PICNICRN

Did she have a leak? Did you check a cuff pressure? The cuff is not always inflated as much as it should be, but does not cause problems with ventilation so we don't worry about it. And even if it is, like the above post says, the OG can migrate with coughing and such. We usually place our OGs as "OD" tubes- transpyloric to avoid this. Sounds like she aspirated... sad.

Ya know..... he could just as easily say the meds in question must be yours- after all, you did live together! Let it go- you seem to have done enough to ruin him for now.

How about the 'hand over the face'?? Usually I try this with our "unresponsive kiddos, but it has worked with some "seizure" pts. But like I said... ours are a little less mature.

I was just thinking about this the other day..... When I was in nursing school, I was 3 of 3 for passing out during my "OR experience"! Normally I took afternoon clinicals because I was not a morning person- first time was a cataract same day surgery anesthesiologist stuck a HUGE needle into the orbit of the old lady that he had just given some versed/fent to.... then he asked her to "follow his finger" and only one eye moved---------------- YUCK! I hit the floor. Next 2 times were both "same day "surgeries- didn't even make it past the IV insertion in Pre-op--- I chalked it up to being early morning and I had not eaten. Let me tell you.... as a "real nurse" I had some concerns in starting out in PICU as a new grad because of this- but, I work for a trauma center and have seen some pretty disgusting stuff- even did internal chest compressions my first year as an RN- it comes down to when you are responsible for someone else's life and you have a job to do- somehow, your brain just does it. No queezyness at all. I cannot explain it- your body just does it! I recommend eating! Also, do not lock your knees, and if you start feeling hot and dizzy- just sit. Don't be embarrassed- OR nurses must deal with this all the time. They will help you. Since I've been a PICU nurse, I've had a number of students pass out- as well as parents and visitors- it's a lot to take in ! You will be fine! It has happened to the best of us!

Our "seizure fakers" are a little smaller and not as "mature" as yours most likely are. I usually try the holding down of one limb or part of a limb- if I am able to, or the original type of movement of the limb changes or weakens... not a seizure. And I totally agree- sometimes you just know.

I couldn't find anything about not using a chest vein either. In our world, if you have a good blood return and it flushes well- use it! I'd imagine that some might think that you might not be able to see if it would infiltrate. But trust me- if you have an ICU nurse with a chest vein as the only access on a pt on Levo...... they will be watching that IV like a hawk! ohhh... and if I were that nurse assigned to that pt- I'd be making darn sure my pt got a central line! You did all you could do!

I think we are a little different in the Pediatric population in that we use feet, scalp, legs, groin, ect all the time- and I prefer the saph to any upper extrem vein in most cases. I've even seen one placed in the abdomen until central access was obtained. I think your main concern should be what the heck is an ICU pt on Levo doing without a central line for God's sake?? Not only for access, but wouldn't they want a CVP on the person?? Many of the pressors are not so good to give peripherally- dopa can really cause some damage- and is recommended for central access only. In a pinch, I guess you did the only thing you could do. The only other place I could think is an EJ or Fem- I don't know how your facility feels about that. Personally, I find it appalling that any patient is stuck multiple times for IV access- it is totally unnecessary! Someone needs to place a Central Line in these folks.

Off topic>>>>>> I wish I could loose 27 lbs in 4 days!!!

Yes.... the SNATs(suspected non-accidental traumas) are by far the worst thing I deal with day to day.There is just no way make sense of it in your brain. That being said, it is not every day. And the ones who get better and go home far out- weigh the ones who do not... even in the PICU. What area will you be working?

Mostly all of our pts are weighed in bed also, one thing that I have learned to do is when I do the initial weight is to put a note taped to the bed that says- "pt weighed with crib sheet, X amount blankets, leads, vent tubing, ect"- whatever the case may be so that the next person knows what to zero the bed with or at least they have some idea of what the last person has done.

Don't worry, if you are going to a national leader in Peds care you will receive a good orientation! They will make sure of it! That being said.... I suggest brushing up on your "norms" for vitals, and basic calculations- we do TONS of calculations everyday because every med is based on weight.(I was shocked after 10 years with kids and I took ACLS and found out they give" liters of this" and "amps of that" to those adults!)lol. Remember you ABCs--- almost ALL peds pts get into trouble because of AIRWAY! Take a PALS class right away even if your employer does not require it for 6 months- you will learn so much including nice little formulas for weight estimation and estimates for tube sizes ect. Also.... go out and buy a copy of the latest Harriet Lane! The best ped resource book out there- I swear! Good luck to you and welcome to the wonderful world of Pediatric Nursing! I hope you love it!

