slcpicu

To answer your first question. We calculate an oxygen index (OI) on these patients needing increased vent support and worsing abg's. If the OI is approaching 20 (most of the time more like >15) we will place them on HFOV. If the OI is >25, we then start to think about elective cannulation for ecmo support. (if that's even an option)

Good Question. I would say that 2-3 months is probably enough. BUT with that in mind. I would have to say the acuity of the patients this nurse oriented to would have to be pretty high to feel comfortable with a true critically ill pt. There are many other factors, but that would be the one I would be most worried about. Some things that you only see in the icu setting will take time to learn and to feel comfortable with. I think anything shorter than 2 months with no previous ICU experience would be somewhat worrisome to me.

This is what I would highlight. Your previous care of critically ill patients. I would highlight your critical thinking skills, vent management, knowledge of abg's, inotropes, and vasopressors. Those things are much harder to "teach". It takes time to get those types of things and can only be learned from experience, which you have. The dosing is different in peds obvisiously, but if you know why dopa or epi works that to me is far more important. Your willingness to make such a huge change will be guided by how much you want to learn and how fast you want to do that. I think someone with critical care experience is a much better canidate than someone with no crit care experience at all but might have had some peds experience. I would highlight those areas and maybe express your desire to learn new things and advance your nursing practice and your skill set and knowledge. GOOD LUCK!

ok, you made it alittle more difficult, but I am assuming that it is 500 MG/250 ml. Otherwise it would be running very very fast. 2.5*99.7*60=14,955 14955mcg/hr divided by 2000mcg/1ml =7.46 ml/hour Hope that helps!

Great Discussion! I will add my 2 cents. Like others posters have said, bicarb in a code situation will help prevent the overwhelming acidosis that comes from decreased to no cardiac output. In most cases, bicarb only fixes the numbers and not the problem. You still must remember to fix the problem of decreased oxygen delivery to tissues and anerobic metabolism. Due to the henderson-hasselbach equation, your pt must have a good respiratory drive to give bicarb or you will end up making their acidosis worse. (coding hopefully=intubated) As for increasing bp, in a round about way it does happen (as others have stated for a short period of time) ph's less than 7.25 significantly decrease Cardiac output and therefore decrease O2 delivery and increases in lactic acidosis. On most of our caridac pts, we will give bicarb to fix the acidiosis and give some volume to help with O2 delivery. In the mean time we fix the numbers because of the decreasing of cardiac output. Hopefully, that helps some along with everyone elses information Thanks!!

Thanks LOVEICU for the update!! I, to, was not worried 6 months ago but I am now. I will be starting school in May 09 and hope the credit freeze has improved somewhat by then. My school has set the COA at a "reasonable" amount and it is doable. But I would feel much more secure with one private loan in my back pocket. The only other one I know of besides those you had listed is Chase. (it is only in certain states though). I will keep looking and updating as things hopefully loosen up.

hey how's it going. 1. I have 4 years experience...will have 5 when I start school. 2.GPA 3.84 3. waived for GPA 4. well i know you said you didn't like the city but the city will most likely have higher acuity pts and therefore a better learning opportunity. I would suggest being in a Level I Trauma Center if possible. 5. I have worked a few places both pediatric and adult ICU. PICU MS 16 bed Level I. SLC 32 bed PICU level I. CVICU-Peds Denver 16 beds. Adult ICU level I Denver TSICU 28, CICU 12, and MICU 14. Alot of the information you will learn post nursing school and feeling like you learned nothing while in school is normal. Try and learn as much as you can when you get out. Also it might not be wise to inform your future employors of your goals to become a CRNA. ICU's invest alot to train you and to find out your only there for a short period they might choose someone without your goals. If you are serious about your goals, I would strongly suggest a large hospital due to most often better experiences. GOOD LUCK!!

