berry

YES you are willfully careless when you take a drug and inject it into another human being with out taking the 30 seconds to verify it is the right drug/dose/ ect. It is a decision that is made each and every time you medicate someone.

Most of the "reasons" listed so far are not reasons, but excuses "too busy/many/much". The reason every med error is made is carelessness. Not just on the part of the RN but and the whole system. from the physician who scribbles something to the RN and pharmacist who guess at what it is to the pharm tech who places the wrong med in the wrong drawer to the RN who gives the wrong med/dose at the wrong time to the wrong patient Each of these breakdowns in the system probably occurs in every hospital everyday and careless or lack of attention to detail is the main contributing factor

I am not sure what he meant to say, but I am just emphasizing that it is not or even close to a conscious sedation drug. There is no need for 1:1 watching the only need is for the patient to be intubated, because they are paralyzed it is not a drug you give and then watch them closely ie 1:1 until it wears off.

paralytics are not conscious sedation drugs.

I hope it is being used in an intubating situation or for paralysis of an intubated pt. Nimbex is a nondepolarizing skeletal muscle relaxant. It should only be given to a patient with someone present skilled in airway management. An intubating dose in adults is .2 mg/kg the time to peak is 5 minutes with a duration of 60 minutes. One advantage it has over other nondepolarizing muscle relaxants is the fact its elimination is independent of renal or hepatic function.

I am currently a sr at camc feel free to send any questions b

I would grab a 250 cc bag of NS pull out 100 cc put a amp of Ca gluconate the amp of bicarb the insulin and the D50 in it and put it on a minidripper and let it go. Some sources will say that Ca++ and Bicarb will precipitate in the same line but I have never seen it. (2 hospitals I worked at mixed it this way when a K lowering cocktail was ordered) then give the Lasix then the kayexalate PO. The kayexalate while messy and not fun to give also is more of a long term thing the drug mix will lower the pts K+

To hell with her.... First off grab a crash cart, I assume that almost anything she could want should be in it(a personal pet peeve of mine people running for stuff we stock in a crash cart just for the explict purpose that you have it on hand when you need it and dont have to look for it). Second any good ER RN should be able to think on their feet so It is sad if a whole team of people sat waiting for you to retrieve a clip instead of starting the iv without one and giving the needed meds. I would guess you preceptor lacks confidence in her abil;)ity and feels better by making you and others feel like an idiot. Keep your head up

As far as painful sticks, try numbing the site with lidocaine just like an Iv start. If you are not starting them offer this up for whoever is. There is no reason for patients to just deal with the pain of being stuck. This is a position I have done a 180 degree turn on since I started using lido for IV starts. You can place a 14 gauge in somebody and they never even stop talking. Same thing with aline sticks they dont even wince. just my $.02

My guess is while she may expect some special treatment alot of the "special care" is the idea of the hospital admin. I remember one pt I had old money lawyer,his wife a docter. We rolled out the red carpet. I had him 1:1 for a couple of nights, hell i sat and watched basketball with him, he thought everybody got this kind of care was kinda suprised when i told him nah he was just specal.

WOW what a contradiction first off you can not handle any airway all the time and that cowboy mentality is why an incredible number of ERs have an open lawsuit at any given time (not related to propofol but by decision made by mds and rns who feel they are the on top of everything). The first step that should be made to preserve you and your patients safety is to not induce general anesthesia outside the OR this can become a very slippery slope when using propofol especially in combination with benzos and narcotics. Moderate sedation/analgesia ("conscious sedation") is defined as: A drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. When you cross over into deep sedation or general anesthesia and you begin to have respiratory and cardiovascular problems. You don't have what you need at hand to fix problems most (none that I have used) crash carts don't have neosynephrine or ephedrine to deal with hypotension (common problem with propofol). While I in no way want to demean your or any other paramedics airway skills you are in NO way the airway expert. As a srna over the last 2 years I would bet dollars to dimes I have intubated more patients than you have in the last 5-10 years. I am the one at the head of the bed (with back up crna or ologist) when the trauma code runs in not the ER doc. Paramedics maybe intubated on average .5-1 patients a month you may personally do more but many go 1-2 months without intubating a patient while anesthesia providers may intubate 3-5 patients every day in the OR even so you will still not find the lack of respect in regards to being able to handle every airway. The bottom line is it is you patients life on the line and your license. As of today the manufactures of propofol sell it as a drug for Induction of general anesthesia in adult patients and pediatric patients > 3 years of age Maintenance of general anesthesia in adult patients and pediatric patients >2 months of age Intensive Care Unit(ICU) Sedation for intubated, mechanically ventilated adults.

The reason anesthesia pays more. You talk in terms of resuscitating somebody's kid. I talk about taking a healthy living breathing child and rendering them unconscious and insensible while using airways, tubes and mechanical ventilators to breathe for the patient, and maintain hemodynamics with IV fluids, drugs, and other interventions.

Hypoxic pulmonary vasoconstriction(HPV) is a physiological response in which pulmonary arteries constrict in the presence of hypoxia without hypercapnia. This leads to redirecting blood flow to alveoli with higher oxygen tension. If a patient is on drugs that vasodilate HPV is blunted meaning hypoxic alveoli have increased perfusion.

