ICUBecky

not anymore...he's dead.

yes tenesmus...he is fully mentating now. kinda sad. he knows how critical he is. at least ppl are telling him the truth though. don't worry...you don't sound horrible....i feel the same way. as far as labs. you are dead on. it's amazing how much my unit uses NAHCO3 for acidosis. we use it all the time. so basically...what (in an actual real life situation) should we be doing for acidosis? just play with the vent settings? or is there something else? his BMP was pretty much normal today. very interesting on lactic acid. didn't know too much about that lab value...thanks for the explanation. yes...he is very hypoperfused. still to this day. i will have to look at the LFTs tomorrow to see what is going on. he didn't have any bowel sounds today, and he did complain of abd. tenderness today...i told the doctor, but don't know what came of it b/c my shift ended. very interesting. a bowel infarction definitely wouldn't be good for him. i think you need to come and manage this patient! you know what's going on and you haven't even taken care of him!

my biggest challenge...resisting the temptation to go out every night with my non-nursing major friends. i definitely liked to go out!! also, getting up really early in the morning for clinicals. yuck. i'm definitely not a morning person. i didn't like community health and psych rotations. god bless, those who do it!!

update on the patient. he is still alive, but continues to have a spiked temp, although down from 106 to 102. no muscle rigidity, ABGs normal. pt awake and following commands. cardiac funtion is shot...needs LVAD. hypokalemic, hypernatremic. kidney function good. this past weekend was one of the most interesting, and thought provoking that i have ever had. lots of things don't add up with him. but, i won't go into it. it is way too much. oh by the way, his lactic acid was 153!! the surgeon is kind of wondering if he arrested somewhere btw. home and the OR. although it isn't documented and we have no proof. but, i wonder if there was/is some kind of anoxic injury...now that tenesmus has brought that subject up. what do you all think? this is also a very interesting discussion. i have learned a lot! i think no- pressure Q&A/ discussion is a great way to learn about different subjects. lets keep it going!!

very interesting. thankyou for your wonderful replies and website postings. guess i should use this pt. as a learning experience...since it looks like it happens in a small percentage of the pt. population. so, has anybody actually seen this and had a pt survive?

just wondering if anybody here can give me an easy explanation of this phenomenon... my patient last night was diagnosed with this. he was emer. cabg X4, IABP, fentanyl, epi, levophed, dopamine, bicarb, insulin drips, pressure problems, very acidotic (17 amps of bicarb given), troubles with potassium, temperature of 105 faren. per swan the anesthesiologist was explaining this, however i was too worried about cooling him down, fixing his v-tach, and playing with the vent, getting the timing right on the IABP, fixing his CI of 6.3, and taking orders from 3 different doctors. that i missed some of the points. did i hear right that this can be/is caused by certain types of anesthesia? also...we cave dantrolene, however we couldn't finish the drip because his cardiac function. his numbers went WAY down. but, his acidosis reversed. did the drip cause this? it was fixed for the rest of the night. anyways, we ended up with a perfusionist cooling his blood, and CVVHD. i know this is a lot to swallow, but if anybody can explain it to me...i would be greatful. just can't wait to see his condition tonight. if he is still alive. thanks, becky

AnnCRNA...i think it would be very wise of you to take the CRNA off of your name. YOU have not gone through the hellish program, YOU have not taken the boards, YOU are NOT a CRNA. i think that it is appropriate that the actual CRNAs on this board are upset by this. just as i would be if someone who has not gone through an actual nursing program put RN after their name. Next...i think you need to grow up a little. nothing in life is easy. you have to be able and be willing to work for what you want. listen to what everybody (especially the CRNAs) say on this board. why don't you do your own research and find the answer to your question, and not rudely insult or ask a question to get the answer YOU want! but, then again with the tone of your post ...that might be too hard for you...

hee hee hee! gotta love it, don't you? i had one experience where a nurse did overtime (16 hrs.) realized that that an IV wasn't working at her 0700 assessment (charted it too), but wasn't considerate enough to start another (the policy is to have at least 2 heplocks in our ICU), or even PULL OUT the bad one!! c'mon no matter how busy you are you could at least take out the bad one, it takes a whole minute out of your day. p.s- she had 2 stable patients! ughhhh!

