cvicugirl

Good advice from everyone. Make sure the docs and nurses disinfect their stethoscopes also (quite important with a surgical chest.)

I'm still curious-what causes green sweat?

We use music therapy in our heart program to decrease anxiety pre/post op. Specifically, instrumentals with 60 beats per minute, to mimic a "calm" heart rate.

In my experience, hespan has fallen out of use due to cost vs. benefit when compared to NS. Also, as PrettyinPink1234 mentions, coagulopathy and nephrotox are potential risks of use/overuse.

[quote name= The Mom (Nadya) has done IVF for all of her children, using the same (unidentified) sperm donor for them all. According to grandma, Nadya "just wanted one more girl"...[/quote] I'm a lurker from CVICU and have enjoyed reading your comments and insight. Question: Is it standard practice to implant this many embryos, hoping for one to take? This seems negligent of her doc to implant so many, especially if she was against reduction (I am assuming she was against reduction, or perhaps just plain ol' crayzee?)

We had a surgeon who used to do that, too. I'm fairly certain our P+P used the same measurement frequency as a "normal" chest tube (measured and dumped hourly) and it also included regular instruction re: JP care. Emptying the JP with a large syringe instead of squeezing the contents into a speci cup will decrease your chance of blood exposure.

I have witnessed many a CCL tech and a cardiologist or two massage a forming hematoma at the same time they were holding manual pressure. The cardiologist was essentially "milking" the hematoma from the cath puncture. Although I sort of see what they are trying to do, I'd never attempt that myself. I'd reevaluate my positioning and intensity of the pressure to prevent the hematoma from enlarging. Depending on the size and location of the hematoma, sometimes they need to be surgically removed.

Okay, what is your experience with online ACLS renewal? I'm catching holy grief from my staff because I found out that many of their renewals are done online and I am not authorized to reimburse them. Our hospital provides and pays for in-house certification and recertification and pays them their regular hourly to attend. What gives?

Niiiice. I hope you kept their tech until the postmortem care was complete!

:yeahthat:I'd also recommend training everyone on sheath pulls, not just a few. Training should include basic A & P review, technique, and troubleshooting (what to do when things go badly.) Ideally, the RN should have several pulls under his/her belt, with a variety of patient body types before going independent. If you still feel strongly against pulling sheaths in your environment, check your unit's Scope of Service (your Manager should have one.) This will delineate what types of patients are admitted to your unit, typical acuity, frequency of assessment and VS, and admission/discharge criteria. You might be able to argue these admissions if the frequency of vital signs and assessment exceeds your unit's scope of service, just a thought.

Hang in there. It is very common to go home emotionally and physically exhausted, especially with this stuff being so new. Do you hear bells and alarms when you are in bed trying to go asleep? We've all been there. As long as you know WHY do are doing the things you are doing in the ICU, don't let anyone bully you because you're slow. Your skills will improve with practice.

I had to make sure I read that correctly...your hospital has no pharmacy on the night shift? wow. I wouldn't hesitate calling the on-call Rx for new orders. Perhaps if they get bugged enough, they'd give you some coverage.

We had so many problems with tardy/missing meds and anesthesiologist complaints (Rx policy won't let them mix their own meds for routine cases) we now have a satellite pharmacy located between (and within shouting distance:icon_hug:) of the CV & Surgical ICUs and the Main OR. All ICU orders are scanned directly to this pharmacy, so they never become part of the main hospital's PYXIS queue. Right now they are doing an antibiotic time study that tracks order, delivery, and dispense times-- so techs will actually hand deliver them to the bedside. The pharmacist also responds to all codes in CV and SICU, and has the designated "scribe" role. Many times they are the ones who are calling out Rx suggestions or letting us know that it is time for more epi, etc.

