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francoml 10,197 Views

Joined Nov 7, '12 - from 'Dirty South'. francoml is a ICU Nurse. Posts: 142 (40% Liked) Likes: 221

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  • Aug 18

    Ohhh that is a very polarizing question on the differences between ED and ICU lol.

    I will first start by saying that I have never worked in the ED except for when I am there as a rapid response and that is limited because they handle all their own codes and line placement. They are both awesome fields and it really depends on your way of thinking as well as what your future career goals are. If your are planning on going to CRNA school 95% of schools require Critical Care experience and ED does not count. Beyond CRNA there are a million different career opportunities that can arise out of ED and ICU alike.

    I will give you a small window into a night in the ICU. I work in a 32 bed Medical ICU and it has been the biggest learning curve I have ever experienced. We take the sickest patients from a 500 mile radius and all of our direct admits skip the ED completely and come directly to us. An example of the toughest patients I take. Patient with end stage AIDS developed a massive infection (atypical pneumonia) which lead to septic shock and acute kidney failure. Patient was placed on CRRT, intubated on a high flow ventilator (250 breaths a minute), completely paralyzed with a vecuronium/fentanyl drips and placed on a BIZ monitor, due to failing cardiac output and hypotension the patient was started on Flowtrack hemodynamic monitoring with the following drips; epinephrine, norepinephrine, vasopressin, phenylephrine, and dobutamine. Beyond the pressors the patient was on multiple antiviral drips and antibiotic drips. I believe the most active drips I had with this patient was 13 between pressors, fluids, paralytics, sedatives, antibiotics, antivirals, electrolyte replacement, and blood products. The key to all of this, an ICU has complete autonomy when titrating all of these medications. There is no doctors orders stating, epinephrine at ..... or vecuronium at ..... or vasopressin at ..... The order states use these medications and titrate them based on your hemodynamic monitoring to maintain blood pressure.

    In our unit our ICU suites can also function as surgical suits in the event that a patient is too unstable to transfer to the OR. I once had a patient that had a intestinal perforation and the surgical team came up and opened the patients belly at the bedside and then proceeded to take out the intestines and systematically inspect them for a bleed.

    This is something you will never experience in the ED or in a small rural ICU. I will admit there are days when I have totally stable patients and I do little more than a bed bath, pass a med or two, and do a few assessments but this is rare (and much needed). You also have to realize that I am incredibly biased toward ICU lol. I am sure there are many people on here that will offer a look into the world of emergency medicine and will have amazing stories.

    In the ICU you need to know A&P, pathophysiology, pharmacology, and hemodynamics inside and out. You also need to be very OCD about your patients because you should know damn near EVERYTHING about that patient.

    Both will offer their fair share of adrenaline rushes and challenges but ED will focus on stabilizing a patient while ICU will be about actually keeping the patient alive and fixing their complex problems. If you truly love your job as an EMT I would suggest going into Emergency Medicine. If you want to truly push your limits of your medical and pharmacological knowledge go ICU.

    That being said, I really hope some one can give you and in depth example of ED on here so you can make a better decision.

  • Aug 17

    I have been an ICU nurse for about a year now. I have learned a million and one things and still have a lot left to learn. I just wanted to offer a little help to new grads trying to get into the critical care scene and newly hired nurses in the ICU.

    First....


    If you want to be an ICU nurse go for it. It is one of the biggest learning curves you can take on but if that is your passion don't let anyone shoot your dreams down.

    Second....

    Apply to a large teaching university hospital. Usually those hospitals will have an internship program that lasts 4-6 months which includes one on one patient care, constant supervision by a preceptor, and critical care classes to teach you critical care medicine.

    Third....

    Study on your own time. Pharmacology, pathophysiology, A&P, ect. This will all be things that help you tie the whole picture together.

    Fourth....

    When in clinical (students) or once hired as a new ICU nurse, participate in everything you can if your patients are stable. If they are intubating a patient, ask if you can record or push meds. When coding a patient be the first one to hop on the chest and due compressions, bag the patient if needed, record everything that is going on ect. Watch the nurses place lines with ultrasound and ask them to teach you. Basically, as long as your patients are taken care of and stable, go around and ask if you can watch and learn or help out with procedures.

    Finally....

    You have to love what you do. You will see more death then any other form of acute care nursing. Some of the things you will see will tear your heart out. You have to go into this career path knowing that there is a very high turn over rate in this field because of how stressful it can be. That being said, there is nothing more rewarding that seeing the 19 year old girl who should have died, walk out of the hospital with a full recovery. It is the "little miracles" that keep you coming back for more even though the day to day can be gut wrenching.

