Atropine

[love-d-OR]

I had a patient who had a very low heart rate, between 37 and 45. Heart rate hung around the 40's most of the day. His blood pressure however, was about 160-190 systolic. We fixed the heart rate and blood pressure by the end of the shift, with a mix of HD, hydralazine, and enalapril. He was also on a versed drip for agitation, and it helped the BP.

Anyway, my question is when do you give atropine? I know it is given for low heart rate but how low is low? I thought my pt's heart rate warranted some atropine, but I was told to hold off if he maintained his blood pressure, which he did so I never got o give it. Does that mean that atropine should be given if the patient is symptomatic and his/her VS are deviating from the baseline? This patient was sedated and very unresponsive, would the BP be the only thing to guide me?

His HR really worried me, I did sternal rub a couple of times and it helped fix the HR for a little bit. One of the MD's suggested it may have somnething to do with cerebral edema (we went for CT scan, no results by end of shift. Pupils reactive). I was too busy to sit with him and pick his brains, anyone care to explain?

All answers are more than welcome, thank you in advance.

[love-d-OR]

Lifelongstudent, you say you are not bashing and I believe you. But to answer your question about why I do not know basic ICU nursing or why Cushing's triad was not covered in my nursing education, did I say it was not covered in nursing school? Unfortunately, I do not have a super memory and I do not remember everything, that's why I research, ask questions, and still study. And about me not having covered it in my training, I am still on orientation. Thanks for your concerns.

[lifeLONGstudent]

Still in orientation -- then that makes more sense. As your preceptor, I would have asked you to tell me what you know about Cushings... and we would have gone from there. Remember times like this when you are precepting the new ones in a few years....teach, teach, teach.

Double cuddos to you for looking it up after your shift. Strong work.

You are on the right track, doing the right things, asking the right questions and taking it upon yourself to look for the answers :-).

LifeLONGstudent

[suanna]

my thoughts:

...You mentioned cushings and that you found out this triad after you looked it up. I am not bashing you, but I think this is basic knowledge for any ICU nurse and should have been covered in your training (or at least school - I cannot imagine you never covered this in school). .....

I would have put on pacer pads -- just to get ready :-))

So, these are my thoughts. I work in a medical ICU (not cards, not neuro). Others with more specialty might have more insight.

I think you are doing a good job by looking up more info ... you are responsible for you now (no professors encouraging you to study). Take all the free classes you can. GET ACLS (press your manager) and they say no, get the books from AHA and start studying on your own. Buy some CCRN study materials -- that will help you alot (not for the exam, but for everyday when you work). Read about ALLLLL the drugs you are giving. Pick your peers brains and absorb all you can from rounds with your docs. These are some of the things that will make you a good nurse.

Happy learning,

LifeLONGstudent

I'm glad someone remembers "Cushing Triad" and other such from school. As a critical care nurse of 25 years experience at a 500 bed hospital, I bet if I asked 75 of our critical care nurses no more than 3 or 4 could pull that info out of their hat without getting on the web or pulling out their books- we just don't see it managed that often- it may be there but I don't see in the progress notes or on the problem list, nor have the docs-(who love to teach) ever shared thier insights about it. Admittedly I work CVSICU not neuro or medical ICU so my area is a bit different. Just though you would want to know just how "ahead of the curve" you are. I think you have pretty high expectations of nurses knowledge base and I applaud you for it, but as a rule, I think you have a better grasp of this than most of us than most. I'm jealous- now I have to look up "Cushings Triad"

[lifeLONGstudent]

suanna

#1 no need to me a smart a$$

#2 this is a MICU and SICU forum, not CVICU... so yes, Cushings IS (or should be) BASIC knowledge for any nurse in this type of unit.

#3. I work in a level I / teaching hospital. We have an excellent training program for nurses and docs (Parkland). I also do agency work in "smaller" (500 bed) hospitals which don't manage as high acuity patients. All this being said, it doesn't surprise me at all that YOU don't know what Cushings is (plus you work in CVICU)

#4 quit looking for a fight. Once he said he was still in orientation, I replied with a different view. Go back and reread. I commended him.

LifeLONGstudent