Got told our/ any neuro ICU is not really an intensive care unit

[labman]

Today I had a patient who has a previous MVA post 13 days from a different hospital for neuro declines and further exam from following commands to a GCS of 5, neuo exam L pupil fixed and dilated not reactive R pupil, no corneals, would flicker upper extremities to pain, lower left would flex toe to pain and right quad to pain, had many facial fractures which included a mandible which is floating, occipital bone fx, temporal and spenoid fx to name a few. Bilateral upper arm blood clots and that is it (no other history and his injuries was limited to his head). So the docs wanted to do a stat CT scan with perfusion to check for blood vessel abnormalities, hospital transport and we had no CNAs. So the charge nurse calls SOS which I had an issue with but different story different day.

Which the whole time this SOS nurse tells me that this patient should have been in the trauma patient because the nurses are better down there (which I guess whatever) he goes you neuro people are good with brains and that is not that critical (just rolled my eyes) and said you guys aren't ICU nurses because you don't take care of septic patients and multiorgan failure. Kind of made me mad.

What do you guys think of this?? Do your ICUs have this relationship where one thinks they are better then the other???

kent

[MalNurs]

I can understa when other nurses say that their patients are more "critical" Because they usually have more drips etc. but they can usually see when their patient is starting to take a turn for the worse. a Head can be perfect one minute during your assessment then 10 seconds later they are herniating. I always challenge someone with the response "well when a patients brain herniates everything else turns off. not just one organ...everything."

[aeauooo]

...the whole time this SOS nurse tells me that this patient should have been in the trauma patient because the nurses are better down there...

What the heck does 'SOS' stand for? Sack of sh**?

I've worked in hospitals where the trauma docs wanted thier patients in the neuro ICU because the nurses had better skills.

[joeyzstj, LPN]

I think we (neuro folks) face the same predjudices. First, ignorance of how extensive neuro care really is and then organ priority. This seems to be especially a problem between brain vs heart. So answer this question. Whats the waiting list for a brain transplant vs other organ transplant?

Think about the need for a specific knowledge base when considering the statement that you just made. The brain is a very important organ.......argueably the most vital in terms of keeping the body alive. I made a comment in another section of this site in regard to CRNA school. I have worked in both units and although the body is screwed without proper brain function, the comments that I keep reading prove my point. When the brain is sick, you have the option of a handful of drugs and surgical procedures as well as recognizing neurogenic shock. I think the reason that a lot of school prefer CVICU experience is due to the fact of all the varying conditions that you need to know how to treat. A sick heart, a dying heart, a newly transplanted heart, all the electrolyte abnormalities that go along with different heart conditions, the equipment that goes along with a good/bad/sick/dying/transplanted........adult/male/female/infant. The fact that a variety of different hearts can be transplanted, placed on various machines (RVAD, LVAD, BIVAD, IABP, Artificial Heart, ECMO, external/internal pacing, ect) means that knowledge base to properly care for a heart is huge. Not too mention the need to identify and treat a wide array of rhythms that can possibly be caused from other organs. SO, the statement of Whats the waiting list for a brain transplant vs other organ transplant? in my opinion shows that you either fix the brain or you dont. With the heart its not quite as cut and dry and "just transplant it" that fixes everything. I worked in neuro for 8 years and I definately have respect for unique circumstances that arise, however I have never felt like I need to be on my toes a majority of the time as I have being in CVICU. To each his own I guess.

[Beentheredonethat]

I did hearts and transplants as well. I have had many "neuro" cases who also developed comorbidities that lead to multiple system failures and the need for internal and external support. An advantage to hearts is the technology and the ability to measure what is going wrong and hardwire it so to speak. Buisy you bet, complex sure but frankly I left hearts because most of the cases are straight foreward and it was the same old drill. Only when you had a disaster case did you revert to even a few of your listed equipment. I think we both know that you don't use rvad, lvad, bivad, iabp, art hearts, ecmo and the old standards of pacing on each case.

The bottom line and the point of my message is that we should always respect the knowledge base of another discipline rather than degrade it when compared to "our" own. Bottom line... respect lasts longer than technology.

[joeyzstj, LPN]

The bottom line and the point of my message is that we should always respect the knowledge base of another discipline rather than degrade it when compared to "our" own. Bottom line... respect lasts longer than technology.