Interesting case....I agree with the other posters that this is a Septic shock state as evidenced by the hypotension the pt had. The latic acid was within normal because the pt was actually managed well and that prevented the anerobic metabolism from starting. They maintained O's to the toes and therefore the latic didn't rise as of yet. I think that the vaso was a good choice. Probably provider preference and it seem that the pt responded well to it. As ghillbert stated, probably could have used some more volume due to being sick and a temp that high, the pt was probably pretty dehydrated. But there are 100 ways to skin this cat. Most importantly the pt responded to the intial treatments.

Although I have only seen it a few times in the adult ICU population, we use calicum gtts all the time in post op cardiac patients in the peds world. If we are having bp issues and the pt responds to the calcium bolus, it is not uncommon to start a calcium gtt to decrease the need for vasopressors to support bp. We then check our ionized calciums farely frequently and will titrate up to an Ical of 1.3 to 1.5. Having a calcium gtt will decrease the peaks and valleys that you have giving it by bolus. This will actually help the conduction system and ventricular contractility; resulting in improved cardiac output, hopefully urine output and BP. Great Question!!

I was a new grad and I answered: "I would like to be the small fish in a big pond because I would have lots of room to grow." Kinda cheesy but after talking with others I think it might have been a good answer. Anyway I did get the job then so who knows.

I would be prepared to answer some of the following: Why do you want to work in the acute care setting? What are your strengths and weaknesses? Name a time you failed and what you did about it? What makes you the stronger canidate? What experience do you have in the critical/acute care setting? Where do you see yourself in 5 yrs? What are your goals if given this opportunity? I was also asked a very weird question not that anyone would ever get it again. Would you rather be a big fish in a small pond or a small fish in a big pond? hmmmmmm Anyway good luck with your interviews. Those are just a few I could think of at 3 am.

movinup The pao2 is 40 which is very low. It is highly likely that there is some anaerobic metabolism going on because there is decreased 02 leading to the decrease in HCO3 although it wasn't given to us. No O's to the toes which will lead to the metabolic acidosis. hope this helps!

Thanks Registered. Wow I ended up being kinda right to begin with. LOL sometimes it's better to be lucky than good. This is a very interesting case. Any updates on outcome? Dinith 88 did you have a question?

Daisy, I am very sorry for your loss. I will attempt to answer some of your questions. I have seen many organ donations and taken care of many before becoming donors. I just want to say thanks for making that very difficult decision. As for the liquid you saw instilled, it sounds like you might be describing an OG? if that is the case, I have seen a bowel prep given prior to procuring of organs if the bowel will be donated. (mostly children though not so much in the adult world). Otherwise, I m not sure, but the organ procurement agency would know because it is probably part of their routine. As for what bluntforce said about extubation, that is not the case what so ever. The pt. is not extubated prior to the organs being procured. The heart would never be allowed to stop prior to getting those organs out when it is a brain death case. There is a donation called Donation after cardiac death but this would occur in a NON brain dead pt that still has some upper brain stem function. In that case, his discription would be more accurate. For the case of Brain death, it is not at all accurate. The organs were procured and your mom was more than likely given anesthesia (most hospitals still give it although the pt is brain dead for relaxation for the incision) once the abdominal organs are recovered (depending if they took lungs and heart) the vent would then be discontinued. I m sure each hospital is alittle different in their own procedures. Sometimes other teams come to procure the organs, so as for the surgical paperwork contacting the agency might be the best option.

Since there has been 103 ppl look and no one reply, I will be the first. IF you search alittle on here you will probably find some of the answers to your questions that have been posted already. But anyway I will answer. I really over prepared to say the least. I had heard of all the horror stories of some very clinical interviews and I was determined to be very prepared. I found a template of possible questions on a different site. (mostly behaviorly though) I answered all of them. I made my own study sheet of all numbers (swan, svr calc, pvr, wedge, cvp, ect.) and what changes in each meant. I listed all code drugs, vasopressor, inotropes, and RSI etc. I study doses, indications, and how they worked. Ended up being like 25+ pages and I studied it religiously for months. Then went to my first interview and didn't get asked a single clinical question. My questions really drove the interview. I felt really good about the interview and I was accecpted. (whew) I know the material really well now though and it was a good investment regardless. So, thats what I did. Good Luck on your interview!!