AUicuRN

@janfrn: You all ran ECMO through the VAC cannula? Thats interesting. What Size? and how much flow are you getting through it? I guess if it is VAD cannula you are pulling from the LV and infusing to the AO? If so, there is no need for a membrane oxy. I think I would like working at your hospital! To others about the equipment. It is important to know the difference between the machine (console) and the ECMO circuit. You can have a big bulky console that takes up a lot of floor space but still have a small circuit. The console is just the machine that has the controls on it . Some of them have big integrated computer systems that control a lot of things from a touch screen, etc. Like janfrn said the quadrox and centrifugal pumps have helped us all decrease the amount of blood in our circuit and decrease the amount of plastic surface that the patient comes in contact with. These things help the lungs stay clear rather than whiting out. With clear lungs we are able to have patients extubated and talking while on ECMO.

I assume you have taken a good look at their website. They have a nice excel tool that helps you enter your last 60 hr GPA and math and science GPA to see where you are. As far as your plan, I don't think I would take a full load on top of working full time in an ICU but that's me. If you have a 4.0 in math and science they must be included in your last 60 so try to come up with a plan where you can have nothing less than a B in any class in your last 60 without booting the math classes out of the top 60. NAIL the GRE. That is another thing to think about while you are taking a full load of college classes, you have to be studying for the GRE. Try to get your last 60 GPA to around a 3.2. That will give you a cumulative GPA of 3.6 plus a really good GRE score and ICU experience and you should be competative. You can take 600 level patho and statistics. A's in 600 level classes always look good and they count in your last 60 hour GPA.

We have 8 hr shifts in the form of 7on/7off. It works for some people but not for all. I'm in Alabama

This is a tough situation. I found myself wondering this same thing recently. I could give a small dose of a narcotic or a bigger dose. I told the family, "we should try the smaller dose now and we can always give it again and make it the bigger dose if it doesn't work." I think it was morphine 1mg or 2 mg q2h prn for pain. I don't know the right thing but I was willing to try the smaller dose and not wait out the 2 hours to give more.

You've got me on this one. I don't have a clue. Is it confirmed H1N1?

Great Job working through this. This one has fooled me before in the middle of the night. The next time it didn't. Working, once again in the middle of the night, with a second year resident we admitted the patient. Checked 4 extremity b/p's and there was a huge difference between the upper and lower extremities. Pt was intubated, given some bicarb and placed on a PGE4 gtt while waiting on cards to ECHO. For the newer nurses reading this: The PDA doesn't always close right after birth and can take up to 4 weeks. Coarctation isn't a "true" ductal dependent heart defect, but when the duct does start to close it can pull on the aorta and close off an already narrow coart increasing the work load on the heart and dropping cardiac output. The decrease in bicarb on the ABG is because of anaerobic metabolism and lactic acid production. Sorry for the glitches with the post. LittleneoRN you're up. Good job.

No GI symptoms. CXR is unremarkable. The patient has had 2 10ml/kg boluses in route. Yes we do have metabolic acidosis. Perhaps I should add that brachial pulses are 2+ femoral pulses are 1+ and not palpable in the feet.

YAY!! Lets see how I do. This one may make our NICU nurses a little happy. 3 week old presents to an outside hospital ED with resp. distress poor feeding and listlessness. Mom says she this all started 4-5 hours ago and isn't getting better. Patient is cool and has a decreased cap refill. VS: HR 187, RR 62, BP 87/48 O2Sat 86 RA. Patient is transported to your PICU and has progressively gotten worse. Cap refill in her extremities are now 6-8 seconds HR 190, BP 69/50. Sat's 92 on closed FM 100% and 8L. Retractions noted. ABG is 7.18 PaCO2 48, PaO2 60, Bicarb, 12. (I made that gas up so the bicarb and pH may not correlate but the idea is the same) What do you think is wrong and what can we do to make this better? This is my first one to write so let me know if I didn't make it clear. Enjoy

one of the top items on my differential list would be a foreign body airway obstruction. I'd request neck films to rule it out. And give her some more O's in the mean time.

Thanks Ginger, here is a specific problem we are having right now; There was levofed infusing at .05 mcg/kg/min and pt was high normo-tensive so the levo was turned off. Then the blood pressure dropped too much. There was no dose between off and .05 mcg/kg/min. with the old pumps it wasn't a problem to calculate the dose and run it at 0.02 mcgs. Is the problem b/c the pump wasn't ready to do that during the trial but will be able to if we buy them? The other problem we had was the pumps sucking air which for IVF is only an annoyance but for pressors e.g. DOPA, Epi, Levo could be a patient safty issue.

The hospital I work for is trying new IV pumps. The one's we have now are pretty old and basic but they get the job done. We are previewing some different types now the first evaluation was just up for Alarys pumps. I wasn't too happy with them. Can any body offer info on them if you use them on a day to day basis? My use will be different from most of yours because I work in a pediatric hospital but i would appreciate any info. Thanks

Do you ever use Papaverine in your a-lines? I've seen it do great things for vasospasims.

Anyone have a good resource for new drugs. In the PICU we have started using Caspofungin and I can't find very much info on it like admixture compatability and min concentration etc. Any info will help.