ShaunES

We cool for ~24 hours, then passive rewarm with space blanket aiming for 0.5 degree celcius/hour. We remove blankets and recommence cooling if they exceed this. We've had several successful cases, but we've also had several unsuccessful cases. Have t...

If you're applying to ICUs why are you getting nervous about going into the cath lab? Just go, it sounds like a good job with a good orientation and it will certainly get you in the door.

Bottom is worst. Properly positioned esophageal probe (at the aortic arch) will give you the closest match and the fastest response to blood temperature changes.

cvp is useless to assess volume status and you should ignore it; better yet, put your vasoactive medications on the distal lumen and you have another free lumen. last or first it doesn't matter, there's going to be a good whack of medication in the a...

Seems much simpler to just use a bag and then you never have to stop it.

If the argument is that it's time consuming, then I agree, it can be time consuming. On the other hand, changing bags takes a minute or two at most, and fluid removal is simple. As for charting, I'm not sure how you guys do it, but it's pretty simple...

That's why they're 1:1. What's the difference between an intubated patient and someone on CRRT? If you lose an airway that's a lot bigger deal than your circuit clotting. I don't understand.

CRUSADE is demonstrating that those treated with Morphine have double the mortality rate than those not given morphine. If one were to use opiates/opioids, I would suggest fentanyl - faster, nicer and an all around better drug.

I work in a large ICU in Australia. We're 1:1, and work 12 hour shifts. We get a 20 min morning tea, 30 min lunch, 20 min afternoon tea, 30 min dinner. We do break with our neighbour; our bedspaces are separated by curtains and benches, and you can s...

I've walked intubated patients around the unit with a transport ventilator, so no, using a bedside comode isn't that crazy an idea. Not every intubated is unstable, if you have the resources and time to do it safely, do it! (The procession for the wa...

I just use the bolus feature in our pumps, saves me having to baby sit the pump, and I don't accidentally leave it infusing at 1200mL/hr.

Our hospital has occupational therapists who do all our splints/etc, they provide scrotal slings to assist with reducing pressure, seems to work.

Sounds like a problem with the system, not with you. In my ICU, all orders are entered onto our electronic system by the doctor requesting them, and show up instantly on our bedside computer. Similarly, lab tests are ordered the same way, but in addi...

When you're sick!

http://www.srlf.org/data/Upload/Consensus/pdf/50.pdf This study has the patients in severe sepsis on an average of 0.45mcg/kg/min of noradrenaline, with a maximum of 1.06mcg/kg/min. While there is still a lot of mystery in when you should add more va...

Our septic patients start on noradrenaline (nor-epi/levophed), once they hit about 30-40mcg/min, we start vasopressin at 0.04units/min, and from there we can wean the noradrenaline down, but keep the vasopressin going. This way we use the optimal pre...

Any trauma like that should score an art-line anyway, so the noise of a trauma bay is irrelevant after that goes in (usually one of the first interventions).

Australian ICUs are 1:1 for ventilated patients, and 99% of patients are 1:1 anyway. Come on over!

I get six weeks a year of paid leave, or 12 at half pay, enough time to relax, dont have to use it all at once, or at all (so can have massive holidays every few years etc), it's nice.

Since we've covered the easy stuff, how about something way out of left field? Paroxysmal Nocturnal Hemoglobinuria!

Hey, I'm in ICU here in Australia, and I've noticed that you guys in the states seem to have 1:2, even with stuff like vents and CRRT. I'm just wondering about the practical aspects of this; what happens when one of your patients tries to rip somethi...

An ECG takes 30 seconds, and pulling bloods takes 2 minutes. I don't understand why you would spend time trying to get the order changed when you could have done in the time you spent complaining!

Vents are 1:1 here, CRRT is 1:1. 95% of our patients are 1:1, even the people waiting to go to the ward.

In our hospitals ICU it is policy that nurses do not reinsert airways (how often do you actually get to use it, and do you want to stuff it up and make further reinsertion more difficult?), nor do we keep trachys at the bedside (a lot of waste given ...

We use ICIP, from Phillips. It's great, I haven't had a problem at all, and it integrates with everything so well.