NewHam CRNA

NewHam CRNA

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About NewHam CRNA

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  1. Meperidine (Demerol) or Morphine for pancreatitis patients?

    Equal analgesic doses of fentanyl, morphine, meperidine, and pentazocine increase common bile duct pressure 99%, 53%, 61%, and 15% above predrug levels, respectively. Hydromorphone is similar to morphine in that regard. That's distinct from an actual...
  2. Freezing During Critical Situations

    What are some examples of times you have frozen up? I think ACLS is every ICU nurses best friend. It's one thing to be certified, it's another thing to be confident with it. Then you have a starting point for action in any situation. Even if you don'...
  3. Reoccurring code nightmare

    I've had this happen to me a couple times. It's seriously spooky. And you were clearly right to continue compressions. Patients in comas, if you open their eyes, will sometimes follow your finger with their eyes if you move it side to side right abov...
  4. ECMO: Most Advanced ICU Technology?

    BIS monitors are neat. Not wildly advanced tech but it's something you might use in the ICU when you paralyze a patient. They're not perfect by any means - and most people who regularly read EEGs think they're nonsense. But i think the future of this...
  5. Ethical Issues

    All the above posters offered insightful comments. I'd just add that if a patient is actively dying, it is nice to have morphine you can give that frequently to keep the patient comfortable and prevent "air hunger" or cheyne-stokes breathing. Idk if ...
  6. Student...I have a question about EKG's

    So a few thoughts: Some of the infarcted area will recover because of collaterals. The necrotic myocardium is cleared, fibrous tissue/collagen is deposited and scarring is complete within about 7 weeks. So the ECG will evolve over this time. If there...
  7. I survived my first week in ICU!

    Woot woot! Congrats! Keep learning!
  8. Which unit is more manageable for a newbie: MICU or SICU?

    I've worked both MICU and SICU at a few different hospitals. I think MICU is a better ICU to start in. No doubt it's challenging, and there's no reliable way to know which patients will be sicker in which unit - all depends on the hospital. That said...
  9. Anesthesia for CPR

    Only a few times have I seen patients have a return of consciousness during CPR without ROSC. First of all, pat yourself on the back for doing damn good CPR. Second, it's almost always in patients who have very low EFs who arrest. Ketamine makes sen...
  10. Vasoactive medication help

    This is a very good, and very tricky question. I'm going to give some scattered thoughts: In undifferentiated cariogenic shock, norepi has been found to be an OK choice until the the cardiac process is identified. A few questions first - did the pat...
  11. Myoclonus From Sedation

    A number of sedatives/anesthetics cause myoclonus that appear similar to tonic-clonic seizures but are distinct from them on EEG: Propofol, etomidate, barbiturates (not used in US). It tends to happen with small doses of these drugs, but can be seen ...
  12. Feeling Incompetent

    Keep your chin up! That's exactly how your ought to feel at this point. Honestly you'll be constantly doubling-back because you forgot supplies for 6+ mo after you graduate and get a job and that's TOTALLY OKAY! Advice: 1) Make lists...as intense as ...
  13. Accidental migration of PICC line (1-1.5cm)...

    Definitely check out hospital policy because that's what'll get ya. That said, If you needed the line is should be perfectly fine to use. Maybe have some caution with things like vasopressors. As long as you resecure it, a picc line thats out even se...
  14. Bicarbonate HC03 - As High as 43?

    Some scattered thoughts: I agree with everyones comments - your patient's kidneys were properly compensating for the prolonged respiratory acidosis (CO2 retention), and that number alone isn't terribly worrisome given the clinical situation. You're r...