I do agree with that

[NatalieA]

Each are has its challenges, but I do agree that CV stuff requires a certain independence and knowledge base that you dont see in other units that often

[shocker29]

I know no one has posted on this one in awhile, but I have to say, who ever said that neuro ICU's aren't real ICU's are nuts! I work in a coronary care/medical intensive care unit. Our other unit is a surgical intensive care unit, but we get neuro patients (every once in awhile with ventrics) on our side.

I love coronary care ... the patients heart stops, you code em! Septic? If it gets really bad, you code em'! Neuro.. the pt starts to herniate their brainstem.... sure you can code em, but it won't fix the problem... you're SOL! Worst night I have ever worked by far was the night that I had a patient with brain abcesses almost herniate their brainstem. That was tough stuff! Kudos to neuro ICU nurses! (They are trying to turn our hospital into a neuro center of excellence, so I guess our unit will have to get used to it...)

[wanderlust99]

What a b----! The only reason people say that is because often times, the neuro patients end up staying in the Neuro ICU for longer periods of times than say a SICU or Trauma pt would. You often hear if they can talk & walk...they don't belong in the ICU. Well, in Neuro it's different. They actually do belong in the ICU because we have to do neuro checks q1hr and many still have EVDs in. So unfortunately, in my experience, sometimes I would get a really sick pt or other times I would get 2 "step down" type pts. That was my only issue in working Neuro. Also, a lot of post op cranis, just there to observe overnight & do q1 checks then send them out to the floor the next day. I prefer to work in Trauma or a busy unit with "real" sick patients. We generally don't have to deal with the step down type patients.

But...also, remember that if you've worked neuro then you have an amazing skill. I work with some great nurses & am still shocked at some of the stupid things they say about neuro patients! clueless. I'm so happy I had neuro experience...but am happy to have moved on.

But we all know how to take care of that very very sick neuro pt you described...and we know well.

[GrnHonu08]

are you kidding??/ When is a patient ONLY neuro?? bc brain injured patients NEVER have anything else wrong with them. (rolling eyes). The minute a pt becomes neuro-even if they are primarily trauma they come straight to the neuro ICU...hmmmm...you should tell your friend specialties are more criticial than general ICUs bc we not only take basic patients (medical/trauma) and add neuro on top of that. The long and short of it we can do everthing trauma can do plus specialize in neuro. Your friend can only do trauma..boo.

[I_LOVE_TRAUMA, RN]

Really? Cause I think it varies greatly by facility. I work at a large level 1 trauma ICU. Our trauma ICU is considered the most specialized place in the hospital, where the sickest heads go. The docs will only send our heads to the neuro ICU once they feel they are stable enough to leave the trauma ICU. Our nurses in the trauma ICU are much more qualified and specialized than our neuro ICU. We even have a few neuro guys who send there heads to the trauma step-down unit and bypass the neuro ICU altogether because they like that floor better.

It just depends on the hospital. I think the above are blanket statements and do not make you sound very knowledgable.

[focker2006]

The nurse who said that needs a Neuro check, as her brain truly isn't functioning properly if she believes that! We have some of the sickest patients around....there is one maybe two words that describe her statement....jealously...or...ignorance. (Possibly both) Either way, embrace and enjoy our specialty, we truly making a difference in peoples lives when they have no control over their own. Although not all look at the big picture, you can rest assured she is in many instances the minority.

[GucciRN22]

a lot of the nurses in my icu have that opinion of the trauma neuro icu nurses and i don't know why. i guess they assume that people are always in the prime of life with no other problems when they get into accidents, etc and that their issues are more easily fixed.

i don't buy that for a second cause from where i see it, there's a huge difference between what they do and what we do (most of the time--when we're not sharing pts via overflow rules, etc). i've never cared much for neuro stuff and i don't know if it's cause i'm not comfortable with it or because i don't like it, but that's the way it is. i mean, i don't know how to do icp monitoring and stuff, but i'm glad there's a unit that specializes in that at our facility!

i hate it when the floors badmouth each other cause it's bad for the teamwork aspect of the job. i've floated up to the trauma unit before and i like it cause they typically give us the easiest patients (i heard one of the icu nurses a long time ago accidentally hooked up a ventriculostomy to suction and they've never viewed us the same way since!!) and i got to learn about more of the stuff they do up there.