Wile E Coyote

That sense of shock at no longer being exceptional has been many an M1's undoing. Do not get rattled when 'the 3 smart folks in the back' get weeded out, it does not reflect on you. You may bomb your first exam or two, if so, just dissect your study process, cutting away what doesn't work. Acknowledge that a surprisingly large degree of your success relies on your ability to manage self-doubt vs actual book lernin'.

I'll chime in to agree with the recommendation to check out SDN. You won't need to spend much time browsing to get a sense that "wth did I get myself into" is an extremely commonly expressed theme for M1's.

I could see a sleeping, prone COPD'er retaining more CO2 from baseline long enough to bump her serum Bicarb if in said hypoventilating state long enough (several hours, overnight, etc). As far as pure #'s I've absolutely seen HCO3 baselines well above 43, particularly at end-stage. For non-respiratory driven causes, I'd start by looking at the rest of her lytes, any new meds, & her hydration status. Is this an acute hospital patient or some other status?

Management.

Just show up to a local SAR training session with some pace-count beads on your pack strap... you'll be in-like-flynn.:) Seriously though, these previous posters are correct.There will be exceptions, but expect to not only volunteer vs draw a paycheck, but to pay for most of your gear. Also, it's common to spend time beyond training on fundraising efforts. Teams are usually pretty cash-strapped as a group.

This is stuff you anesthetists know very well, but if the providers avoid the Versed recommendation and stick to only Ketamine, ( I'm not advocating this BTW, just giving a 'for instance' scenario) they most likely will avoid suppressing cardiac output. However, I too feel that the scenario they are trying to avoid is rare enough and the fix (Ketamine mono-therapy) has enough downsides that it's a poor solution. Perhaps waiting 20 mins for the emergence reaction from Ketamine-only sedation (probably now in the ED, mind you) to then give the benzos, right? I think that's a bad choice. too.

I'm cornfused here... OP, your line about aspirating and coughing violently for 20 minutes doesn't jive with no "apparent swallowing concerns" nor does the violent coughing jive with the statement that the pt's cough was weak.

18 years ago, my tele floor charge RN used to get a daily list of all 'missed charges' from the previous day. An IV catheter was $18, a bag of fluid was $56 (prices charged to the patient, not the negotiate rate paid by any insurer). Currently, I sit on two different committees that discuss price on every product or device we evaluate. Now, that doesnt specifically speak to your question, but is in the ballpark.

Ouch, that's embarrassing. I've probably corrected someone on this very cite about that particular mistake.

Could you please sight your source for this statistic?

It's pretty much expected in acute care hospital settings. You'll care for coworkers, family of the guy that does your yardwork, your kid's teacher's kid, etc. at least once, if not often. I've taken care of doctors, my mayor, my hospital CFO, my recently former nursing instructor.

If you consulted lawyers experienced in professional licensure issues, I would think their advice has high merit. I recommend you consider deleting this entire thread, or at least heavily edit it. I'm also compelled to recommend getting a professional, objective opinion on your mental health both past and present.

That's how I read it, and my answer is private duty nights.

Stellar post, amigo. I'm picking up what you're laying down. I agree that although sound in reasoning, it reads like a sad indictment of nursing's state of affairs.

PERT Consortium