rarjn5

Congratulations to you on your new position! There are many drugs that one uses in the Critical Care setting. Some common drips that we use are: dopamine, levophed, cardizem, nipride, insulin, heparin, diprivan, ativan, esmolol, nitroglycerin, fentanyl, and dobutamine. This is a list of some of the drips. I'm sure other nurses have a more extensive list.

I have been reading about Neo-synephrine and its pure alpha effects and that it does not effect the heart rate. In what circumstances have you seen it used? I have been asking at my ICU/CCU and nurses have very little experience with this drug. Are you using it in place of Levophed? Any response would be appreciated. Thanks

Congratulations to you! How long did the test take? How many questions? Did you use any of the official CCRN study books or CD study questions? I'm still trying to get my strategy together on how to tackle this TEST so it is encouraging to hear of a recent success story!

Thank you very much and you have helped me with the ongoing learning process of critical care nursing (or nursing in general)! And most of all just having the feedback from other nurses is a great encouragement.

Thank you Papawjohn. So just to recap: inverted T waves don't mean ischemia? Secondly: inverted T waves are not considered reciprocal changes. Thirdly: Do reciprocal changes correlate with specific areas of the heart? Such as anterior vs posterior changes? I don't know if I'm asking questions that I should know or complex questions. I'm fairly new to critical care nursing and work in a small ICU that has limited resources. Any comments are encouraged!

Thank you for all the help. I think I will try Laura's DVD first and go from there.

Thanks Pricklypear! I think my question is more complex to answer then I thought.

specifically, should I buy the Laura's DVD's and the CCRN review book, or what? And where is the best site to buy from?

Thank you Reddy! I started to look at the link and it looks like a lot of good information.

Thank you pricklypear for your response. I appreciate the time put into responding because I know it still takes time out of your schedule. In response to your post, are all reciprocol changes inverted in configuration on a 12-lead? Or backwards. What about opposite of lateral leads? Where would reciprocol changes show up for lateral leads. And why does that happen? I know I have a lot of questions, maybe someone can add comments to assist in understanding. Thank you!

Can anyone help me with understanding inverted t waves in leads say V2, V3, V4 or V5. What does reciprocol changes mean?

I don't know of a card system for IV push meds but I use 2006 Intravenous Medications. Authors: Betty L. Gahart and Adrienne Nazareno. Publisher: Elsevier Mosby. It is the size of a regular drug book but it is spiral bound and very informative. It is also easy for a quick glance and easy to follow. The Nursing Spectrum Drug Handbook does a good job of describing drugs for IV push, rate and dose.

Thank you Lindarn. I sent you a private e-mail. I'm new at maneuvering through allnurse, so I hope you received my private e-mail.

Oh good, somebody who has heard of the adverse effects of paralytics and steroids used together. I my short time in critical care I have not seen a paralytic drip. What I have seen in my small Unit is the use of norcuron as a prn, used in specific situations. That same pt my also be on IV steroids. I wondered if the IV steroid should be spaced so as not to be given close to the paralytic? My other question is have you ever heard of using Train of Four for prn doses of paralytic, which by the way can be given frequently.

Does anyone know where to find the laws for nurse-pt ratio for the critical care (ICU/CCU) areas in the state of California. I have looked but cannot find it. Is it a law or just a guideline? What happens to Units that understaff critical care areas? How are they regulated? I would appreciate any resources or stories on understaffing in the critical care areas.

Thank you for the information. Does anyone know why steroids are contraindicated with paralytics? How do steroids and paralytics interact to cause a adverse reaction? I really appreciate all this information. It is very helpful.

Does anyone have any advice for a new ICU nurse, almost 2 years, for studying for the CCRN test? How should I tackle the studying and what study helps should I buy? What is the test like and how long is it. How many questions does it have. Appreciate any advice.

Does anyone know of a website that has a picture of the train of four? Thank you for the reply. I really appreciate the response.

can anyone direct me to protocols on train of four? Or does anyone know about the parameters for train of four and guidelines on how to administer the test. And is it mainly used for a drip for a paralytic rather than a particular procedure/event?

sorry I meant 0.78 to 0.89 serial troponin. Does that seem significant in light of the st segment elevations that I wrote earlier? And how would one distinguish between if someone had an MI with postive troponin or if some one was still evolving in the injury process? How do you know if the person is still having injury or is trending down? I hope someone can understand the questions-I know I may not make sense. Thanks

I'm having a hard time with st segment monitoring. For example if you had a pt with serial troponon levels between 79-89, mbcpk 1.8. The st monitoring shows: avr) 0.9, avl) 0.4, avf) -1.5, I) -0.3, II )-1.6, III )-1.4. Chest leads show: v1) 1.6, v2) 0.8, v3) 0.8, v4) -0.5, v5) -0.7, v6) -0.7. What would this indicate based on the st segment monitoring. How many leads need to be postive (st segment elevation) to be dx as ischemia/MI? How many mm does the elevation need to be to be considered postive? Do you have any good sites for more infor? Thank you.

Does anyone know how to read labs for thyroid. For example: If a person is DX with hypothyroidism, will the T3, T4 come back low. And the TSH come back high. My understanding is the body is sensing low thyroid so produces more TSH. But the body is not converting enough of T3 and T4. Thank you for any response

Continuation of loricatus' response. If esmolol comes in a premixed bag of 250ml, concentration of 10mg/ml, my calculation would be to set my IV pump to 150cc to deliver 250mg (25cc) of esmolol over 10 minutes.

Thank you for your fast reply. I have actually read everything on Mark H's website. It is great! I found it by accident and was relieved to read answers to some of my "dumb questions" and realized I'm not the only one to wonder about things in the ICU that are never explained. My problem is math, which I'm a little deficit in calculations. This is a totally fictitious problem. Say you have to give a loading dose of Esmolol of 500mcg/kg/min over 10 min. How would you calculate that and what would I set my IV pump at to run the dose over 10 min? What is the math formula to use? thank you

I'm new to allnurse. I would like to post questions on calculating drips for drugs in the ICU/CCU setting. Any suggestions on how to get the best response from people. My math comprehension is lacking in understanding so I need some help.