neuro23

Like CCRNJEN stated, the term "triple reflex" is often used in place of terms such as "triple flexion response," and "trigroup contraction" (and isn't related to Cushing's Triad, i.e. (1) bradycardia + (2) systolic HTN (i.e. pulse widening caused by elevated SBP with small or no changes to DBP) + (3) respiratory pattern changes or bradypnea), though the triple reflex is usualy a grim prognostic sign. It's sometimes similar in appearance to the evoked clonus (e.g. as we see in SCI pts after a quick manual dorsiflexion of the ankle causes clonus for several seconds following the stimulus). Like clonus that is evoked by the clinician, the triple reflex is a motor response that outlasts the duration of the stimulus. It *can* look like a spontaneous "twitching" but it is not caused by seizure activity. Often it is unilateral, but sometimes both legs are involved. The triple reflex is most noticeable in the ankle, but if you look closely, a true triple reflex also involves the knee and hip. Before calling the movement described a "triple reflex," have a neurologist (or experienced neuro resident) check, because it's quite rare (I've seen it in maybe 10 different patients) and it's often something else. A true triple reflex is a very ominous sign. Aiden Neurosurgical ICU nurse BSc. in neuroscience P.S. You'll have more luck looking up the term "triple flexion response." P.P.S. It's almost 5am so please forgive me in advance for any spelling/grammatical errors (thanks)

Honestly, I'd never thought of that. I don't think most vented patients could be positioned lying at 30 degrees in a CT scanner because the head wouldn't be centred in the gantry. I'm sure a 30 degree position would be possible in our angio suite (biplanar with 3D reconstruction). I also think the incidence of VAP may be decreased by suctioning and cleansing the oral cavity before transferring the patient to the CT or angio table. If a patient with an ETT must remain supine (for whatever reason), maybe placing a couple of throat packs (or any easily removable absorbent swab) might help -- might need McGill forceps. Great point though! Neuro.

Here's an interesting link pertaining to the lack of seatbelts on buses (school buses in particular). http://www.osba.on.ca/releases/pdf/bus.pdf I'm not an expert, but it seems as though there are other ways, such as the 'compartmentalization' concept that allegedly make seatbelts on school buses less safe. That said, new European school buses come equipped with seat belts, so I'm not certain what the solution is. NHTSA statements argue against seatbelt use in heavy passenger vehichles such as school buses (which use the compartmentalization safety concept). Others claim the NHTSA statements are mere propaganda -- cost being the motivating factor for the absence of seatbelts. School buses in at least 16 districts in NYC have had seatbelts since the 80s ... Even if they're not required (based on the compartmentalization concept), the use of seatbelts on school buses would seem to implant the idea at a young age that seatbelt use is "natural". We would hope this would transfer into higher seatbelt compliance in the lighter vehicles most will occupy or drive in the future. FYI, one law states that the driver of a vehichle is responsible for ensuring seatbelt compliance for under-age passengers in any vehicle equipped with seatbelts ... I'm sure school bus drivers would ensure such compliance if the buses they drove were equipped with seatbelts. Neuro.

Pretty much the same in our Neuro ICU in Edmonton ... HOB @ 30, OG vs NGTs, oral care: cleaning the tongue and teeth (where possible) with a toothbrush + toothpaste Q12h + mouthcare Q2H using toothettes with chlorhexidine mouthwash & suction. We also started using EVAC tubes (which sxn secretions above the cuff) about 5/52 ago. The Q2H mouthcare is also important in maintaining long-term patency of the EVAC tubes.

This link may help ... http://www.jointcommission.org/AccreditationPrograms/AssistedLiving/Standards/FAQs/InformationManagment/Planning/abb_list.htm Also, when I did my hospital orientation, we were told that our Alaris pumps should be set to 0.5 cc/hr TKVO (I checked the Alaris website and the newest pumps have a KVO button / soft key that delivers 0.5 cc/hr). EMS often come into emerg. with 10 gtt/min sets running by gravity, and their KVO rates are sometimes about 100 X higher (~ 50 cc/hr) than our pump KVO rates, but since rates fluctuate when an IV is running by gravity, and there are no alarms, etc. 2 drops in 15 sec (~50 cc/hr) is what we've been told is an acceptable KVO rate with such sets ... can't find a reference. We switch to a pump or 'take down' and saline-lock these lines. I don't work peds ER much (I've done maybe 10 shifts there including 3 buddied shifts), but I've seen the 24 ga angiocaths hep-locked by the "peds. core" RNs. Anyone know how long a S/L'd 24 ga will last before needing to be flushed? Is it not safer to use an Alaris pump at .5? FYI, I also work in Neuro ICU where some RNs still use saline drives (i.e. NS Y'd in with a slow-running med line) to maintain patency of some drips (e.g. insulin 1u:1cc, which we always double-prime because insulin binds to sites in the lumen of the tubing), but our clinical educator says our pumps don't need "drivers" and can be run as low as 0.25 cc/hr.

For vesicants (e.g. KCL), a smaller ga needle allows greater hemodilution and less vein irritation. If I'm starting an IV on someone with "ropes" for veins, I'll start an 18 because I know there's going to be plenty of blood to pass over the angiocath, diluting the med. For a non-cardiac, med-surg patient, who needs meds or non-bolus hydration only, I'd probably use a 22 ga for patient comfort. I've never heard of insuffusing lidocaine befoe the insertion of an 18 (14 - 10, yes, but not an 18) ... lidocaine hurts more than an 18 ga needle!

She probably has the results already. I got mine the next day (Pearsonvue, in Vancouver). Anyway, I have almost 2 years of critical care experience (and 2 other science degrees other than my BScN) and I was cut off at 75. I was stressed, but the test took me almost an hour and I found the questions to be quite challenging. When I got cut off at 75, I though ... oh sh*t! But I passed and now have a US licence. My advice -- don't stress. Stressing won't change the outcome anyway. If she did fail (unlikely if she was prepared), she'll get to re-write ... not the end of the world.

How is that possible?

What does "INT" stand for?