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Med onc, med, surg, now in ICU!
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bethem specializes in Med onc, med, surg, now in ICU!.

RN in ICU transition program and loving it!

bethem's Latest Activity

  1. bethem

    Albumin administration rate and IV tubing

    In ICU we slam it in stat.
  2. bethem

    A/C vs. SIMV

    What do you guys (US) call what I know as Pressure Control Ventilation plus Assist? It's a Draeger mode on the Evita models. It delivers breaths at a set rate, with a pressure limit. The breath is delivered until the pressure limit is reached, therefore the tidal volumes can change from breath to breath. The 'assist' part of it allows the patient to spontaenously trigger breaths, which are then delivered according to the pressure limit set. You can control the Tinsp on this mode as well which I understand you can't on SIMV on the Draeger ventilators. So what is it called in the US?
  3. bethem

    Not taking 0xygen Saturation on patients...???

    I'm an ICU nurse, so the thought of not knowing my pt's SaO2 is downright scary! Of course there are signs of hypoxia which may be picked up in a good assessment, but why wouldn't you just pop a probe on a finger and make sure?
  4. bethem

    Bad room

    We've got 2 bad rooms out of 16 beds! Bad mojo in our unit.
  5. bethem

    Hypovolemic Shock

    We would fill first, then use a more alpha-adrenergic pressor like noradrenaline. Dopamine tends to be used as an addit to norad, and only when the norad is maxed out and still ineffective. The reason you would want vasoconstriction in hypovolemic shock is to ensure that blood is shunted to the vital organs - hang the peripheries, if it's lose a toe or your kidneys I'm going to save your kidneys.
  6. bethem

    Endotracheal tube securement

    We use cloth tapes tied in a particular way. There is some movement to get the EndoTrachead Attachment Device (ETAD) in our ICU which is an adhesive thing - like Comfeel with a zip tie on it.
  7. bethem

    Question about ICUs

    In my ICU (in Newcastle, not far from Sydney but more 'rural' even though we are a level 6 ICU), we do CRRT and the dialysis nurses do haemodialysis. Hope that helps.
  8. bethem

    night shift (7 on 7 off) 12 hour shifts

    That's what our docs do. They do three days and four nights, each 12 hours, then 7 off, then four days and three nights, then seven off, every month. I dunno, it seems to work for them. They don't make the nurses do that, though. I think 7 nights in a row is a killer, especially if you aren't a night person to begin with.
  9. bethem

    Intra-Abdominal Pressure Monitoring

    We do it when indicated; we have a set of criteria for indicating IAP monitoring. Every trauma gets it, some abdo surgeries and some other stuff that I can't remember - it doesn't happen all that often. I had a guy with a nasty intra-abdominal sepsis the other night, and the medicos declined IAP monitoring. I dunno, I'm still pretty new to ICU (6 months in). Anyway, we have our own jerry-rigged kits with a transducer, sterile tubing, a connector, 500mL NS, 50ml syringe, and a three-way tap. Sounds pretty similar to the one mentioned earlier. There are commercial kits available, but they are quite expensive, so we make our own.
  10. bethem

    Have you had this happen to you?

    It has happened to me; we use bite blocks to ensure the patient can't bite, and do qshift tape changes during which we reposition the tube and the pilot line. Good idea to check for snaggleteeth and other hazards to the tube though. If you have artery forceps handy, you can put a bit of gauze around the pilot line above the level of the leak (if it's not in the pt's mouth) and clamp it off until you can get a tube change.
  11. bethem

    Please help...got ICU interview and I'm sooooo nervous!

    This might sound weird, but... pretend, just during the interview, that you ARE confident. Imagine what a confident person would say and how they would act, and do that! It got me a job in ICU, despite my being cripplingly shy. I was asked a clinical scenario question (basically a patient with chest pain - what would you do?), and why I should be hired over other applicants, as it was a competitive position. I was also asked to demonstrate my committment to life-long learning and I was asked how I would deal with a situation I was unfamiliar with (I said look up the info in the policies and procedures manual and ask for help from a senior nurse). They also asked about my understanding of the area health service's 'values'. Bear in mind I'm in Australia, but I hope this helps. Good luck!
  12. bethem

    Consider going for MD?

    Is that that dodgy Oceania University thing in Samoa? Where you do your theory on line for the first year or something and then you organise your own clinicals? Yeah, they advertise in our Aussie journals too, but they say RN to MBBS (B Med/B Surg, as some of our unis have). Oceania University medical grads are not eligible for registration in Australia, at least. Sorry, I don't think there is any short cut to becoming an MD. If there were, I would take it in a heart beat!
  13. bethem

    What is your most memorable interaction with a Doctor

    My mum had a miscarriage between my brother (now 23) and my sister (now 20). She had two doctors seeing her in the ED. One was all concerned with the paperwork and the dispo. The second pulled a chair up to the bed, sat net to my mother and held her hand while she cried. Mum can't remember the doc's name, but after all those years she remembers how much it meant to her to have that doctor show compassion.
  14. bethem

    biased workplace!!

    I know some hospitals prefer new grads in ICUs because they haven't learnt any 'bad habits' yet, and can be moulded into the very model of a modern major ICU nurse. I personally think a bit of experience is a good thing prior to going in to ICU - but there are a million threads on this topic.
  15. A Cert IV in australia is actually a certificate 4 - the IV is roman numerals, not an abbreviation. Cert IVs come from our technical schools. Don't worry, IV meds are only given by nurses in Australia too! Good luck Matt, sounds like the working visa is the best way to go. I would take the traditional aussie route and be a bartender if I were you, unless you really, really want to do personal/home care stuff.
  16. bethem

    75 mcg Fentanyl patch a day early on lethargic patient?

    Why would it matter? Forgive me if I'm wrong, but I thought the point of fentanyl patches was to receive a continuous dose of fentanyl (in this case, 75mcg/hr) and that the patch contained enough fentanyl to provide this continuous dose for three days. It's not like they get a spike of fentanyl as soon as the new patch is applied - well, it shouldn't be, anyway. I amy have the wrong end of the stick completely here, but I don't think it would have mattered, as long as you (sing it with me here) took the old one off first. Anyone think anything different?