zookeeper

I had a pt, say 5 yrs ago maybe, that I was giving his ordered nitropaste to. (It was just after we had had an inservice mentioning nitro in an RV MI and the result if you do) It wasn't 5 minutes later the wife came out of the room a little nervous---said something wasn't right. This guy was gray and BP was 60. All I remembered from the inservice was GIVE FLUIDS in a Right-sided MI. So I ran for the fluids while someone else called a code. We hung the fluids, respiratory ended up having to intubate, but he died in the code despite our efforts. Profiles; hot of the press -positive. (we weren't doing Troponins back then). Yeah, I definitely wanna know what type of MI if I can. By the way, thanks, Indy, for the tip about "post pacer" CP I've never heard that.

I don't live in Indpls, I live in Richmond which is 60 mi east. My brother and 2 nieces now live there though. I used to commute to Methodist though when I was in nursing school. It is a 900 plus bed trauma center and Wishard is the county hospital and has, I believe, the only official burn unit in the city. IU, Methodist and Wishard are all downtown. There's a new Heart Hospital which I've heard good things about, I think it's on the north side, correct guys? St Vincent's is northside and St Francis has a couple three locations, one south, one more south and is the other north? We send pts to IU Med for bone marrow transplants and high dose chemo. We used to send all our heart pts to St V's before we did any kind of interventions here. My brother has lived on the southside in and near Greenwood coming up on 20 yrs. He has a 9 yo boy who attends a charter school now and used to go to Mary Brian. They like the schools very well. There is a lot more school choice in Indpls than where I live. One of my nieces just moved to Fishers and other niece is on the west side and has a 2yo and is pregnant. They live in a nice home off of 56th her husband works at IP&L. My Fishers niece is the director of a day care downtown if you need daycare! I would advise shying away from moving to the east side of town and some parts of the west side (near Layfayette Square Mall there has been a lot of gang activity there).

Only CP r/o MI are on a CCC. On our tele floor if someone develops CP we have standing orders that we can give SL ntg x3, O2, and do an EKG. If we're doing all this we're usually on the phone pretty quickly to the doc getting further orders to treat the cause. The standing orders we have in place are the result of going through a committee and the signing thereof by that particular section chief or by the medical director.

Do you have basic or advanced arrhythmia classes you can sign up to take? You can't have PAC's in A-fib. A-fib can speed up to over 100---hence the RVR or slow down to a controlled rate (below 100). You can have lots of PAC's especially in lungers and sometimes it's a pretty strong indicator they're going to go into A-fib. There's also multi-focal atrial tach which can look like PAC's because you actually have a P. Steelcity may have been thinking of Ashmon's Phenomenon which looks like PAC's in the middle of Atrial Fib. Atrial Fib is a rhythm, PAC's are an incidental in a sinus rhythm.

We have a couple different pathways called CCC's which I think stands for Collaborative Care Continuim (sp). There is one for low risk MI and one for hi risk MI. In ED they do MONA, serial EKG's, cardiac profiles, etc. Within 30 min. of arrival. Once on the floor, if doc continues the CCC (most do) he orders the type of stress he wants for the next day, that is if profiles are neg, also nitropaste, lipid profile, EKG in AM, etc. are all on the pathway. (These are all just check marks on a list.) If profiles are pos they fall off that pathway and go to ACS pathway at Dr's discretion, which has things on it like integrillin, Lovenox, IV nitro, echo. There's room, of course, for the Dr to modify so they're not feeling like it's cookbook medicine. A lot of these things are national reportable indicators though and our hospital developed these pathways for that reason. In fact there was a guy at Harvard University who, this year, was doing a paper on quality care and our hospital came up in his research. He ended up doing his paper on us We are the top hospital in Indiana due directly to developing these pathways. Here is the link to our hospital's feedback from that paper. There was a big write up in our local paper too about the same time, but I can't get the wording right to find the archived article. http://www.reidhosp.com/news/releases/20060214-best.html Our hospital also hired people to do chart review to make sure nothing was missed and to do Pt call backs.

I have worked tele for about 15 yrs. We have 33 beds divided into 3 modules that used to be split 11 each but we remodeled the floor about 8 yrs ago and mod 1 has 10 pts, mod 2, 11 and mod 3, 12 pts A typical day is 1 RN to each module with and LPN so 2 licensed people and hopefully one tech sometimes 2 split the floor. Module 3 is always the bear. We do caths, r/o's, AICD's, perm. pacers, PCI's pre-operatively and pre-op CABG's. We have pretty much the same staff for days as we do for eve's and nocs. We are an extrememly busy floor. So busy we seem to have a revolving door especially for the LPN's. Our hospital recently changed from JCAH and went to HFAB (I think it is) as apparently they are about 50,000 cheaper than JCAH so now the RN has to assess all pts, as HFAB requires, BID. Basically all the LPN gets done is passing meds. We sometimes have a float RN to do admissions and discharges----but 1 person isn't enough to go around. We cry about staffing to no avail. We have the same staffing we did 15 yrs ago when we had 8 monitored beds and only did caths in a big truck 2 days a week. No CABG's or PCI's back then either nor did we have an EP guy. In fact we only 2 cardie boys back then, we have 7 now. No gtts back then either except Lido. (Eastern IN)

I am an RN and my husband is an LPN in ICCU (go figure) anyway, he gets along with ALL the docs splendidly. There is one doc in particular that I can't stand much. He changes the spelling of his name on the board if someone happens to spell it wrong, yells at people when he's on call (doesn't anybody tell these guys they're gonna be on call?) and I've seen him throw a chart across the room because the wrong test was ordered. My husband hasn't had a single bad encounter with him, in fact in the past when I've seen other male nurses interact with him he treats them with much more respect than he gives the female nurses. One time one of the docs called said he was "looking for, oh, you know......that one who's wife is a "....etc. My husband said, "we use names here, gimme a name and I'll tell you who the nurse is" and he hung up on the doc! I about died! When he did rounds he was sweet as pie! I think the guys get away with much more.