bellehill RN

Neuro Critical Care
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bellehill has 9 years experience as a RN and specializes in Neuro Critical Care.

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  1. Pupillometer guideline

    We obtain a pupillometer reading on admission for all our neuro patients. Our protocol is to call the MD for: NPi CV %change >1mm difference between pupils We also trend the NPi and if there is a difference between R/L pupils of >0.7 or if the...

    We treat any stroke symptoms the same with the standard benchmark goals. Door to doc in 10 minutes, door to CT in 20 minutes, door to CT read in 45 minutes and door to TPA in 60 minutes if applicable. Our hospital uses a "stroke alert". The important...
  3. Neuroscience - I need some help in Cerebral Circulation

    Grab a textbook, preferably by Hickey and look at it then draw it. I always learned better when I drew the subject (like the Circle of Willis). I think I drew the COW a million times when I was studying for the CNRN. If you can draw it you can visual...
  4. Flotrac for Triple H therapy

    An update: we are seeing great success using the Flotrac. Our goal is SVV40 and CVP>8 for non-vented and >12 for vented patients. If two of the three parameters are not in range we bolus the patient. No more swans...YEAH! Just recently had a p...
  5. Unit Staffing?

    We have a 20 bed ICU we staff with 9-10 RNs, 1 charge nurse (who may have patients), 1 unit secretary and 2 techs. Our goal is 11 nurses plus charge but that doesn't always happen.
  6. Pupils and Brain

    Depends on the location of the hemorrhage and the size. The pupils could be completely equal or unequal. Remember that Cranial Nerve 3 controls pupil dilation so follow the nerve path. Also, increased ICP will affect pupil dilation by compressing the...
  7. cnrn test

    You can purchase the AANN core curriculum to study from but otherwise, there is very little material. I studied from AANN core curriculum and I read the Hickey textbook to prepare. Good luck.
  8. Anyone apply to the OSU Medical Center Residency?

    Why don't you check out the Ohio Health Critical Care Fellowship. I know they were accepting applications last week, not sure how long.
  9. Levophed shortage

    We have a Neo shortage as well, anyone else? We have been using Dopamine and Epinephrine.
  10. Problems with shift to shift report

    Have you tried a bedside report? If you are having trouble remembering what happened during the day go in the room and talk about the patient. Chances are you will remember and the patient will appreciate knowing how thorough you were with report (if...
  11. Shared Governance

    Our unit has a shared governance with 4 different quadrants: customer service, quality of worklife, practice and research, and education. Each quadrant has a chair and co-chair as well as the chair and co-chair of the shared governance. Ours meets on...
  12. Need some Precedex advise

    In our neuro patients it seems to work very sporadically. We were just inserviced on Precedex and it is not to be used for the patient when they are wild. Ideally, you would get the patient calm with Ativan/Haldol/Versed and start the Precedex drip w...
  13. "One Born Every Minute"

    Is anyone watching "One Born Every Minute" on Lifetime? It was taped at Riverside Methodist Hospital in Columbus. I work there (not L&D) and I love to see the exposure. Even if you don't work at Riverside, what a great opportunity for Central Ohi...
  14. Pregnant in Neuro ICU?

    I worked in a busy Neuro ICU my entire pregnancy. I was supposed to work the night I had my child. It is like any nursing job. You take normal precautions just like you would with any patient, even if you aren't pregnant. If you want to try neuro the...
  15. Flotrac for Triple H therapy

    Thanks. We are going to be looking at the SVV, SVI and CVP. If 2 of the 3 numbers are below the parameters the patient will be bolused. This has worked well so far!