bethem

In ICU we slam it in stat.

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?

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?

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

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.

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.

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.

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.

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.

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.

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!

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!

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.

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.

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.

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?

:yeah:Awesome! I read your other thread and I am so glad you've found something that suits. I am a little biased, but I love ICU too! I think ICU is 'think deep' vs ED, which seems to be 'think fast' (absolutey not my intent to offend anyone, and I have only worked a couple of shifts in ED when they were short). I'm so happy you're happy!

Is this a homework question? What are your thoughts about why you might not want to take blood from a peripheral IV? It's not that it is not possible, but it's not appropriate. Think about why the IV was inserted, what you are using it for and how that use may affect any blood/tests performed on the blood taken from an IV.

I hate the unpredicability of neuro injuries. I am totally inexperienced when it comes to neuro pts, but it seems that I can never tell which ones are going to get better and which ones we should never have tried to save. A patient I saw once was a teenage boy who was found semi-conscious in the bedroom; it was assumed that he had OD'd. In ED he had 3(!) VF arrests and 3 times got a return of output. He was found to have had a significant bleed near the cerebellum from a massive AVM which they could not coil. He's alive. He will have surgery some time soon to chop out a section of his cerebellum to make room for the AVM, reducing pressure on it. He has a 75% chance of surviving the surgery, and if he does, he'll be disabled. Aren't you glad we worked so hard to 'save' him?

Who needs to flirt with the docs (especially when they're looking rough at the end of their 7th day on in a row) whe you work with some hot male nurses like I do? And you know the nurses won't get called out of your bed in the middle of the night to go care for a patient!:chuckle:p

Wouldn't a NS neb be more comfortable and equally effective? It seems so counter-intuitive to stick water in someone's lungs on purpose. Especially if you don't then suck it out again.

I'll often duck in to the shops on my way to or from work with my scrubs on, but they're not as commonly worn in Australia so not many people recognise that I am a nurse. I like it that way.

If I get into nursing education, this would be the program I'd like to teach! I think the mix of clinical and theory is really important. In my B Nurs, we had no prac at all in the first semester (skills labs with dummies only), three weeks in second semester, four weeks in sem 1 and 2 in second year, 6 weeks sem 1 3rd year and all of sem 2 3rd year (but no theory this semester). The most I ever learnt was post-grad, when I was working full time and studying on line. I integrated my practise and my theory so much better, and it really made the theory stick. I love your uni!

Susanne is the poster you want, but in the meantime, you need to contact the nurses' registration board in the state your wife will want to work. In New South Wales, it's the Nurses and Midwives Board. You may also like to contact the Australian Nurses and Midwives Council. Good luck.

A little off topic, if someone is third-spacing, would the administration of an osmotic agent like mannitol or hypertonic saline help? I'm imagining that the osmotic solution in the intravascular space should draw some fluid back out of the tissues/extravascular spaces and then be excreted by the kidneys. Am I correct? Obviously this is not the first line treatment but I wonder if it would work.