Joshua21

I think that it is time for some clarification of assumptions. First, We follow an MD's order, not create our own little retarded recipes. Second, the physician in the one giving the Lidocaine, it's his procedure. I am dissappointed in the direction this thread has gone. It has deteriorated to something less than intellectual. As a point of follow up I asked one of the physicians why the Benadryl and was informed the benadryl was used for a reason other than sedation. It simply is given around the same time by coincidence. It is not part of the retarded recipe we unqualified staff nurses decide to create and practice. The point of this forum thread is lost. Please feel free to throw in your remaining two cents as I ask a mod to close this misdirected request for help.

Thank you for the many opinions you have shared. I have learned much from you and also about CRNA's. I do appreciate the insight into the benadryl. I have been moving away from using it at all and seeing little change in the sedation provided. Now I will simply stop using it. As for the original question, thank you for confirming what I already thought was going on. If anyone else would care to make constructive comments about the original question that would still be appreciated. I will be presenting everything including your comments to my manager to implement change so the more said, the more ammunition I would have. Thank you.

Thank you all for your responses so far, even your's yoga despite the unwarranted crisp hostility. I am pursuing many avenues in researching this problem and my suspicions related to Lido Tox. I am being specifically vague as I do not want to contribute to your experiences and biased them. Being as your all so helpful so quickly I would be happy to share some of the background. Recently I've been exposed to 4 cases of an odd phenomenon that appears like acute seizures, with gross global tonic/clonic movement, eye deviation, aniscoria and incomprehensible sounds. The patients appear ill but gradually over an hour seem to improve, usually by the time we get them to the unit, tubed, otherwise unsupported. This is usually preceded by a bout of hypotension. One moment I'm speaking with the person, next they're seizing. By morning at the latest they're back on the floor. The procedure is implanting of Pacers and ICD's. The people are of variying health backgrounds but usually compromised cardiovascularly. Two were very emaciated. All were female. Meds used by myself are usually Diphenhydramine 50 mg iv once Fentanyl 25-50 mg bumps Midazolam 0.5-2mg bumps Docs use Lidocaine 2%, anywhere from 60-100ml's volume, instilling the tissue involved with the generator pocket and obtaining venous access. Sedations scores are different at every location so suffice it to say we want to keep VS within 10% of baseline, patient will awake to voice, not evidence pain or little discomfort and maintain own airway. Take from this what you will but again I am looking for witness accounts to see if these match up. If you feel you have knowledge that will contribute or direct me please feel free to offer a hand. Thank you

Thank you for taking the time to read this. I work in a procedure lab that does a lot of local anaesthesia with Lidocaine 2% and though not often, some patients are having very similar rx's to something in the procedure. At first I thought it was related to part of my moderate sedation meds but now I'm looking out farther and eyeballing Lidocaine 2% as a possible suspect. What I would like is your personal experiences ie. signs, symptoms and treatment when you suspected a lidocain OD. PLease refrain from too much quoting from a book. I am looking for personal accounts please. Thanks Joshua

Just an overheard rumor but if your willing to travel a bit look in to Good Samaritan in Lexington. I heard they have some insane wage bonuses. Possibly Central Baptist as well though I cant remember if its great benefits vs wages.

I hope I caught you in time. This is not really related to the licensure issue but! When you cross the border, if your driving or plan to take your vehicles across 1. Get a letter from your manufacturer stating that it meets emission controls set by the US and 2. Be sure to declare it at the border when you cross. Saves you a huge amt of hassle. Hope these help.

