monkeyman1000

Thought I'd drop in on the conversation. My fiance and I (actually I'm asking her on this trip) are going on a scouting trip this Sept.. We are traveling from Bellingham, WA to Redding, CA. Trying to decide on a place to move next year. I'm an RN and a PTA (physical therapist assistant). I've worked ICU the last 2.5 years as an RN but am switching to home health. Anyone have any info on the home health scene or the PT scene in OR? My fiance's sister lives in Bend so that will be one of our stops as well. Gotta get out of Tulsa, OK.

I keep getting emails from this company and I don't remember giving them my name. Anybody ever heard of them?:barf01: (I couldn't resist this smilie)

I get that a lot too. It's really annoying when I've already explained to the family about art lines being the most accurate way of measuring the BP then the doc tells me to go by the cuff.

Does anybody do this? I usually try it on my art lines and CVP but when I get a wierd result, either no one knows what I'm talking about or they say ignore it. For instance, the last 2 days one of my patients had an art line and a CVP. I checked both and on the art line I had a good square wave test but the CVP (it always seems to be the CVP) showed that it was underdamped. I removed an extra piece of tubing (little short piece with a stopcock) and it didn't improve anything. The AACN guide said to add a dampening device but I and everyone else had never heard of such a thing. The actual CVP wave form looked good and the doc's never seemed to care so should I just toss this practice. Serves me right for reading.

No I didn't see any labs at that time regarding amiodarone. The standing orders in the chart normally for amio are what you said but the cardio specifically stated to keep him at that rate. Doesn't amio cause fibrosis? Anyway I saw the pt today and he's doing sort of better, cardiac issues are stable and they're trying to wean him off the vent. Thanks again for the replies.

Thanks for the reply. No I didn't see anything like that in the progress notes but a rumor that the pacer settings had been changed during all this was somewhat passed on in report. I think that at the end of this year I'm going to switch to a CVICU/CCU (what's the difference?) to learn some of this stuff. Cardiac stuff scares me which tells me I need to just do it.

Allright, I'm a relatively new nurse (2 yrs) and I have spent the whole time on Med/Surg and Trauma/Surg ICU's, no cardiac experience. I've had a patient off and on for the past 4 weeks who came in for cholecystitis with a resulting non ST elevated MI. He had a previous history of A fib and has a pacemaker. He kept going into V-tach requiring a total of 4 cardioversions over the period of a week along with being on an amio drip, esmolol drip, lidocaine drip, levophed drip as well as a heparin (he had a stent placed in the LAD this admission along with a cholecystectomy), versed, morphine and brief vec drip also. Initially his ECG showed atrial pacer spikes without venticular pacer spikes. Then later in the week he showed no p wave or atrial pacer spikes but a ventricular paced rhythm with a wide complex. Then yesterday I came back and he has a Atrial paced beat only with a rate anywhere from 83-120 (all with the atrial spikes). The last note from the cardiologist that I could make out said his pacer had been set at a DDD function. The cardiologist I spoke to said DDDR. One nurse told me that pacemakers can be set so that they will do all the normal stuff then in the case of afib they will run at a higher rate to try and "overrun" the afib rate. The cardiologist told me that the pacer was set so that if it felt that the patient was being more active (sensing the movement of the pectoralis muscle) that it would increase it's rate to match the patient's activity level. First question is what in the hellfire and brimstone? Next question has anybody seen anything like this? (I also saw that an EMG specialist came in during the vtach episodes and made some changes on the pacer but the note didn't say much other than a recommendation that the patient get an ICD when he is more stable). Basically I'm not sure what to think. The guy made me totally nervous. At one point during the v paced episode one of the older nurses (experienced I mean) started saying that the guy may be getting refractory(?) to the meds, ie that he had been on the amio drip for about 6 days at 1mg/hr and might not be responding anymore. I'm confused.:monkeydance:

Sorry, Both patient's are in their early 20's. Both C5-C6 fx's. The resource I found stated that neurogenic shock occurs due to loss of sympathetic control resulting in, among other things, bradycardia. It went on to say to use atropine. My question, why would I use atropine if they are making an adequate pressure and in the one case the guy was responsive. Did that make sense (it's not unusual for my questions to not make sense, they say that there are no stupid questions but there are a lot of stupid people asking a lot of questions). Thank you Gwenith:bowingpur

Hi, my question has to do with SCI's and bradycardia. When do you begin to worry about it? I've had two patient's with SCI's the last few weeks with HR's in the 40's; both had systolic pressure's in the 90's and above and the doc's weren't worried. Just curious. The patient I had Sunday had to go to MRI and his HR kept hitting as low as 29 but with adequate sys pressure (the neuro PA was there and didn't seem concerned so I tried not to be but...:uhoh21: ). Thanks in advance

Also thought this might be funny. During nursing school I did a brief rotation in an ER in a seedy part of town known for seeing all the drug addicts and prostitutes. The nurse I was following was straight out of the 60's and just not quite right, funny as crap though. Apparently she was a little offended by the reputation of the hospital in the community. She wanted to see what my view was on the place so she started to ask me: "If you were having heart problems what hospital would you go to?" I mentioned the local hospital known for having the best cardiologists. This line of questioning went on "pediatrics?", "ortho?" etc etc. Finally she said "if you were a crack whore who had OD'd where would you go?" I of course stated the place we were standing. She got miffed and started to tell me how this was a wrong perception and tell me all the wonderful departments they had that could rival any other hospital in town etc etc. About that time we passed a bed with a disheveled lady on it and I happened to ask what she was here for. "Crack whore that OD'd last night" After saying it she just turned and walked away. I ended up following someone else the rest of the day.

