aCRNAhopeful

aCRNAhopeful specializes in CVICU.

Latest Activity

1. Fluid bolus by gravity or pump?

   aCRNAhopeful replied to delphine22's topic in MICU

   We are talking about different things. You are saying that if you give a medication through a central line it will reach its target tissue faster than if you had given that same medication via a PIV. No one would question that. The thread was about g...

2. Fluid bolus by gravity or pump?

   aCRNAhopeful replied to delphine22's topic in MICU

   I dont think anyone would deny that a central line is closer to the heart than a PIV but thats not the point. The most effective way to get volume into a patient fast is a large bore peripheral IV hung by gravity (or pressure bag). Hang the same bag ...

3. Fluid bolus by gravity or pump?

   aCRNAhopeful replied to delphine22's topic in MICU

   See Poiseuille's law in the post above. In other words you can increase flow rate by decreasing length of the catheter, increasing the pressure on the IV bag, decreasing viscosity of the fluid, and most of all increasing radius of the catheter (incre...

4. Cause of uneven pulse/ox wave form

   aCRNAhopeful replied to anon456's topic in PICU

   Not a PICU nurse but I had a couple thoughts. I am an anesthesia student with experience mostly in adult CVICU and now anesthesia FYI but I think the concept is relevant in pediatrics as well. I agree with the previous poster regarding the pulsus par...

5. Neo/Levo

   aCRNAhopeful replied to LNRN11's topic in CCU

   That's incredibly stupid. If you really insisted that the patients hemodynamics dictated both drips with overlapping mechanisms of action then why wouldn't you infuse both separately so you could tailor the ratio based on changes in the patients cond...

6. Triple Lumen Cath anatomy

   aCRNAhopeful replied to NurseCollins799's topic in CCU

   They are separate lumens each with their own size. The brown port is typically the largest and best for volume

7. Leaving Phenylephrine on with an Epi Drip?

   aCRNAhopeful replied to Dodongo's topic in CCU

   I agree but the point is you can still use neo with epi. It does work even if epi may have a stronger affinity for alpha1 receptors. So in my opinion it is reasonable in circumstances where you want more vascular tone without the increased myocardial...

8. Leaving Phenylephrine on with an Epi Drip?

   aCRNAhopeful replied to Dodongo's topic in CCU

   I wouldnt be so sure that everyone knows what receptors they work on... Yes there are situations where it is useful to have both drugs on. Unless the doses of epi were so high that they have saturated all the alpha 1 receptors then neo is still going...

9. Leaving Phenylephrine on with an Epi Drip?

   aCRNAhopeful replied to Dodongo's topic in CCU

   When i worked in CVICU it was not uncommon to have both going at once but not for the rationale you're stating. First of all even if epi and neo are structurally similar they are night and day different as far as pressors go. Epi is a powerful Beta1,...

10. Leveling art line to tragus for cpp???

    aCRNAhopeful replied to jimmy_hat's topic in Neuro

    I dont have any evidence to support the practice of leveling to the tragus but it makes sense. The perfusion pressure of any organ is going to be equal to the MAP minus the highest force opposing the map. In the brain it could be ICP or CVP if that i...

11. Stroke volume variance

    aCRNAhopeful replied to Lynda Lampert, RN's topic in MICU

    Regarding SVR - you have the basic idea but just remember you're not treating the actual SVR number. You're treating the hypotension or low cardiac output state or whatever. So yes if pt is hypotensive and has a low svr (sepsis for example) then a pr...

12. Stroke volume variance

    aCRNAhopeful replied to Lynda Lampert, RN's topic in MICU

    Other than the SVV they should want to know things like the CO/CI (or SV/SVI same concept) and the SVR/SVRI. Just like with a swan the goal being try to figure out how to fix a hemodynamic problem (fluids, pressors, inotropes). As far as which number...

13. CPR question

    aCRNAhopeful replied to Sand_Dollar's topic in CCU

    Thats because there isn't one. The patients brain is literally dying rapidly during a code so trying to limit the blood pressure and perfusion is just silly. I can see not being over the top aggressive with compressions but anything else doesnt make ...

14. Drips

    aCRNAhopeful replied to A_Simp's topic in CCU

    Your pharmacy probably has a policy as far as "max" doses for pressors which should give you an idea of what high doses are. The typical dose ranges are just memorization info you can find anywhere. There is no rule to know if it is too high or too l...

15. Drips

    aCRNAhopeful replied to A_Simp's topic in CCU

    if the infusion is running in mcg/kg/min you could multiply mcg by kg to get mcg/min. Not sure what that would do for you though? Some hospitals run certain gtts like epi, levo, or neo in mcg/kg/min and others do mcg/min. The therapeutic dose is the ...