Hey all, I've been chosen to create a hospital specific pocket reference manual for new staff to ease transition. I know this is far from new and I know there are others in cyber land who have experience in this. I've been racking my brain trying to think of what are the useful policies a new Grad or Hire would like to have at hand in a portable pocket book. Not much success so I now turn to you all. Could you please throw some ideas at me? Again what I'm specifically looking for: Policies and Procedures that are common but maybe slightly different in each ED Common Policies and Procedures that are used enough to need to know but not often enough to become routine Routine Policies and Procedures Items that help you to hit the floor running. An example is P&P for hanging blood. I will post this in other pertinent forums but I hope to get a great response here. Our hospital is primarily Cardiac and Neuro, 40 bed ED with,...yes with borders occasionally. Thankyou all Jeff

Dear Educators, I've been chosen to create a hospital specific pocket reference manual for new staff to ease transition. I know this is far from new and I know there are others in cyber land who have experience in this. I've been racking my brain trying to think of what are the useful policies a new Grad or Hire would like to have at hand in a portable pocket book. Not much success so I now turn to you all. Could you please throw some ideas at me? Again what I'm specifically looking for: Policies and Procedures that are common but maybe slightly different in each ED Common Policies and Procedures that are used enough to need to know but not often enough to become routine Routine Policies and Procedures Items that help you to hit the floor running. An example is P&P for hanging blood. I will post this in other pertinent forums but I hope to get a great response here. Our hospital is primarily Cardiac and Neuro, 40 bed ED with,...yes with borders occasionally. Thankyou all Jeff

Thankyou CN, I'll be sure to include those and please feel free to list any others you feel would be needed. Your needs as a new grad are one of my two target groups.

Hey all, I've been chosen to create a hospital specific pocket reference manual for new staff to ease transition. I know this is far from new and I know there are others in cyber land who have experience in this. I've been racking my brain trying to think of what are the useful policies a new Grad or Hire would like to have at hand in a portable pocket book. Not much success so I now turn to you all. Could you please throw some ideas at me? Again what I'm specifically looking for: Policies and Procedures that are common but maybe slightly different in each ED Common Policies and Procedures that are used enough to need to know but not often enough to become routine Routine Policies and Procedures Items that help you to hit the floor running. An example is P&P for hanging blood. I will post this in other pertinent forums but I hope to get a great response here. Our hospital is primarily Cardiac and Neuro, 40 bed ED with,...yes with borders occasionally. Thankyou all Jeff

:angryfire I'm trying to find some research on how hospitals or nurses are dealing with physicians leaving sharps for other staff to clean up. Not so much on a personal level but on a hospital wide administrative level. Can anyone point out any discussions on here, research links or plans of action to change a dangerous culture in my hospital? :angryfire

I was the same way when I graduated. I was hell bent on getting into the ED and Med/Surg was not for me. Fortunately no ED was going to adopt a new grad at the time and I put my time in on Oncology then ICU and CCU before ED. Looking back, omg, what was I thinking. I was living proof of ignorant is bliss. I was way over my head in knowledge, experience and skills and had not a clue. Now, if I could do it over again, at least! a year cardiac/tele floor nursing, two being the minimum ideal. Like it as much as not, when crap hit's the fan it usually comes back to cardiac. Next break into SICU or CCU or both for atleast a year, again two would be an ideal minimum. This would be my recommend for a new grad who wants to fast track to the ED, more experience being better. Why put in the time? You develop that sixth sense, your "feelers" if you will. You'll learn to recognize when a patient is going downhill. Critical Care will give you skills and knowledge that are invaluable in a crisis. I do know from my own experience that few new grads will heed this advice and not realize it's worth until looking back. If you can tough it out and put in the time, the ED when you enter it will be so much more rewarding in the long run. Good luck!

I'm not sure if this is where you've come up with your topic but there was an article in the Journal of ER Nursing I think a couple of months ago. I read it but I don't remember if it had any references for you to peruse. Give it a go if you haven't read it already.

All the previously mentioned (that is positive) is true by my experience. I love working in the states and at this time have no intentions of returning anytime soon. True, the money is nice but the respect, training (free) and opportunities for advancement are what keep me here.

Safety was the biggest reason we went to this system. When campers would come out with an m&m tray of medications and say they get these at this time etc, you really didn't know what you were giving. Time and organization were the second reason. Overall a huge benefit to our organization. One thing I learned from experience is have the familes pack an extra day or two incase the meds hit the floor and disappeared into the nether world.

