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Adult and pediatric emergency and critical care
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PeakRN specializes in Adult and pediatric emergency and critical care.

PeakRN's Latest Activity

  1. PeakRN

    Blood pressure in peds patients

    Just for perspective I have found essential hypertension in otherwise healthy 2 and 3 year olds several times in the ED. While the ED is not the kid's primary care, that may be the only medical provider they see for months or years. These kids could easily end up with long term kidney disease if they weren't completely evaluated during their visit.
  2. When we hire in my center we typically favor critical care over floor pediatric experience. Unfortunately adult med/surg is unlikely to give you either experience, but you also have to start with the job you can get. If you are willing to relocate there are often programs where you can start as a new grad in a large ICU.
  3. The ICU book. The Ventilator book.
  4. PeakRN

    What is your "favorite" procedure?

    Reducing dislocations. Instantaneous gratification.
  5. PeakRN

    Coping with death and bad outcomes

    I'm fortunate to have the perspective of having worked with adults and peds in EDs and the units. Life is unpredictable, it isn't fair, and not everyone gets dealt a good hand. I've had plenty of kids with poor outcomes from heart disease, the flu, and just about every other thing possible. It exists in adults too. It exists in the EDs, adult ICUs, NICUs, floors, and so on. I think that in order to survive critical care you have to come to terms that a lot of patients are going to have poor outcomes, and be able to not take it home. We are able to recover many more patients, and give lifetimes back to so many of our kids and their families. Over the years I've worked with a lot of nurses who don't ever really handle the stress well, and ended up leaving the units or EDs. It isn't natural to see death and suffering like we do everyday, and they found that another care environment ended up being much better for them. If you do choose to leave the PICU don't think of it as a failure or weakness.
  6. PeakRN

    Scab nursing?

    I think that it's just part of the business for hospitals that have unions. There is probably variation based on union contracts and state laws, but if your union has the right to strike then is it egregious that the hospital has the right to hire temporary workers? That's kind of the point though, you hope that you are valuable enough that the hospital will take you seriously and the you use that as negotiation leverage. But if the ask is too great or the value compared to temps isn't worth it then it is up to the hospital to decide whether to keep or fire the union nurses.
  7. PeakRN

    CCRN question

    Research before intervention.
  8. PeakRN

    Advice for a future Trauma ICU student nurse :)

    Do you have TNCC and ATCN?
  9. PeakRN

    Esophageal Intubation

    Ask you quality department, I'm sure they have plenty.
  10. PeakRN

    ICU or IMU telemetry?

    I did the hour commute (a decent bit more than an hour actually) for almost two years. It wasn't fun but it can be done. Some HCA hospitals have a very poor reputation, some have a good reputation. Magnet status does not guarantee a good manager or a good learning environment. Also several HCA hospitals have magnet status. It's really hard to give good advice without knowing specifics of the who hospitals. A couple of things I would recommend thinking about. Which hospital provides a better learning experience for new grads. How easy is it to transfer to the ICU from the PCU unit. Who's hospital actually sees sick patients in their ICU, especially cardiac and sick fresh post ops?
  11. PeakRN

    TCRN Certification Study Materials

    The society of trauma nurses has a study guide.
  12. PeakRN

    Any 22 weekers out there?

    Because the expectation of parents and family are just that. They aren't going above or beyond, but rather to not be present is to do less. When you become a parent the bar is set at the top. This isn't to say that the family doesn't have a hard go at it, but that is part of having a kid. Also you're the one who referred to "miracle baby stories."
  13. PeakRN

    Any 22 weekers out there?

    The hard thing about premies is that their NICU course may have little to do with their eventual outcomes. I have taken care of 23 weekers that code 5+ times and make it out without any serious deficits. I've taken care of 'healthy' 32 weekers who end up neurologically devastated. Recently I got to take care of a preschool aged ex 22 weeker who came in for an injury after playing. Neuro intact, no respiratory disease, no eye problems. If we hadn't always had a birth history I wouldn't have guessed he was a NICU kid, let alone a kid who was born under 500 grams. The record holder for our lowest birthweight kid is thriving and doing great. The assumption that premies are universally going to have poor outcomes or full term kids will all do well is incredibly flawed. And regardless we should always have compassion for our patients and their families.
  14. Know your limits, know your emergency drugs and procedures, learn when to say no. Take advantage of every learning opportunity. Don't be afraid to ask questions. Don't be afraid to talk to the Docs. Don't get abused, but don't immediately withdraw from the harsh advise of the old-timers.
  15. PeakRN

    Pediatric CVICU experience, can I travel to NICU?

    Another thing to consider is the massive difference in independence in between the NICU and PICUs, even if the latter cares for preemies. We will take premies as long as they present with serious congenital heart disease, but our management is very different than in the NICU. In the NICU small details are held with more importance than in the PICU, which often means that you have to talk to the NNP or Neonatologist before something so minor as even starting a new IV. Whereas in the PICU nurses have a lot of independence. We have very extensive standing orders and may have replaced several different electrolytes, transfused multiple products, titrated or started multiple pressors, and even runt the first several minutes of a code without a provider. More than just a matter of skill, the NICU and PICU have very different nursing personalities. Not only would I think about whether you could do NICU, but also consider if it is even something you want to do.
  16. PeakRN

    Medfusion pump question

    It depends on how biomed/pharmacy set up the pump. Typically they will have 'normal' doses given the weight of the patient.

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