labordude

This is where I was going. The presentation screams this to me. AFE, especially the rapid cardiorespiratory collapse, neurologic symptoms, moving into DIC and left ventricular dysfunction. The low platelets and low fibrinogen are hallmark and I bet that EJ would high fibrin split products if that lab value was present too. The upside is that AOK is really effective IF AFE is recognized and the meds are given quickly. They are easy to keep available and can be kept together in an AFE kit.

I think I'm with you. If I'm right, we were just talking about this at work the other day and WAY too few people have ever heard of the acronym that helps both identify the condition and the initial treatment for it.

Woohoo! Let's go...I'm waiting for the promised later excitement too. Initial presentation is pretty much..hey I see this every day ?

They are incorrect and this will help you, especially if it's something of interest to you. I have the pocket guide, but I don't have or use any other books. For reference on medications I use Hale's Medications and Mother's Milk as well as LactMed. Get the apps (they're free!). Sidenote: What would they think of me? I'm a dude and I've been a CLC for 12 years!

They all have their ups and downs. The issues with the NOVII are independent of the system it is connected to. Placement, falling off, reactions, etc are more than likely user error or doing the prep incorrectly. There is a correct way to place it according to the vendor: http://www.monicahealthcare.com/Monica_Healthcare/media/Monica/Novii Support Material/107-PT-005-US-rev2_Novii-Operation-and-Maintenance-Manual-(DOC2111914).pdf The issues with connection (it's Bluetooth) are likely poor implementation of the antennas in the unit and too much interference. We have several rooms where it works great and others where we don't even both.

You have heard incorrectly about Houston. While Ben Taub & LBJ have midwives, they are part of the staff. The midwives at Texas Children's are part of the Women's Specialty group which is OB/GYNs, CNMs, and NPs. Methodist Willowbrook also has midwives (who are amazing by the way). Memorial Hermann also has at least 2 credentialed midwives who work as part of private practices but have delivery privileges. By and large the city is not CNM in hospital friendly, but that will likely change. More and more people want the combination of the CNM with hospital. I have no intention of doing out of hospital deliveries.

This will definitely fade over time, meaning how much it bugs you. Also "5 but I can stretch her to 6" is still a 5.

Artificial Rupture Of Membranes. In general terms, breaking the bag of water using a special tool.

Guttmacher has this up to date reference on minor's access to different kinds of care. The third column is prenatal care. 33 states allow minors to access prenatal care without parental involvement or notification. https://www.guttmacher.org/state-policy/explore/minors-access-prenatal-care I agree with the others who suggest looking for your particular state laws, but in the presence of ambiguity, I'm protecting my patient's confidentiality and supporting her choices.

There is a distinct difference between the skills necessary to place an IV or an NG tube and the assessment/knowledge/etc needed to titrate drips. It is this difference that forms the major gap between CNAs and RNs. Give me a new grad with a strong physiologic and a pharmacologic knowledge base any and every day and I can teach them physical skills like IVs, NGs, and Foleys. The opposite situation is much more difficult.

Yeah, I have that and my RNC-OB and AWHONN and CLC and whatever. Seriously, at some point it becomes RN, (insert alphabet soup) ?

I agree with Klone, though if the answer options don't have that it would just be prolonged because of the greater than 2 min but less than 10 minute long deceleration and return to baseline.

I made this switch 5 years ago after almost 10 years in Level III-IV NICU. I only wish I was able to switch sooner, but I knew exactly what I wanted and it wasn't a maybe situation for me. Since I didn't need as much (or really any) extra training on the baby side of the delivery, I was able to really focus on the mom and fetal side which was awesome. I was able to care for moms with likely NICU admitted babies really well and prepare them for what they might see/experience/etc. It was tough sometimes if my baby wasn't good at delivery not to jump over to the warmer because I was the mom nurse and not the baby nurse (though there was one time we did an "okay switch" because the mom was good and the baby needed help which was taking a while to get there). If you think you want to do L&D ask them to shadow. It shouldn't be an issue as a current employee, we do it all the time for people interest in internal transfers.

Well let's start Education: The nursing education system needs a revamp. We need a single defined educational entry that allows one to sit for licensure. More focus needs to be placed on pathophysiology and other science-based curriculum topics and not as much on theories (sorry Jean Watson) at the entry to practice level. Since clinical experiences with live patients can continue to be limited, maximize simulation while finding alternative experiences that practice application of knowledge. Interdisciplinary training/classes are incredibly important and the earlier in the educational program for every discipline the better off for future collaboration. The NCLEX needs to add a hard lifetime limit. Other professions have this. Standardization of curriculum across states will also help. Residency/preceptorship programs need to be improved and also standardized. There exists best practice for many of these programs, but they aren't always used. Nurses need to be more visible as community, organizational, and political leaders. Nursing is always considered one of the most trusted professions, but it's only recently we've started climbing up the list of most respected. When it comes to the future of care in the community and education to keep it that way, nursing must be on the forefront. Having representation at higher and higher levels of the government is necessary to have the voice heard. Very few members of Congress are nurses and as far as I can find, a nurse has never become a U.S. Senator (one from TN tried but she didn't win back in 2006). Also, did you know that in some states, in court a physician can be an expert witness on nursing standards of care? I won't argue that resources aren't an issue, but having seen this from the top down in several organizations, it has often come down to poor planning, budgeting, and forecasting. The organizations that handled this better were ones where nurses had voices higher up that were listened to. I have seen plenty of organizations where nurses are in visible positions of title that either have absolutely no business being there or are simply great "yes men/women" (although this happens in all industries). There is an experience/complexity gap with staff today. The "shortage" is because we have a glut of inexperience not a number deficit. Healthcare itself needs a gut check and must work on increased collaboration across disciplines which includes less improvement in silos and more truly impactful projects. This silo issue is a reason why many initiatives (in healthcare and outside) fail due to lack of actual stakeholder input. Since we know we are going toward a more electronic system and the ones we have now had nursing input...mainly after the fact, it's time to fix that for the next generation. Regulatory requirements put a huge damper on things, though if we stuck to one it would still be easier (e.g. something like using CMS rules for documentation and other insurers accept those). A lot of this is driven outside and away from the bedside BECAUSE there are no nurses there. I've worked for some amazing organizations who did so many things well and also for others where the left and right hand actively hid things from one another. I've worked in positions from bedside staff nurse to right-hand of the COO & CFO and many things in-between. I'm not trying to say all of this should/would/could/can be done, it's just things that I believe would help.

Those things don't fix the profession, they fix the job. I'll admit my wording could have been better.