Janet Barclay

AV pacing is preferable because of the atrial "kick". (IMHO)

Don't forget that coma is a generic sort of state which can be caused by a number of different things. The pinpoint pupils may be caused by narcotics, which could also be the cause of the coma. Dilated/fixed pupils are a late sign of high intracranial pressure. I think the best answer is coma. good luck

There is new legislation in Canada called Protection For Persons in Care. It requires that a criminal records check be done for all new employees prior to a job offer being made. There are of course differneces between a murder conviction and a shop lifting conviction (think Winona) and allowances are made for stupid teenager tricks. Personally, I think some things are indicitive of basic honesty/lack thereof and need to be considered in all circumstances.

:) Let's see... Arrive 45 minutes prior to shift change to make the assignment sheet, fill any gaps, etc. Arrange for the bedside nurse's breaks, communicate with the physician group . Attend rounds (3-5hours). Assist with patient care if necessary, trouble shoot, mentor, teach, clean poop, wash the bottles etc. This is the day to day stuff. The other areas of responsibility are performance reviews yearly for the team, "performance management", "attendance management" , participating in hiring and interviewing, liasing with the unit educators regarding whatever issues arrive, liasing with other departments. There are four of us, so we take turns replacing the manager when she is away. The role, really is to be all things to all people :) . In our place, it has a huge clinical (vs admin) component, and depending on what day you ask, it's the best job in the hospital.

Not silly to think about fluid overload ever! Remember, though, that the crackles of pulmonary edema sound different than retained secretions or atalectasis- they are best heard at the bases, and sound like saran wrap rubbed between your fingers. Also check neck veins for distention and listen for a third heart sound. 250 an hour sounds like a lot, but with a septic patient, the fluid is largely third spaced into the interstitium. Your assessment about the patient's sats was a great one. Janet

how much nights, weekends, and holidays were going to effect my life

Hi, I've worked in critical care for 15 years, and when you are starting out it is really hard to know how much information to divulge to families, espescially when you are still sorting the information yourself. Tell families only what you are comfortable discussing with them (this will get to be more as you gain experience), and offer to set up a family conference with the Doc ASAP when they have a lot of questions that you can't answer. When it comes to prognosis etc, even us "old-timers" don't usually hazard a guess until we have a really good idea about what direction the docs are going to want to take, particularly if there are end of life issues involved as it sounds like there were with your patient. Above all, be honest, a sincere "Idon't know, but I will find out" goes a long way. be patient with yourself :) Janet

Hi, I have seen doses beyond the usual .01-.04 u/min, but only for severe GI bleeding (because I'm old :) ). It does cause serious ischemia including the myocardium, but it is coming back in vogue for sepsis. Janet

Nice Barb, I love the eye opening and insightful remarks. As a manager, please be honest, if I find out a sideways way, I will not hire. Good luck, and congratulations on your ongoing recovery

Hi, welcome to critical care. Thelan is a very good text book, The Journal of the CACCN is a good reference (also a good organization), a pocket guide to ECG's is a must, and Mark Hammerschmidt's on line guide is quite good, escpscially for beginners. he has quite a few posts in the ICU sections. Good Luck, Janet

Hi all, we have a 24 hr open visiting policy in our 24 bed combined Med/ surg/ neuro ICU, at the nurse's discretion, and only immediate family. Of course, if the pt is A and O they can designate other people to come in. We also have a handbook for families that explains that while the policy is an open one, that there are times when they will absolutely not be allowed to visit. This causes us some grief about 10% of the time, but it is worth it for the other 90%. We explain very carefully the need for little stimulation for our neuro patients, and if families are unable to comply then they are limited. This also causes us not very much grief. I always stop and think, what if it was my husband/dad/brother, would I accept the stringent visiting policies that some units have? Janet

Hi Snoopy, Sorry that you've been hit by the bug. Being sick is no fun. As a manager I have a few things to bring up. As much as I know that an employee is not faking being ill, or calling in on a Friday night, it is sometimes hard to keep smiling and being supportive when you've had your fifth sick call for a shift, and there are times when I let my frustration get the better of me. Second, and please understand that I am not in any way suggesting that you are one of these people, but we get burned sometimes. We ask the question at interview if the person has physical limitations that would interfere with their ability to perform full time work, and you know, I have never had someone tell me that they do. We find out after the fact. It is frustrating hiring someone to a full time postiton when part time would be much better for them, or 8 hr shifts, or a less physically demanding place etc. Sick time is a priviledge that we have all fought long and hard for and I also agree whole heartedly that is should be there, no questions asked when needed. Lots of places have had to put really stringent policies in place for the employee that calls in as soon as a sick day is earned and added to their banks. Again, I want to emphasize that I am not suggesting that you are not genuinely sick, but rather trying to put a different perspective on things. Be well,Janet

banana bag= bag'o shame

Hi, We level the transducer to the foramne of munro, halfway between the outer canthus of the eye an the pinna. Most of these policies are Doc driven, so whatever they want, and make sure all RNs are doing it the same way.

Hi Jane, I guess we're all too embarrassed to admit that we don't know what PICCO's are LOL. I've worked ICU/CCU for 13 years and haven't a clue what you're talking about. Maybe we call it something else? We use PA cathters, though less than we used to, and have a continuous cardiac output machine/ SVO2 moniter that only comes out of it's hole every 6 months. Janet