    I hope this helps, ICU nurses are a breed of their own. It has been the only job that I have ever had that I truly wake up in the morning and am excited to go to work. You will either love or hate working on a unit and you will most definitely develop a dark sense of humor. I wish all of you students and new grads the best of luck in your nursing careers and always remember, there is a lot of people out there that are "dream killers." Don't listen to the negative people out there. You can accomplish anything you want as long as you put everything you have into it.

  • Aug 11

    I have been an ICU nurse for about a year now. I have learned a million and one things and still have a lot left to learn. I just wanted to offer a little help to new grads trying to get into the critical care scene and newly hired nurses in the ICU.

    First....


    If you want to be an ICU nurse go for it. It is one of the biggest learning curves you can take on but if that is your passion don't let anyone shoot your dreams down.

    Second....

    Apply to a large teaching university hospital. Usually those hospitals will have an internship program that lasts 4-6 months which includes one on one patient care, constant supervision by a preceptor, and critical care classes to teach you critical care medicine.

    Third....

    Study on your own time. Pharmacology, pathophysiology, A&P, ect. This will all be things that help you tie the whole picture together.

    Fourth....

    When in clinical (students) or once hired as a new ICU nurse, participate in everything you can if your patients are stable. If they are intubating a patient, ask if you can record or push meds. When coding a patient be the first one to hop on the chest and due compressions, bag the patient if needed, record everything that is going on ect. Watch the nurses place lines with ultrasound and ask them to teach you. Basically, as long as your patients are taken care of and stable, go around and ask if you can watch and learn or help out with procedures.

    Finally....

    You have to love what you do. You will see more death then any other form of acute care nursing. Some of the things you will see will tear your heart out. You have to go into this career path knowing that there is a very high turn over rate in this field because of how stressful it can be. That being said, there is nothing more rewarding that seeing the 19 year old girl who should have died, walk out of the hospital with a full recovery. It is the "little miracles" that keep you coming back for more even though the day to day can be gut wrenching.

    I hope this helps, ICU nurses are a breed of their own. It has been the only job that I have ever had that I truly wake up in the morning and am excited to go to work. You will either love or hate working on a unit and you will most definitely develop a dark sense of humor. I wish all of you students and new grads the best of luck in your nursing careers and always remember, there is a lot of people out there that are "dream killers." Don't listen to the negative people out there. You can accomplish anything you want as long as you put everything you have into it.

  • Apr 26

    Ohhh that is a very polarizing question on the differences between ED and ICU lol.

    I will first start by saying that I have never worked in the ED except for when I am there as a rapid response and that is limited because they handle all their own codes and line placement. They are both awesome fields and it really depends on your way of thinking as well as what your future career goals are. If your are planning on going to CRNA school 95% of schools require Critical Care experience and ED does not count. Beyond CRNA there are a million different career opportunities that can arise out of ED and ICU alike.

    I will give you a small window into a night in the ICU. I work in a 32 bed Medical ICU and it has been the biggest learning curve I have ever experienced. We take the sickest patients from a 500 mile radius and all of our direct admits skip the ED completely and come directly to us. An example of the toughest patients I take. Patient with end stage AIDS developed a massive infection (atypical pneumonia) which lead to septic shock and acute kidney failure. Patient was placed on CRRT, intubated on a high flow ventilator (250 breaths a minute), completely paralyzed with a vecuronium/fentanyl drips and placed on a BIZ monitor, due to failing cardiac output and hypotension the patient was started on Flowtrack hemodynamic monitoring with the following drips; epinephrine, norepinephrine, vasopressin, phenylephrine, and dobutamine. Beyond the pressors the patient was on multiple antiviral drips and antibiotic drips. I believe the most active drips I had with this patient was 13 between pressors, fluids, paralytics, sedatives, antibiotics, antivirals, electrolyte replacement, and blood products. The key to all of this, an ICU has complete autonomy when titrating all of these medications. There is no doctors orders stating, epinephrine at ..... or vecuronium at ..... or vasopressin at ..... The order states use these medications and titrate them based on your hemodynamic monitoring to maintain blood pressure.

    In our unit our ICU suites can also function as surgical suits in the event that a patient is too unstable to transfer to the OR. I once had a patient that had a intestinal perforation and the surgical team came up and opened the patients belly at the bedside and then proceeded to take out the intestines and systematically inspect them for a bleed.

    This is something you will never experience in the ED or in a small rural ICU. I will admit there are days when I have totally stable patients and I do little more than a bed bath, pass a med or two, and do a few assessments but this is rare (and much needed). You also have to realize that I am incredibly biased toward ICU lol. I am sure there are many people on here that will offer a look into the world of emergency medicine and will have amazing stories.

    In the ICU you need to know A&P, pathophysiology, pharmacology, and hemodynamics inside and out. You also need to be very OCD about your patients because you should know damn near EVERYTHING about that patient.