It is irresponsible the way your unit is staffed right now--eventually nurse retention and patient care will suffer. While it might seem fine if the MS nurse is given the easy patients, who has your back? Do your MS RNs have ACLS? Is your mgr also the MS mgr? It makes no financial sense to pay OT to ICU RNs when MS RNs aren't getting their hours. When the suits look at the overall hospital staffing costs, nursing OT sticks out like a big red flag. IMO, your mgr needs to either hire more ICU RNs (even a few prns) and cut MS positions (if they aren't making their hours) or (a better idea) suck it up and properly cross train some good MS nurses to ICU. You can always hide orientation costs in the unit or hospital's education budget.

Plavix too. I'm sure that's why they didn't want to take the dude back, they figured you can't sew up oozy coagulopathy. What did his initial post-op chest film look like? I'd argue that it might be worth the re-op just to remove the big blob of goo that was probably sitting behind his heart. Wow, glad to hear he is neuro normal--sounded like he'd be a long term pump head at the very least. Good job!

1. Don't deliver a dead person to the ICU and then argue that they aren't dead. (This has happened to me. Twice.) 2. Please don't tell me that you didn't treat the 2.1 potassium level that was reported hours ago because you were "having trouble" with the pharmacy. 3. If you come into the unit complaining that you had to hold my ICU patient for three hours, don't be surprised if I write you up for not calling in the consults or initiating orders that were written in the ED. 4. If someone deemed it necessary to place a femoral arterial line in the ED, kindly transduce it.

Here's an update from my previous post: I finished reading the Fink book, concentrated on finally understanding what I didn't already know, and easily passed. The answers to the questions came from my experience, not a book, jmho.

If you only have 2 or 3 night shifts/month, schedule them all together and make sure you have at least 2 full days off to recover before going back to days.

Sounds entirely reasonable to me. Ever have an uncomplicated manual sheath pull blow on you? I'd rather catch it sooner than later.

Think of it this way: Dobutamine is an inotrope, milrinone is an inodilator. Dobutamine will increase CO/CI and heart rate (and cardiac O2 consumption) with a small decrease in SVR. Milrinone will increase CO/CI with little effect on HR and cardiac O2 consumption (all inotropic effects), while seriously decreasing your SVR (dilator effect.) Milrinone has a more profound effect on systemic BP and has a longer half-life than dobutamine. It is very useful in primary pulmonary HTN. In my opinion and experience, milrinone and levophed is the best combo to treat low output states in a normovolemic surgical or medical heart.

I took the CSC recently and would agree that if you know cardiac A&P and have been recovering hearts for several years--you'll do fine. I didn't study, but then again, CV is my thing...

I feel foolish asking, because I'm sure it is obvious. I've been to the Louisiana BON website and I can't seem to find out the procedure. This is driving me NUTS (and they are closed today...)

I'm so frustrated with the lack of accountability shown by nurses! For example, isn't it a nurse's responsibility to maintain their licensure and certification?! I use an excel program that I use to track license, TB, CPR, and ACLS dates of my staff. Six months before expiration, I send a friendly reminder e-mail (which I think is pretty nice of me to do.) Last month I sent two ICU nurses home because of lapsed licensing, and they were mad at me for not re-reminding them! And they think it is unfair to not let them work on a lapsed BLS or ACLS card! I find this unbelievable...

Remember, asystole is what you get when you combine a right bundle branch block with a left bundle branch block. With RFAs you are trying to interfere with an abnormal conduction pathway. With valve surgeries, it is common to "accidentally" interfere with conduction pathways (normal or abnormal) due to the very location of the valves. The simple act of suturing and the inflammatory process can do this, which is the reason why surgeons place temporary epicardial pacer wires. Since this guy was halfway there (with a R or L BBB) perhaps this inflammation advanced his existing block into asystole. Since the patient was most likely on a Bblocker pre-op and still in an atrial rhythm, I think it would be appropriate to restart it post-op, especially since he had AV wires (At least more preferable to cutting it cold turkey.) I'd rather be 100% AV paced than have flutter any time.