mattcastens

I used to have that problem until I said, "you're an intellegent nurse -- read it yourself." I also broke the habit by simply not using the flowsheet to give report -- I do it all off the top of my head. If I'm not reading, they're not reading. Of course, it takes some practice, but working flight and EMS got my brain working.

Usually the neighborhood of 30mcg is the upper limit. If you get that high, watch for tissue necrosis in the extremeites -- you can be they aren't being perfused!

At our hospital there is no mandatory on call for us (unless a nurse works in OR, the cath lab, or other possible emergent areas). If the census drops we are asked if we would like to take call -- if everyone says no, then so be it. If we are on call we get paid minimum wage. Our hospital also gives pagers to all of the critical care nurses if they want one (cost to nurse is something like $2 per pay period). That way, not only can you be contacted if you're on call, but staffing also pages out all available shifts for the taking. If you want to pick up, you know what's available and can call in.

Here's another example: I was watching "Scrubs" last night and noticed that the Pyxis machines in the background had a huge "Pyxis" emblazoned on them. Honestly, who's this going to influence? It's not like I'm going to go out and buy my own medication system, and we all know that administrators are going to buy the lowest costing system rather than one they see in a product placement, right? I just don't get it.

Would it be used in conjunction with milrinone -- also used as an outpatient treatment for CHF?

I've only sort of heard about it. It's sort of a combination between MAST trousers and a balloon pump. The idea is that this inflatable suit (well... from the abdomen down, anyway) inflates rapidly during diastole to assist with coronary blood flow and then deflates just before systole to decrease afterload -- the same theory behind an IABP. As I understand it, it is only used on an outpatient basis. This is only what I've heard. I don't have any experience with it personally, nor have I done any research. Would it be used in conjunction with meds? What is this a treatment for?

Occasionally I have run across old ladies that say they use Tylenol to help them sleep (not Tylenol P.M., mind you -- the regular stuff). I would always blow it off, thinking that it was all in their heads. Now on some of our standing orders, the docs have Tylenol ordered at h.s. PRN for sleep! Since I have never taken anything to help me sleep (I do just fine on my own), I just gotta ask -- does it work? Has anyone out there actually used regular Tylenol as a sleeping pill?

Um, I don't know about you, but I find it very easy to not shine the laser in people's eyes. Or we can all wear sunglasses and be "Joe (or Jolene) Cool Nurse".

I'm currently doing the research on whats available. What I've been using in the meantime -- and might recommend to the unit -- is a $13 laser pointer from Target that I can easily place on the transducer manifold and shoot at the the patient. It takes about three seconds to set up, works perfectly, and fits in my pocket when I'm not using it.

Don't worry! You will get the hang of it. People learn at different rates, but eventually you'll be able to read a monitor or an ECG as easily as you're reading this. Start learning now! Get some books and start studying. While the books will only give you the "perfect" versions of the rhythms, at least you'll have a grasp of what to be looking for. Good luck!

Anybody out there use laser levels to level your PA catheters? If so, what company do you go through? I'm looking to contact some product reps, but haven't had any luck on the internet. Thanks!

Some of it is from experience, some of it is from studying, a lot of it is from asking questions. We are all continually learning.

Mario -- A couple of possibilities: 1. Transient heart murmer. Sometimes people get what are called "high output" murmurs. That is, when the heart starts pumping more blood than it is used to, the increase in volume creates a slight regurgitation through the valves causing the sound. (Pregancy frequently causes this with the extra circulating volume -- are you pregnant??) After waking, your heart is still in a relatively low cardiac output state which increases as you start moving around. Once the heart "awakens" to the new day, it normalizes with the increased cardiac output and the murmur disappears. 2. Transient gallop. Along the lines of the transient murmur, it is possible to have a transient extra heart sound (s3 or s4). Again, once the heart readjusts to the higher cardiac output state, it can disappear. 3. Pericardial rub. Probably not, unless you have had a recent infection, renal failure, or lung cancer. (Stop smoking, Mario!) 4. The stethescope. Occasionally, a cold stethescope diaphragm squeaks. (Sleep with it under your pillow.) 5. Since the squeaking clears when you yawn, it might be a little wheezing in your lungs that you hear when you breathe. The yawning wakes up your lungs and clears the squeaking. All in all, I think the chances are good that you're not going to die. Today, anyway.

I'd have to agree here, but i think it depends on your hospital culture. Where I work, no one is offended by an incident report, and much improvement has come of them from faster lab and pharmacy times to better staffing on the night shift. There is one nurse in particular who seems to be incident report happy, but we all (NM included) have learned to take them with a grain of salt.

You know, I attended a critical care symposium last week and listened to Tom Ahrens, CNS, PhD speak. (If you ever get the chance to attend one of his talks -- especially if you work in critical care -- I extremely highly recommend it!) He brought up the fact that perhaps instead of making everyone a full code unless otherwise ordered, everyone should be made DNR/DNI unless otherwise ordered. His point was that in terms of statistics, only about 15% of coded patients (hospitalized patients) are ever discharged home and only about 5% suffer moderate to little to no neurological damage. If more than one system is compromised, the percentage approaches zero. Seeing as how much pain and suffering this can cause to both patient and family, and considering that a leading cause of bankruptsy in the US is health care costs, we really should be educating patients and families better. Naturally, the patient or spokesperson would get the final say.