Real World Med Math Problem

[Music in My Heart]

Often times, when "med math" is discussed, someone will pipe in with something along the lines of "well, the pharmacy actually does that... we just verify it," or "we use 'smart pumps.'"

Here's a real-world example from yesterday...

Ambulance delivers a patient who'd taken a header from the third floor balcony... obvious severe head trauma...

The patient gets intubated and needs to go to the scanner STAT. He's just starting to brady down a bit, "Bolus him 75 grams of mannitol and get him to the scanner now."

Our pyxis holds mannitol available as 20% mannitol in 250 mL of D5W.

What do I do?

++++

Think about and I'll post the answer in a bit...

I hope ♪♫ in my ♥ doesn't mind me jumping in....

I don't... I. Glad... I've been very busy over last couple days and haven't had time to keep up. Going to bed soon and will chime in in a few hours.

So, a few other thoughts..

1) As stated, no sedation so that we could monitor the patient's LOC... no longer using GCS because, as noted, pt can't talk. Instead assessing whether the patient is responding to commands.

Initially we avoid sedation for a very practical reason... waiting for the neurosurgeon to assess the non-sedated patient.

Now, given the TBI, we don't want the patient to awaken, start bucking the vent, and thrashing... Fentanyl and versed PRN to help them relax.

After neurosurg assessed, started on a propofol drip... keeps them sedate but has a very short half-life so you can continue to assess them.

2) Other STAT medications: Keppra loading for seizure prophylaxis and tranexamic acid to help prevent hemorrhagic shock

3) Neurosurgery placed and EVD (external ventricular drain) to both monitor and relieve ICP.

Patient was whisked off to the ICU and I went to help wrassle a drunk... It's an ED life :-)

[smf0903]

I'll check out those meds, some I haven't run across yet. Thank you so much for posting this, it really was interesting! I spent some time yesterday reading over TBIs in our text, but you experienced nurses give SO much more information than the book covers.

I'll check out those meds, some I haven't run across yet. Thank you so much for posting this, it really was interesting! I spent some time yesterday reading over TBIs in our text, but you experienced nurses give SO much more information than the book covers.

And in response to your "I'm hogging the thread," why do you think Esme and I are doing this...

Because YOU are responding...

Personally, I'm here for the *interaction*, not just to lay stuff out there... otherwise, I'd just make a website...

[Esme12, ASN, BSN, RN]

School is the basics...believe it or not...just the basics. The rest you get later.

[Esme12, ASN, BSN, RN]

And in response to your "I'm hogging the thread," why do you think Esme and I are doing this...

Because YOU are responding...

Personally, I'm here for the *interaction*, not just to lay stuff out there... otherwise, I'd just make a website...

I love "talking" with the students. I love sharing how to start thinking. I love when they have the "Oh I get it!" moment!

[smf0903]

And in response to your "I'm hogging the thread," why do you think Esme and I are doing this...

Because YOU are responding...

Personally, I'm here for the *interaction*, not just to lay stuff out there... otherwise, I'd just make a website...

Well, I guess I shouldn't apologize, but I am a question asker, and I'm one of those people who doesn't like to know the basics, I like to get all the nitty-gritty. I get a lot of eye rolling in lecture, even though I don't ask my questions during lecture but rather I reserve them for our breaks or after class. I can't tell you how many times I've heard "Ugh, we don't have to know that for the TEST so who cares"...seriously. I think one of the reasons I love nursing school and will love nursing is that you're NEVER done learning. And while I could give a hoot at the eyerolling, it does make me wonder why some people just scrape by and are not curious to learn more. I don't know, maybe I'm just weird LOL Anyhow, I think you all rock for sharing your experience with us :)

[kiszi, RN]

You're not weird, but in defense of the eye-rollers, it may be that they are too overwhelmed with all of the information they already have to learn to be concerned about digging deeper. Some people don't develop that inquisitiveness until starting that first job and seeing some of those real world situations. Then the lightbulb goes off and they're like that's why it was so important to study that! So you are just well ahead of the curve!

Of course, there are some who never want to learn more than the minimum. Too bad for them.

Don't ever stop asking questions! Lord knows I haven't.

[4Pack]

Oops. I can see the question has been answered. My mobile device wasn't displaying the threads correctly.