PetERNurse

PetERNurse has 6 years experience.

Latest Activity

1. this did not make sense to me.

   PetERNurse replied to turnforthenurse's topic in Cardiac

   Even though your platelets are 65 or 50, they are still capable of forming a thrombus. This is why the doc ordered the hep drip. Heparin is not a "blood thinner", and does not decrease the viscosity of blood improving arterial flow. IT DOES potent...

2. Anyone have any good critical care questions to quiz me on?

   PetERNurse replied to nurse678's topic in Critical

   CVP, PAP, and wedge will all be elevated.

3. Anyone have any good critical care questions to quiz me on?

   PetERNurse replied to nurse678's topic in Critical

   The answer to these depends on what the current vent settings are and full assessment of ABG taking disease process into account.

4. metabolic acidosis and tachypnea

   PetERNurse replied to vic_rn's topic in MICU

   It's not as simple as saying the pH is X and the PCO2 is Y, therefore the disorder is N. It's not like a hemoglobin, where if it is low the disorder is anemia. You need a complete ABG to evaluate acid-base (pH, PCO2, HCO3, AnGap, PO2, lytes, and pr...

5. Ketamine during an emergent intubation

   PetERNurse replied to BelgianRN's topic in MICU

   Ketamine causes increased HR and myocardial oxygen demand, while decreasing ventricular filling time. Don't fall into the trap of thinking it doesn't "stress out hemodynamics". Given that the patient needed RSI, a little transient hypotension was th...

6. Best one sentence handoff report

   PetERNurse replied to emtb2rn's topic in Emergency

   "521 is a babysit. When he goes to bite you just toss the pill in the back of his mouth."

7. Ketamine during an emergent intubation

   PetERNurse replied to BelgianRN's topic in MICU

   I think we can all agree that it increases morbidity and hemodynamic sequalae as it increases the likelihood of vasopressor dependence in the PO period. Yes jury is still out on if it increases mortality. And yes the ventilator study is when used as...

8. Ketamine during an emergent intubation

   PetERNurse replied to BelgianRN's topic in MICU

   Controversies surrounding the use o... [Ann Pharmacother. 2010 Jul-Aug] - PubMed - NCBI Etomidate versus ketamine for rapid sequence intubati... [Lancet. 2009] - PubMed - NCBI Acute adrenal insufficiency aft... [J Intensive Care Med. 2007 Mar-Apr] - ...

9. Ketamine during an emergent intubation

   PetERNurse replied to BelgianRN's topic in MICU

   People used to think the etomidate did not increase m+m, but that is not the consensus now. Even a single dose has been shown to cause prolonged adrenal supression that increases m+m, especially in septic shock. Use of etomidate during mechanical ...

10. Self extubation

    PetERNurse replied to Jdalt10's topic in Neuro

    Dipravan causes significant myocardial depression and decreased CO. Definitely can effect BP especially in a CV compromised patient. I agree you may need to up your sedation/look to other meds (fentanyl/midazolam as others have said). Additionall...

11. Nitro vs Morphine

    PetERNurse replied to moidla's topic in CCU

    Morphine is also more vasodilatory than fentanyl and will provide more of an increase in myocardial oxygen delivery. Additionally the increase in mortality with morphine demonstrated by the CRUSADE study was in non-STEMI patients. It's also a non-ra...

12. Respiratory acidosis/failure s/s

    PetERNurse replied to Aurora77's topic in CCU

    Your body wants to blow off the excess carbon dioxide so tachypnea is an early sign. Along with tachycardia as the heart tries to increase it's output to meet an inadequately supplied metabolic demand. You're mixing a couple different things here. ...

13. How bolus infusions of NaCl may affect low sodium levels...?

    PetERNurse replied to Xsited2baNurse's topic in General Nursing

    the problem here is that your answer to the op "original simple question" contains fundamentally incorrect material (see post 39 above). i'd be interested to see the clinician's reaction when you attempt to water/fluid restrict a hypovolemic patient ...

14. How bolus infusions of NaCl may affect low sodium levels...?

    PetERNurse replied to Xsited2baNurse's topic in General Nursing

    It's not so much that the kidneys separate Na, Cl, and H2O, but that it is an aqueous solution. NaCl does dissociate when in solution. It's just basic chemistry.

15. How bolus infusions of NaCl may affect low sodium levels...?

    PetERNurse replied to Xsited2baNurse's topic in General Nursing

    Right, 140, because that measurement is a measurement of CONCENTRATION, not a count of the absolute number of sodium molecules. Got that? If not, work on it, because you have to "get" it. If you have a concentration (140 meq/L) and a volume (blood v...