Guest193822

Agree with my fellow nurses MAP I remember when i was in my critical care course (no going to tell you how long ago ) i was taught MAP >65 is all organs perfused , MAP 60 is brain only & MAP Hope this helps :)

wedge is a no no with fresh hearts in my facility. We aren't risking busting the artery or valve when PAD is close enough to wedge. Besides in combination with your other hemodynamic you can tell if the issue is (cardio or pulmonary). We are old school as well swan is preferred method for open hearts (CT surgeon). However we are also using The Vigileo monitor for our CHFers/septic pts. but i have issues with it cause you need a working a line for my #'s to be write. We wedge pts only if the don't have any cardiac surgery PRN &'its usually cardiology who like this they swear by it but we all know wedging is going away cause of the risks.

No such thing with on the job training with this population. My facility had a program specifically for fresh hearts. Its not only about meds it's about the equipment & the situations you can be in with these very ill pt. Agree learning the routine & the procedures to handle any thing that can happen. It was a very strong, educated structured 6 program for me. When i was on my own. I was ready. I was in a heavy CVICU they do these surgeries like an assembly line.

Congrats to everyone who recently passed the CCRN. I know it's a hard exam. Good Job. I personally am not ashamed of confessing I failed by 1 question. I still have my results. I was so angry I decided not to retake it. This was 10 years ago March 7 2003. I understand today I'm not the newbie (only 5mons in ICU) that I was back then. Today I'm the seasoned Open Heart Trauma Flight OIF Veteran who trains everyone & then they get certified. When they see I'm not certified they're shocked. It's not mandatory to be certified to work on my CTICU, but it's highly recommend. There's also no extra payment for any certifications in by job. This is why some of us aren't certified. However, the unit has names of all CCRN/CMC/CSC certified nurse on board. I studied my brains out for this exam once & didn't make it. Even today I have doubts to taking any certifications all related to my 1st experience sitting for the CCRN as a new ICU nurse 10 yrs ago.

I plan to apply for the MSN in Nursing Education. I spoke with them today. This school is very military friendly a + for me. I was disappointed they ended there Adult Acute Care CNS program which I was very interested in but I noticed the classes are still taught at the school. I just have to speak with the nursing director for the course. I haven’t been contacted yet. I’m a little nerves going to an online school I’ve never done this before. Can any one recently describe their experience with the school’s program? I will appreciate it.

I have to agree hands on training is definitively important to Open Heart Recovery. Especially that wonderful 1st 12hrs. :) There's nothing wrong with reading books. I also have "Cardiac Surgery Essentials for Critical Care Nursing" on my Nook. You'll gain a wealth of knowledge from the CT team of nurses, RT, Surgeons, Anesthesia, & CNS b/c you'll work with them every day on every case coming through & out the door. However there should be a protocol competency list & training program in the hospital. It's about 1yr along were the new orientees will take classes & have a 1:1 preceptor ship with an experience CT nurse. 50-60 cases with minimal assistance & of course your preceptor feels competent enough to give you the autonomy to care for the pt independently. As a reward you're given the CT Surgery patch on your fleece & have a hospital wide graduation. It's hard training where we believe you should be rewarded. These pt can be very ill. I went through it 4yrs ago. Good Luck

I'm working on my application for Graduate School. It's not a simple processes. I've been at the bedside for 12yrs so I really don't know to much about new entry RN school. I think you should go to the website & investigate. I do know however for Graduate School there's 4 program one can do all on line. Good Luck :)

Is anyone on this site in this program. I'm seriously thinking about applying. I just want know how the programs is like. I did the online seminar session already, however I would like to get feedback from those already in the program.

Levophed max is 40mcg/min. I've worked in some hospitals that will not allow over 20mcg/min & a order is required to go above this. I recently worked in an hospital where the Pt was on 75mcg/min with a Vasopressin at 0.02U/min. Of course the pt's in septic shock but my Maps were lingering between 60-65. I eventually did go up on the Vasopressin.

I've been in this nursing field for 12 yrs. Critical Care/ Trauma is all I know. I attempted to take the CCRN in 07 & failed by one question. I still have my score card. I was so upset I never open another book or took a practice test again. Today I'm preparing to go to Grad school after so many years at the bedside. I'm thinking of retaking the test b/c of course my focus is critical care. I took the old exam. Is there anything out there other than the Gasparis & Dennison. This was 5 yrs ago & I'm wonder is there anything new out that can be helpful. An On line seminar will be great.