    Both will offer their fair share of adrenaline rushes and challenges but ED will focus on stabilizing a patient while ICU will be about actually keeping the patient alive and fixing their complex problems. If you truly love your job as an EMT I would suggest going into Emergency Medicine. If you want to truly push your limits of your medical and pharmacological knowledge go ICU.

    That being said, I really hope some one can give you and in depth example of ED on here so you can make a better decision.

  • Jan 22

    Quote from VANurse2010
    Your autonomy is perceived autonomy, and a lot of floor nurses exercise the same also.

    I have to respectfully disagree with this statement. I have way more autonomy as a ICU nurse then floor nurses do. I have standing order sets that allow me to give multiple drugs without first contacting the physician if my patient is quickly deteriorating. I can order just about any diagnostic test (labs, cultures, CT, EKG, ABGs, ect.) with out contacting physicians. I can also give ativan for seizures, reversal agents, and fluid boluses. Further more I can give atropine and start vasopressors if a patient drastically declines and a physician is not available. If a patient is hemorrhaging I can initiate mass transfusion protocol before consulting the doctors. Granted these are all standing order sets and only used in emergencies but they are at my discretion none the less. As far as access goes I can place large bore (16g and 14g) ultrasound guided arm and EJ lines if fluid resuscitation is needed. Although great floor nurses have great clinical judgement I highly doubt floor nurses can do all of these things. Much love to floor nurses for what they do but the scope of practice is drastically different.

  • Jan 4

    Levo, vaso, neo, epi, dopamine, saline, albumin, blood, plasma, platelets, meropenem, vanco, TPN, acyclovir, insulin, fentanyl, and vecuronium. needless to say the patient didnt make it.

  • Dec 3 '15

    Wow I can't believe what some of you missed in nursing school. I will graduate in may and I have something like 200 hours of clinical time this semester alone! We have to do all of our patients NG tubes, IVs, Foleys, ect. The only thing I cannot do as a student nurse is give blood products or push drugs in central lines. Our clinical rotations are 12 hour shifts in the hospital and we have up to 4 patients we are required to give total care to. My program is super intensive, maybe that is why so many people drop but I must say even though I have a ton of things still to learn, I have always felt prepared going into my clinical rotations. This semester we even spend 5 days (all 12 hour shifts) at a level one trauma center were we focus on intensive care, emergency medicine, and one 12 hour shift in the burn unit! I have also spent 3 days (12 hr shifts) at a mental institution that housed severely unstable and criminally insane patients and I was involved in every aspect of their care. This final semester only consists of 2 days of class time during the week and 3 days of clinical rotation! We even have clinical on the weekends sometimes. We are known in our state for our rigorous program and in 5 weeks we will be having a recruitment luncheon in which employers from around the state will attend! I have already been approached my the head of ER and ICU asking me to work for them when I graduate (ER all the way baby)!!!!

  • Oct 30 '15

    I really am not afraid of taking on the "establishment" ....This is going to sound conceded but I can afford to fight the good fight. I truly believe that patient care is paramount but that being said, I want to show people that alcohol and tobacco are way more harmful the marijuana. I think hospitals should be allowed to test for marijuana on the job, but not in a urine test. They can just as easily use a mouth swab or even a blood test to detect RECENT use.

    I know legislations will take a few months at the least to kick in so I will see what the future brings.

  • Oct 30 '15

    lovinlife.... So i guess you have never had a glass of wine on your day off..
    Alcohol (ETOH) is a drug the same way the marijuana (THC) is. Alcohol binds acetylcholine, serotonin, and GABA receptors to produce euphoria and sedation. THC binds cannaboid receptors to produce euphoria and sedation.

  • Oct 30 '15

    But it is legal in the "State" and it is the "State" board of nursing that makes the rules... If alcohol is legal and you can drink on your time off then why can't you smoke on your time off.

  • Oct 20 '15

    One thing I have noticed in my practice is the fact that we are "snowing" people on benzos for sedation. We have to get away from high dose ativan and versed when it is not needed. I feel that benzodiazapines are a leading cause of psychosis and delirium in the ICU. One thing we are starting to do is using high dose fentanyl over ativan/versed. Studies show if you treat pain first then there is a significantly smaller need for sedation. Propofol is also a great choice when a true sedative is needed as it does not have the long lasting effects of benzos. Just my humble opinion.

  • Oct 18 '15

    One thing I have noticed in my practice is the fact that we are "snowing" people on benzos for sedation. We have to get away from high dose ativan and versed when it is not needed. I feel that benzodiazapines are a leading cause of psychosis and delirium in the ICU. One thing we are starting to do is using high dose fentanyl over ativan/versed. Studies show if you treat pain first then there is a significantly smaller need for sedation. Propofol is also a great choice when a true sedative is needed as it does not have the long lasting effects of benzos. Just my humble opinion.



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