Ohh...poor girl. I have suffered this same thing. I tried everything for about a month. Carmex, blistex, burts bees, petroleum jelly, neosporin. Then I finally asked a dermatologist. He said, I either irritated, and dried the cracks out too much with carmex, burts bees and blistex or moistened them too much with the petroleum and neosporin. He gave me a corticosteroid, and told me to take more vitamin b and iron. Within a couple of weeks the cracks were gone. With in a day the cracks didn't hurt as much. Just remind her to have clean hands while putting stuff on!

kristi don't listen to these ppl...you know what you do. i get the same thing btw. our adult ICUs at my hospital. we have a neuro, med/surg, cardio surgical and cardiac ICU. well, i work in cardiac, and i have heard the other ICU nurses comment on how cardiac isn't a "real" ICU, and that we are incompetent nurses. yes...i agree that sometimes our pts. are less critical, but i have seen many times that their condition can change in a heartbeat (excuse the pun). there are many times that we have pts. from the other services, called "boarders", b/c we have a big unit with adequate staffing. well..if one of their pts. goes bad, we are the ones blamed, because to them we don't know what we are doing!! i can see this attitude coming from doctors (because they don't want to take the blame for not answering our calls and our pleas to see their pt), but from nurses...come on! everytime i float to one of these other units, i find myself defending my unit half the night!! and NICU nurses not being real nurses....paallleeeaaase! (didn't they watch the NICU episode of Oprah?...that definitely opened my eyes). and some day shifters need to get off their high horses. b/c if us night shifters didn't want to work those tough nights...they would have to work them! so don't piss us off!! becky

what year is it again? ohhh yeah 2002. women have been fighting for a long time to become equal to their male counterparts. it is a HUGE slap in the face when i hear "it is the WOMAN's job to raise a kid" and "the MAN should always be the breadwinner." i'm sorry the Ward and June Cleaver days are looooong gone, and people need to realize that....even if they are in the earlier generations. i did not go through highschool as an honor student and go through a hard 4- year nursing program so that a MAN can take care of me. right now....i make more than my fiancee. as for a man staying home with the children. i feel that this is perfectly fine, as long as they are able to love, nurture, and play with their children. i'm sorry, but some of the posters here who have had bad experiences with the father staying home, married men that were incapable of these things and did not realize this to begin with. i don't know...but i see ALL OF THESE QUALITIES in my fiancee, and i believe that he would be a great stay at home father. if he actually WANTS to do it. i think the main word there is WANT. not because he was laid off, or disabled, or just didn't want to work. i plan to stay a staff nurse for awhile, or at least until my child(ren) is/ are still young. you can work 3 12 hour shifts, and be home for 4 days. tell your husband to find a flexible job, with a flexible work schedule and he can stay home those three days that you work. i know 4 nurses that do this, and they said it works out perfectly. i know one nurse that works three straight 12s nights, and takes care of her child during the day. luckily...he sleeps a lot and she gets enough rest. her husband is there to take care of the child during the evenings. there is more than one way, so that you can spend time with your child, and still earn enough for a comfortable living. but, keep in mind money isn't everything, and there are ppl that raise children with a lot less than a nurses salary!! good luck in your decision. becky

just becareful not to puncture a lung. i have seen 3 doctors do this (not a nursing function at my hospital), and cause lots and lots of problems. not good. i don't like dobhoffs...

brandy, sometimes you just have to leave work saying "i did my best" or even "well...i kept them alive" and never think about it again. when i first started 2 years ago, i was really bad about this, but i am starting to get better. i have a fairly long drive home, so i only allow myself to think about the days on goings during that drive. i try to think if i charted everything, charted of meds, gave insulin etc. if i truly forgot something i just call my coworkers that took my assignment, and they take care of it. everybody at my work gets along, and realize how hard the day can be...so we watch each other's back. at the end of my drive home, i do not allow myself to think about work again. i enjoy time with my boyfriend, go out to eat, watch tv, read a magazine etc...to get my mind off of things. honestly, though, there are a lot of times that, if i get a really critical/stressful/ going down the tubes patient, i get a lot of adrenaline and can't settle down. those are the hardest nights, because i have vivid dreams of what i did or forgot to do, the doctors yelling tons of orders to me, me running around like a chicken with it's head cut off. it's really weird. guess you really can't stop the dreams, unless you wake up. that's my 2 cents. becky

any kind of "centesis", lumbar punctures, epidurals... just watching a large needle being jammed into a body part, and watching the fluid poor out, absolutely makes me sick. i've almost blacked out a couple of times... starting foleys on women who don't have good peri-care....bleeeek. how hard is it to wash down there???

i have one just like dawnglove's story... a sleeze bag guy has a massive MI and is rushed emergently to the cath lab. well...he must have been really sedated, b/c when he woke up he said to us "man...i've been having these really fu***d up dreams". when asked to explain further he said there were these black blobs calling his name, in spooky voices. later on, he fell back to sleep. well...immediately before he tamponaded, he sat directly up and yelled "no, dammit, i'm not going with you". his eyes rolled back in his head and he slammed back down on the bed...coded and died. FREEEEEEAAAAKKKY!!! on a lighter note... i worked in a nursing home as a CNA. one of the residents one night said to me "i see a beautiful angel, and she is tapping on my shoulder." she died in the morning.