Not sure if this qualifies or not but I'll put it out there. I'm an ICU nurse and we get our share of strange families (although it sounds like you poor guys are weeding out most of them, how do you do it?!!). Anyway had a patient who was in his late 80's, forget the diagnosis but he was one of those poor souls who have been sick for too long and should be allowed to pass peacefully but the family can't let go. Anyway he codes about 8:00 one night and we do our thing wishing we didn't have to. The ER doc calls the code after about 20-30 minutes (by the way the family is right there, we have open visiting hours and were trying to see how having families present at codes would work). The son jumps in the room and starts doing chest compressions, screaming "don't leave us, you can do it" and I'll be damned if he didn't bring the guy back. He died about noon the next day anyway but man.

A PAC told me the same thing the other day. Here I was feeling all proud of myself for 'dumping him on his head'. The last hospital I came from that was what I was taught. If I ever have a raging fever please not the ice in the groin thing. Armpits okay. I'd rather stew.

What in the world is an eicu?

Wow, I'm glad I found this site. Abetta was one of the companies I was looking into. I don't plan on trying to travel until this winter so I can get more experience before I venture out. I'll have 3 years by then. Anyway I'm disappointed, Abetta was at the top of my list. I've called about 10 companies so far. Abetta, On Assignment and RNnetwork where the 3 I was seriously considering. What was it about them that I should steer clear of?

Cardio, sorry about your horrible day. Be proud of yourself for still being human, I'd want you as my nurse. I don't know what your religious convictions are but there is a verse that helps me at times like this. "I will ransom them from the power of the grave, I will redeem them from death. Where o death is your victory?, where o death is your sting?"

google did it

thanks for the advice.

our trauma docs leave them in the collar (usually an Aspen) until they are both cleared radiographically and the patients are able to tell them they aren't hurting to palpation. Sometimes they are in a collar a long, long time.

Just curious (read: ignorant), why is Ancef always used. I just looked it up in my drug book but nothing specific noted about meningitis or anything. Does this med cross the blood brain barrier better than other antibiotics? Enlighten me O' sage ones, your humble student awaits. (seriously)

I'm fairly new too (2 years). I make sure I ask the neurologist. I had a patient the other day that was in cervical traction and a collar and wouldn't have surgery to stabilize his cervical spine for a few days. I was told in report not to move this guy no matter what. I'm thinking 'great, what am I supposed to do if this guy takes a dump?' I asked the surgeon and he told me that I could turn him to change sheets and for ADL's, just make sure I log roll him with help. That's what the docs get paid for, pick their brain.

papawjohn, thanks for the reply. I enjoy reading your posts as well as those of the other more experienced nurses on this forum, it really helps me at work. I used to work in Jacksonville, fl with a john that I think used to go by your moniker, wondered if you might be one and the same. OOPs, hit the button twice

papawjohn, thanks for the reply. I enjoy reading your posts as well as those of the other more experienced nurses on this forum, it really helps me at work. I used to work in Jacksonville, fl with a john that I think used to go by your moniker, wondered if you might be one and the same.

Well before you start the med (vec in this case) you establish a baseline of how much mA (milliamps) it takes to elicit a response from the patient. By response I mean that the stimulator applies 4 electical impulses in rapid succession and normally this would cause the thumb to abduct and your little fingers to flex with each impulse. Your goal is to titrate the vec so that you are only getting 1-2 twitches. hope that makes sense.

I've been working in ICU for just over 2 years and I'm just now starting to feel somewhat comfortable, although I still ask a million questions a day. I was told to give it about 2-3 years before you start to "get it". Hope that doesn't sound harsh but try to stick it out. Hopefully you will be as lucky as I have been by being able to work with a great staff that doesn't mind helping you learn. I've done plenty of stupid things too. I don't know what you're faith background is but this job has made me rely on God more than anything I have ever done. I trust Him to get me through the day and to keep me and my patients safe. Hope this helps.

I work on a Trauma/Surgical ICU and generally it's the head injuries that are on Vecuronium that require checking the TOF. The vec keeps them from moving around and increasing their ICP. The electrodes are placed along the ulnar nerve near the wrist and you're trying to maintain 1-2 twitches. They are also usually on versed and morphine for pain and sedation management. the black terminal is closest to the wrist with the red terminal closest to the body. Eye care is important, we use lacrilube. Sorry not real technical explanation but I like to keep it simple.