brought up treason, starting with Tim Kaine. Nancy Pelosi said something about "crimes of espionage". And on this thread, people such as Nel said he was guilty of treason.
    So is it possible he still did something wrong even without meeting the definitions of treason?

  • 0

    PA caths feed our thirst for numbers, but even proficient management of those numbers doesn't change patient outcomes in most of the patients we've used PA caths for. Many years ago they were common for severe sepsis, then it was just OHS patients, now they're only considered useful in OHS patients with marked LV dysfunction, otherwise even open hearts don't benefit from them. Wedging the PA cath carries a high risk of complications and death, at my current facility wedging is only allowed on initial placement, even by MDs.

  • 6

    I agree with him, but he's countering an argument that isn't really being made. Until this article, I hadn't heard that people were claiming Don Jr had committed treason, I'm sure there are some fringe arguments claiming this, but the actual law that people are saying he may have broke is a federal law that says campaigns cannot receive or even attempt to receive anything of value from a foreign country. Don Jr's lawyer doesn't even argue that this law applies to him, his argument is that "opposition research" isn't something of value, despite the fact that it is a well established commodity in political campaigns.

    More importantly, whether something is wrong isn't solely defined by whether or not it fits strict criminal criteria. We know that Don Jr enthusiastically attempted to get dirt on Clinton which he was told was being provided on behalf the Russian government to help the Trump campaign. Personally I find that to be wrong, but I get there's a large portion of the country that sees no problem with that.

  • 7
    nurseactivist, Ted, SC_RNDude, and 4 others like this.

    Quote from SC_RNDude
    And Steny Hoyer is out there blaming republicans for not fixing Obamacare.
    I listened to Rush today too, his basic point was that healthcare was fine before Obamacare and it was only when Obamacare came into being that our healthcare system was in trouble, so it's silly to blame republicans for failing to fix a problem that didn't exist before.

    I was hoping he would finally make the argument that we were better off before Obamacare, but he never did, and as far as I know neither has any anti-ACA conservative. There's a reason every conservative group, candidate, etc had a healthcare insurance reform platform in 2008, the pre-ACA system was collapsing, median hospital operating margins had turned negative, the insurance death spiral was well underway (more than 200,000 people per week were no longer had insurance, which means they were no longer contributing to the system that they were still going to use). We could certainly do better to secure the sustainability of healthcare, but the ACA clearly made it more sustainable that it was. This is why repeal only has even less republican support than repeal and replace.

    The fact is that Republicans have been promising to fix/repeal&replace Obamacare for 7 years, so when they fail to do that I think it's a bit silly to say they aren't deserving of some criticism.

  • 6

    Quote from tntrn
    None of that answers the question as to why she was allowed to overstay that special visa she had gotten from the Obama administration.
    It doesn't appear she "overstayed" a visa since the Don Jr's emails state that she was flying in from Moscow to represent a client that day, it doesn't appear she had been residing in the US for some time which would have required the type of visa she had before.

    I know this has become a common talking point, but I'm not sure how it makes the Trump campaigns actions any less concerning. The argument seems to be that it's Obama's fault because he should have known that Don Jr, Manafort, and Kushner can't control themselves when given the opportunity to collude. It's like if a husband cheats on his wife with his wife's friend and then claims it's his wife's fault because if she wasn't her friend he never would have met the friend and therefore wouldn't have cheated on her.

  • 4

    I've agreed to this point that the Trump campaign cooperation with the Russians has been all smoke and no fire, a very unusual amount of smoke to be around without any fire, but all smoke nonetheless. I don't see how it's possible to look right at the fire which is now clear to see and say it doesn't exist.

    I'm not sure what's left to argue at this point, here's what we know from what Don Jr has told us: He was offered information obtained by an adversarial government and told that this information was being offered on behalf of the Russian government as part of their desire to help Trump become president, he enthusiastically took the meeting. Game over.

    Charles Krauthammer pretty well sums it up:
    Charles Krauthammer: Bungled collusion is still collusion

  • 16

    You're injecting your sister with dietary supplements you got from Russia?