We don't use Precedex at all for our hearts. My experience with Precdex isn't great b/c it doesn't work all the time & it does cause hypotension & bradycardia. It's for short term intubations & easy neruo checks, but it doesn't work for every patient. We've used it for 2 yrs now & I'm not a fan of it, it usually causes me more work for fix the side effects for such an expensive drug. go to the main website http://www.precedex.com/ it should explain dose there. This is a medication of mcg/kg/hr & I agree bolus of medication does cause issues with hypotention & I usually give it in 10 mins but stop it before then & just start the maintenance rate.

LOL! This is to much for me. I never heard of any such policy. I personally have taken care of 2 pt's with Levo & multiple drips at once & both intubated. This is a daily life of the ICU nurse. I think you should look up the policy in this hospital. However as a Med Surg Nurse & the drip started you will not be caring for this pt anymore, I would as Rapid Response Nurse b/c I'm ICU & have the portable monitor & the knowledge to care for this pt until the bed is ready which should take no longer then 30mins. Yea been in this situation on the regular medical floors it was solved with getting ICU nurse to go to the floor to start the care. Pt care is #1 so RRT is assign to this situation.

I think I would have gotten fired this day b/c there is no way I will I will allow this until I called Datascope (MAQUET) & taken out the hospital policy to explain to the Cardiologist I question his method. We are using the new fiber-optic technology & the it's clearly recommending the sheath & the balloon is removed as a whole. Any anticoagulants should be shut off for 4-8hrs & a fem-stop is used. My hospital is a teaching facility & there is no issues when a heart nurse questions a MD & pulls out policy, calls the CNS & supervisor involved. We don't play out with IABP or ECMO.....

I love to see newbie proud of themselves. This of course couldn't have happen without the hospital critical care program & your preceptor. Don't forget the nursing is a forever evolution & new things come out every day. Don't forget to look up the thinks you don't know & of course always ask when you feel that nursing intuition for a 2nd look. Congratulations

I'll be honest when I get an order for Precedex, I'm in the habit of pulling out Propofol. I've used this medication since it appeared in my hospital & I'm not a fan of it. It doesn't work for everybody & it does have have effects I'm not crazy about like bradycardia. Is a short term thing for extubation in 24hrs like an overnight PACU. I don't suggest it for long term basis, but we use it short time for Neuro assessment however once we get the good assessment we back to Propofol. This medication is Not for intubation.

I love to hear that you don’t have a space issue, but at my hospital we don’t have that luxury. I work in very tight space. So comfort, safety & easy access is the rule for us. Most of the time my IV pole is on the side of my IV access. My pole for my ventriculostomy is on the side of the bolt placement & my ventilator is usually on the side were it’s easy assess. The artic sun is at the foot of the bed & my codmen & licox at the side of the bed on a bedside table for easy viewing & documentation. It really doesn’t matter what side you have it on. It’s the zeroing mark that counts for you measurements. IV poles have transducer holders allowing zeroing at the phlebostatic axis & our ventri poles allow use to transduce separately to the tragus. We even have tranducer holders for the arms for our open hearts or crash patients. There’s limited but we try to make space enough for nurse, doctor & a visitor. But I make sure my numbers are right where ever they are placed at.

It's not a policy but it's just a common nursing courtesy. It's the best thing to do when you have tons of meds tubes lines etc. My hearts, septic, & neuro pt's all get them labeled. Pumps & lines are labeled. It just helps with idenification of meds & location of things.

I'm 4'11 & weigh 95-96lbs not only Im I an ICU nurse for years but I'm also an officer in the Army Nurse Corps. Size has nothing to do with the best way you can do the job. I use stools all the time.

To all the new ICU Nurses “thanks for coming into ICU” I remember the day’s of the “charts & the papers”. I wanted to pull my hair out. :uhoh21: I used an hourly chart for my VS, I&O, FS, Drips, Assessment etc. I really needed something so I could remember what it was I needed to do when I 1st started on the ICU. I would get lost or behind if I didn’t have them. I still have them on my hard drive. If you need them give an email & I’ll send them to you. It did help me out but as I looked back it also slowed me down but it helped with organization & getting all the vital information documented. I made them for myself. The good news is with experience & time your time management skills start doing better. But they’ll still be days that you’ll always be behind b/c the pt’s so critical you don’t have enough time to get the paper work done expect for you hourly I&O’s & VS b/c you’re providing direct nursing care. ADVISE: don’t get behind on I & O’s or VS. The MD’s depend on that. With time you’ll see the sheets disappear. I don’t use them anymore. I guess the info is locked in the “brain”. I do however still carry my “Kathy White” & my tiny green med book with all my drips. I took them to Iraq with me & they came in handy. I don’t carry paper around anymore unless in’s my Med sheet & my H&P.