You absolutely DO NOT want to "ice" a child or infant- I cannot speak for an adult patient- however I cannot imagine that the pathophys is any different. Ice baths/ cooling the core temp rapidly will produce the "shivering" effect! What does this do? It produces body heat- increasing body temp! Many times in the PICU we must use a cooling blanket to keep a temp down for many reasons- sepsis, hypothalmus issues d/t brain injury,, ect- we chemically paralyze the pt to prevent shivering. Then provide the abx, antipyretics. Sometimes cool cloths under the pits, groin, and forehead of the "not paralyzed" pts- but NEVER ice baths.

Like the above post said.... kids who are vented are kept nicely sedated, could even be in a pentobarb coma with the seizures- who knows. I do know that the kid would most likely not be up for play. How about some music therapy??? Ask the parents what kind of music he likes and get a CD player for him. Maybe that will count??

2 days of orientation is CRAZY!! When I was a new grad it received 6 mnths- I know it is a different specialty- but 2 days! This is an accident waiting to happen- IMHO. I can rememeber my first few days of orientation... my preceptor had to remind me to push air into my vial before drawing my med into my syringe.... that is how little I knew as a new grad. You have orientation to learn- policy/procedure, documentation, and Skills(which you are totally lacking as a new grad)- and I do not mean to put you down by saying that- It is the truth, none of us had those skills as new grads! To put you in the situation to be responsible not only for your patients, but to cover unlicensed staff with your license with 2 days of nursing experience total is just NUTS!! Please do not start your nursing career in a facility that is going to set you up for failure..... remember, if you agree to your assignment after 2 days of orientation- you agree that you are in fact competent to perform the task- YOU will be responsible for anything that happens! Don't expect your employer to have your back. Please think about this!!

Exactly as the above poster said!! They, as your employer ,would be required to report this if they actually think you are diverting. Obviously, they do not and cannot prove it.... they are bluffing you so that you will resign. Sounds like you are being totally railroaded! I'm so glad you have searched leagal councel. I'm sorry you have to go through this crap! Shameful of them! Please keep us posted!

All three Children's hospitals I have worked have used the Braslow cart in the ED and a Pedi cart in the rest of the house- as you said- we already know the weight. Braslow is the standard of care, I believe. Now, I could see them not liking that you use the tape without the actual Braslow cart that it was meant for. As for standardization, that really does not make any sense to me either- you cannot compare ED to the rest of the house. That being said, I work at a children's hospital trauma center and all of our traumas go directly to us in the PICU and bypass the ED completely. We almost never know the weight with these kids and usually EMS has already "estimated" a weight when they hand off the kid. Technically, we use the 2X(age+4) to estimate and dose from there.

I'm a little confused- were you cited because you had the tape but not the cart itself??

Back in the day.... there was a list of all the NICU staff who were 0 neg blood type. When a baby needed transfused- O- nurse sat down and they pulled off 20mls and gave it right to the baby.

Got news for ya...... Unfortunately, it's not just LTC I feel your pain!!

Well..... after the first brain death exam- we stopped escallating any care- no titrating gtts up, no labs, no meds, ect ect. These parents were not saying "do everything"- just would not accept brain death-so....Since she was already DNR- her body went very quickly and she had cardiac death pretty quickly from there. Family was all there including their religious leaders- they did a ceremony and stayed with the body for a very long time. Very sad.

Problem is.... that 3K is for a position that is hard to fill, usually. And who do they want to fill it with? Someone experienced- especiallly if they are paying a 3K referal.

I would have to agree with the above. Now, I work in the world of kids and for the most part all of the docs I encounter are pretty great to work with but there is just a special something about the Pedi Orthopods--- usually quite arrogant group of folks. And ONLY concerned about the bones!! Did you guys ever hear that joke?? What is the Orthopedic's definition of the heart??........ It is the organ that pumps the ancef to the bones!!

Ok, lets see if I can clarify the whole "correlation" thing. I can only speak for my self..... I was taught that, as many have already stated, your A line is your gold standard- that IS your accurate B/P- provided it zeroed appropriately, ect,ect. By "correlating" you are checking to see how close your cuff is to your A line- does it always run 10 higher, is it all over the place?? Then.... if something happens to your A-line- you kinda have some idea where you stand until you can fix your A line problem. I guess what I am trying to say is that I think when people use the phrase "correlate" they not speaking about the accuracy of the Arterial pressure, but the accuracy of the cuff as compared to the arterial pressure. Does that make any sense? Maybe I'm just rambling???

Yes.... There is a PCCNP- Pediatric Critical Care Nurse Practitioner track that is not found everywhere, you'd have to do a search(Our PCCNPs were trained in Chicago, but I cannot remember which University- DePaul maybe??? I couldn't be sure). They are trained for Pediatric Intensive Care- focus on the ICU/cardiac component. Then there is an Acute Care PNP- which hase focus more on the "hospitalized child" as opposed to the PNP. But still not critical care based.

I can totally see your point... I mean there are a hospital full of DOCTORS there 24 hours a day. Why not just have a Doc come and place those lines ect??? I do agree.