When pts are coughing or bucking the vent the most likely cause for the alarm is increased airway pressures. When you are suctioning most likely alarm is for disconnect, if not using an inline suction cath, if you are then it could be several different things but most likely you are making them cough and increase airway pressures is the reason

Not sure if this is, what you are talking about but it is a rule about abgs and has an 8 in it. I always heard it as the golden rule. It is used to calculate if the patient's deviation from normal ph can all be accounted for by ventilation of if other problems are involved. The Golden Rule states that for every 10 units of CO2 above normal, the pH should inversely change by 0.08 (0.08 is called the conversion factor) Example: If the patient has an arterial PaCO2 of 58, you would have to establish how many units of 10 it is over normal (Normal is 40). If you subtract 40 from 58 you will have 18 units difference. Remember, however, that you want units of ten. 18 divided by 10 is 1.8 (The 1.8 is the units of ten away from normal) 1.8 times 0.08 = 0.144 (The 0.144 is called the conversion number and represents the amount of change we would expect the addition of these volitile acids should change the pH) Because the increased CO2 inversly affects the pH we need to subtract this conversion from the normal pH (Normal pH being 7.4000) 7.4 minus 0.144 = 7.256 (The 7.256 is the Calculated pH) and needs to be compared to the Actual or Measured pH to complete the interpretation. When you compare these numbers and find the measured pH lower (more acid) then we know there must be other acids dragging the pH down besides the respiratory acid. These acids have to be metabolic acids like lactic and pyruvic acid. If the measured pH is better than the calculated value, there is compensation probably by the renal system. If the calculated and measured pH are fairly close, you have a pure respiratory acidosis.

I think everybody has to have 550-600 case some schools may require more, but the accrediting body requires either 550 or 600. They also require (x) number of regionals, hearts,. lungs, cranies, ob management, macs and so on.

The ER cause burnout out very quickly most rns after 2-3 years of working a busy ER are usually angry and resentful about most of the pts the see. It is hard to see that never ending stream of drug seekers, criminals, idiots(drunks cleaning gun and forgot to unload it, parents leaving a toddler alone in the house with stuff boiling on the stove the 80% burn pts who blow up his meth lab) and the people who confuse hotels and hospitals. I left the ER to get my ICU exp for crna school but I continued to work 5-10 shifts a month in the ER. I never realized how burnout I was until I left. Recovering hearts allowed me to take care of sick patients who for the most part appreciated nursing care. It was almost a daily event for a patient's family to bring in food for the staff to try and thank you for helping out their family member. I lost my negativity with the change and when I would go back and pick up extra shifts, I enjoyed the ER more than I had in a while.

Join Date: 06-19-2007 PostsTotal Posts: 1 (1 posts per day) lets see a crna for 5 years makes her first post on a crna board praising the mighty ologist and proclaiming how little she and other crnas know.

TO the original poster did you interview and take the job. I worked in both the ER and SICU and had a good experience with the hospital, good working conditions, and steady raises. I took many classes on the clock ACLS, PALS, IABP. We had liberal protocols in both the ER and SI allowing a great deal of autonomy. I say this as a current SRNA with the opportunity to compare it with other classmate’s experiences from several different areas of the county. I would also not like to sign a contract that says I am penalized for leaving (Air Force sticking me in North Dakota for 3 years soured me on contracts). I think the rational is to try to keep staff in place. My unit (SI) had seven people accepted into CRNA School in 06 and 1 left for PA school and one that finished NP degree and left for a new job. MICU had two leave for school, CCU had 1-2, and NICU had at least one. This staff turnover is beyond their control and unrelated to working conditions. Just my $ .02

10 mls is placing way too much pressure most people will seal with 4-6 ml of air. Tracheal necrosis and stenosis may result from inflation of endotracheal tube cuffs (ETTc) to pressures >15-25 cm H2O, at which capillary perfusion pressure is exceeded

In controlled trials automatic NIBPMs perform constantly more accurate then manual auscultation. I will add this involves proper size and placement of cuff. If you have frequent errors (everybody's pressure is up or down) it is far more likely operator error than machine

As a former ER rn I say go big or go home lol seriously you will never hear anybody say man I wish they had a smaller IV. I remember a new nurse who was orienting with me giving me grief over putting a 16 in a little old confused lady. It turns out she had a bleed we had to push lots of drugs and she went to the OR. You never know who may code, go to the OR or just need volume quickly so why not put in something useful. A previous poster mentioned I have found with using lido it doesn’t matter if you use a 22 or a 14.

You could run the Insulin into the tpn..

You dont let people stay hypoxic. If it means cranking up the O2 then so be it you dont have to get a sat of 100% but 90-92% is a better place. If it means putting you patient on a 100% O2 thats what you do although this is a short term fix,

If you can palpate a vein, it is not central. If you have to use blind stick based on landmarks it is central kind of the rule I go by. When I worked in the ER we could stick EJs (Alabama BON scope of practice allows if you have had instruction and has a length limit if I remember correctly) later hospital policy was changed and RN were no longer allowed to stick EJs. Just my 2 cents