I would have to disagree on the MICU /SICU critical thinking & skills portion they told you about. It’s the ICU, you will learn & master both in any of these sections, Period. It’s critical care that’s what so different than regular ward nursing. You can’t do the job with out both critical thinking & critical skills together. They both go hand in hand - 1 to1 For me I find that MICU & CCU the patients are more chronic b/c of the long standing illness. The population is much older. They have multiple medical health issues (Diabetics, CHF, MI’s, and Hypertensive Crisis). So you’re managing more then just complications of a surgery or injury. Not to say that we don’t see them in the SICU, TICUor Neuro. It’s just less liking we have those issues. I can tell you my crashes on the SICU/TICU/Neuro are no joke we don’t like losing them b/c the population is much younger & healthier & the fact that the complication is due to a voluntary/involuntary surgery that needed to be done to sustain the life. (Car Accidents, Gunshots, TBI’s, Open Hearts) I do think that MICU is a slower ward & SICU/TICU is a “chaos” ward. We have to be honest that in the SICU the goal is for the pt to stat for 2 days & you’re being transferred to the ward. On MICU I could have a pt’s for months & transfer them to a rehab long term facility. I’ve had the “slow codes” on MICU & I’ve had the “rapid codes” on SICU/TICU. The decision is yours but you will learn all you need in any ICU it all depends on how you like the pace of the ICU & how well you’re able to pick up & learn with of course competency & safety for the pt. GOOD LUCK!

i have to laugh b/c when i get asked this question. it's very difficult for me to answer. i tell them i do everything a nurse does are more. i'm the only medical person in the family & the first in my generation to finish college. i can’t describe what i do b/c it’s hard for me to explain. so i usually tell them to see trauma in the er & baghdad er. that seem to help sort of. i can say critical care nursing is like no other job. but it’s a job you are willing to take & sacrifice for. there’s a lot to do, learn, work, things to deal with, critical thinking, critical skills, dealing with relationships, technology, mental & emotion tolls. it’s a lot. shadowing some one is good idea. i let fresh newbies do it all the time. i can only let them decided for themselves if critical care is there way to go. i will admit i love it. i’m adrenaline junkie. let go:caduceus:

Most of our "open hearts" come straight to TICU/SICU. We recover them. Depending on how stable or guarded they come out there a 1:1 ratio for about 24hrs. Within 6hrs hr if stable we like to extubate. If it's one of our guarded pt's we will know ahead of time to have 2 heart nurses on staff to have 2:1 ratio. We do get information from the OR on the status of our Pt. We get time to prepare for anything or everything. And usually there's always on day shift 3 heart nurses & 2 on night.

i remember my icu internship period as being a very different atmosphere then being a ward nurse. as for internship being “nightmarish”, i look back now & say it wasn’t that bad. it was ruff but manageable. it was nothing i couldn’t handle & sacrifice to get the knowledge i needed to be on my own & feel comfortable to care for critical pt’s. i was glad when my 6wks was over. :yelclap: i think you should try it out 1st b/c what’s not so horrible for one person, may be horrendous for other. especially if it’s a program you’re really interested in. going in there with an open mind & a good attitude helps with the learning progress. patience & just going with the flow helped me out. it’s bad when you hear about orientation stories b/c they all sound the same any where you go. nursing is so competitive in general, but i can tell you when it’s over you’ll be proud of yourself b/c of your accomplishment. icu isn’t for everyone. i’ll say as a preceptor myself. it’s not simple to teach someone when you’re trying to manage 2 critical patients at the same time & have to explain every little detail you’re already programmed into doing. this breaks me from my daily routine & time management skills. so also try to understand their point of view. b/c believe me you’ll be in there position after the 2 yrs are over. good luck! bronxny :redbeathe

I would say I didn't fell comfortable until about 1 year in the ICU. However, I had about 5 yrs of Med Surg experience on my belt when I decided to take the plunge. I'll be honest, with 8yrs of nursing experience & 3yrs in ICU anything could still surprise me & I'm learning everyday. What's important is your patient's safety & health. Anything can happen in the ICU & from my experience I have yet worked in an ICU that other staff members didn't help you out when your pt's crashing. Even when I was deployed. Hell my head nurse has come out to help with a codes or take pt's when staff is low. There's no time to be peddy when there's critical pt's around. Life is precious especially when you have 18-30yrs coding on you. Keep asking questions, Keep reading, and Keep mastering those skills. Just be the best nurse you can be for that patient whose life is in your hands.

Hey what up, I'll be honest I haven't send it. I just had a brithday & I want a break from CCRN brain fry. The army just really wants ICU nurses certified they are even giving us money for it. Like I need any more stress. I need to breathe. I'll let all the buddies know when I've done it. It will be after the holidays. Thanks DeeDawntee