Matthew89

Thank you for everyone's reply. Appreciate all the input and shared knowledge. For that patient all electrolytes were normal k, mag, phos. 2L bolus and bicarb was being given assuming it was acedemia. In terms of hx patient was not compliant so that is the only hx I have. He was originally in afib. But then he would have ventricular tachyarrythmias. Wide complex and were regular. That's what I was wondering half a bag of amio was infusing but the provider wanted to cardiovert. The VS was stable. HR did go up to 160s but maintained at 140s. No adenosine was given. I was wondering if amio should have been given and if he did not convert how long do we wait. And what other meds. Should Adenosine been given after amio bolus? Was not sure. Pt was cardioverted and became pale. I don't know if he went to cardiogenic shock. Liver enzymes doubled. Pt eventually decompensated. Had a cardiologist read the EKG. He did say VTach.

Sorry, Hx of afib newly diagnosed, DM, EF 50%, I forgot most of the HX. Admitted for DKA. Ph 7.1 and lactic 9. Normal WBC. No open wounds. Nothing on XR. Provider only gave half of amio. Pt a and o x3, asymptomatic, VS stable. Shocked pt converted to NSR at 60s. Thank you so much for the reply. HR was only in the 140s. Occasionally would go up to 160s.

Hello, Here for learning. I have a question can we shock stable Vtach with a HR 140s to 160s? SBP 113/60s, alert and oriented, no chest pain. Asymptomatic. Amio bolus was not even finished was only half way through. Decision was made to shock at 100J. He turned pale, hypotensive and rapidly decompensated. Not sure what the right decision was. Asking for medical advice. TY

Hello! Has anyone ever seen a dark brown JP drain output? It was serousanguinous for a couple days and not its dark brown. My patient has two. One one became dark brown like chocolate syrup and then overnight the other one became dark brown but then cleared up to serous. I asked the surgeon. He said he is confused about it. Patient had SP appendectomy. Im not sure but I kinda feel this is urgent but the doc said he wants to wait a couple of days and reassess.

Hello! So working in a hospital outside the US. Practices are different but I would assume medical treatment would kind of be the same? Have a patient with increasing D-dimer. Asked doctor what needs to be done. He said patient is already on lovenox. Is that all that we should do?

I appreciate your response. Thank you also for the literature and the imparted knowledge. I'm new to this and want to learn. I was just worried because the ascites was there for a year and they are currently treating with IV abx - Zosyn. I didn't want my patient to become septic. It's difficult without much notes or doctors explaining since we work in a small hospital. But I thank everyone for answering my questions. Everyone is very knowledgeable. Will read up on the literature. Thank you. ❤️

Wow you're are very smart. I tried researching for a rationale but it always leads me to liver cirrhosis. So if ascites is present and they suspect peritonitis, they don't have to drain it? I was just afraid that my patient would deteriorate if they didn't culture or drain it. Patient said ascites has been there for a year. Tried albumin and dialysis with no success. There was not really any notes that I could read so I was not sure.

Thank you for all the responses. So all ascites needs to be drained? I don't understand the doctor. Why they won't drain especially if they think there is peritonitis. I'm not sure if this is something new or if anyone has an idea about this. I'm afraid that a bad infection will happen.

Have you ever heard this? The doctor doesn't want to drain massive ascites with possible peritonitis. Because they are afraid of recurring drainage and risk for infection. It was ascites from low albumin. Ckd patient.

Hello! Just wanted to ask anyone who is familiar with ascitis? The patient has massive ascites per CT scan. But the doc doesn't want to drain because she said once you tap you have to continuously tap the patient which might expose them to infection. But my question is the pt is abdominally breathing and another MD thinks its peritonitis. Does peritonitis have to be drained?

Thank you for the reply! ? It confused me if I was wrong. The patients PCO2 was trending down from 110 to 90s. But the patients mental status was not improving but further deteriorating. I asked the doc if the ammonia level could affect it. Rather than focusing on PCO2 thats trending down. He told me ammonia level would only affect the mental status and not respiration. I understand but would being obtunded on bipap shouldn't airway protection be considered? And he had had already aspirated three times. Hence the rapid. He was desaturating on the floor. When is intubation considered? RT kept on saying he was sating 100. I felt like a criminal who just wanted to intubate someone. ? That's why I wonder if I was wrong. And if elevated ammonia levels does play a part for the patient being obtunded aside from PCO2. And when is airway protection considered.

Hello everyone! New nurse here. I had a question and wanted to know your opinions. Working in ICU. Had a patient that was a rapid. Ammonia level was 293, lethargic, PCO2 101. Came in to our unit lethargic of course A&O x1, GCS 12 at the time. Placed on bipap gave lactulose. But in 4 hours patient GCS declined to 8 or 9. Obtunded. Called the doctor about possible intubation to protect airway. He said leave him on Bipap for now because pCO2 went down from 101 to 92. But patient mental status was declining. Question can high ammonia make the patient obtunded where they are unable to protect their airway? I know he wasn't already doing well with the elevated PCO2. But was wondering aside from the elevated PcO2 could elevated ammonia level also cause them to be obtunded where they are unable to protect their airway? I was told to metabolic encephalopathy had nothing to do with respirations. And should just monitor CO2. Im confused now.

I have a patient who weighs 600lbs actually even more who just got a fresh tracheostomy. The senior nurse wanted to fully turn him to bathe and said it was OK if it dislodged as long as we have an extra trache. He was vent dependent too as well. I didn't want too because my preceptor stated we don't fully turn after a new trache is placed for atleast 6 hours due to risk of bleeding and dislodgement ( This was their policy ib their previous hospital). We don't have any policies. Does anyone have these kind of policies on not turning especially for newly trached patients? My senior nurse was mad cause I didn't want to do it. Thank you.

Sorry new to ICU. So I have a patient post code and they already have levo and epi running and they patient continues to be hypotensive. Can we just run vasopressin? Are levo and epi almost the same? If levo is not working why do we still hang epi? Sorry. Just want to know. Thanks.