I'm not sure what you mean by mandatory rotations but I can describe a little of what goes on. University ICU is a level one surgical/medical icu, 12 beds with 99% of pt's on a vent (if no vent usually on their way up), Art line and Central etc. You work on a "team" that has the same rotation (over what time period I'm not sure) and there are like 5 or 6 teams. It's really quite nice once you break the ice. While being the highest in pt acuity the ward is also the oldest and least modern, physically. Kind of like a dungeon, gloomy, 2 windows etc. Staff parking? 4-5 year waiting list minimum. St. Pauls ICU is a beautiful modern ICU, open view etc, 14 or 15 beds. The staff are some of the nicest I have ever worked with. About 1/4 to 1/2 of the patients are vented, typically, but that can easily climb. A M/S ICU as well, deals with a lot of vascular OR's (with the exception of CABG's which are the sole domain of University ICU), all hospital codes and anything else which wonders in. Overall acuity a little less than University. City Hospital is/was a technical dream hospital ahead of it's time and budget. Built in the 90's it's still a truly beautiful hospital. I don't have any personal experience with the ICU there but I understand its a beautiful ICU with a low level acuity and one or two vent's. RPC I know little about other than if you have the stomach for it, it's seen as a golden goose. The money is great (for SK) about 50-60K I'm told and also that it's federal union with incredible benefits. Not much more I can say. The info from ICU is a couple of years old so things may have changed a little but I doubt it. Hope this helps.

I have worked in Saskatoon for the last 5 years and can offer a little insight. Saskatoon itself is a beautiful city, clean, well organized and cheap (compared to other large centers) to live in. From a nursing standpoint...we are as short as anywhere else. What may be different about saskatchewan is that we are losing almost all of our new grads to the wealthier, better paid provinces on either side. Our nursing crisis is not getting better by any means and there is a serious lack of support by government officials, local to provincial, to do anything about it. Work conditions: We have a strong union which does get positive local results but we are in a strike year and it is likely that we will make some form of job action. (I often wonder, do the recruiters woo you with praise and comments but tell you that once you sign on the dotted line they will lock you out and play the media against you like you have been here for 40 years?) Our health care system is breaking down due to shortages of skilled labour on every level. We have some of the longest waiting lists for surgury and even medical admissions. Working here can be very dis-heartening. Do not expect to be treated as well once you get here by management. There is no recruitment effort worth mentioning within saskatchewan. Retention efforts are near non-existent. The only continuing ed courses outside the basics (bcls, acls) are and intro ICU course and Surgical course which they will pay for with your 2year commitment. Anything else and you are on your own. Orientation is usually 7 days including partner shifts in M-S and a little longer in the critical care areas. As a plus to new grads seeking entrance into critical care the district is really moving into hiring them with extensive orientation programs in place. As far as overtime, tonnes of overtime available unfortunatly not enough people to take it up which means beds are closed and you may end up working over census or with much higher acuity than even I am used to in my brief career. I have NOT heard of any attempts of mandatory overtime. Yet. In general, when I first started I thought the Saskatoon Health District was alright. You worked hard, made a good wage and pursued your educational goals on your own. Having gotten a different perspective in Alberta I really believe that SDH and Saskatchewan are getting away with murder. They retain their nurses with barely a hint of effort to retention as compared to the other provinces yet the nurses work just as hard. Saskatoon is a beautiful city and Saskatchewan a great province. Just two things: Don't get sick in SK and don't expect the job to be satisfying or appreciative. Please let me know if this helps! P.S. I'm not a bitter person, I'm just calling them as they are.

Apples and oranges. Two different types of nursing with their own stresses. Proof? Put an ICU nurse on the floor, put a ward nurse in ICU. Both will likely be fish out of water. I wouldn't try comparing the two as different organisational skills are required. Different kinds of people fill these jobs for that matter. They really can't be compared. Both are equally difficult.