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 intracrania...

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 ...

:) 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, ...

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. Als...

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 comfo...

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 beginne...

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 fa...

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 an...

Hi Hayden: Folowing several run ins with steno, MRSA, VRE and all the other nasties, we started doing a "terminal clean" on our rooms post transfer of patients. This includes washing the walls as well as the beds and surfaces and changing the curtain...

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, Do it lots, like JWRN described and it has been diagnositic of abdominal compartment syndrome and the need for immediates surgical intervention. :0)

Start the day with about 5G of caffeine, chased with a healthy dose of nicotine. Midmorning suplement of another 2G caffeine with a donut and nicotine chaser. Midafternoon bag of cheesies (doritos if I'm feeling espescially rundown), as well as decaf...

I recently attended a time management seminar and they told us we should work to our biorhythm. I guess that means I shoud tell my boss I need to work shifts only between 1000-1400 and 1700-2000. LOLOLOL

Hi Salmi, There are many , many ways to work out shifts. It depends on what the staff nurses want to work. We have a variation os 2 on 2 off three on 2 off. We have also developed four distinct rotations to try and please folks (as if that'll ever ha...

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 ...

Hi askater, I worked in surgical specialities for 3.5 yrs befor moving to ICU. In some ways, ICU's are easier, only one or two patients (in our institution) and all the information about the patients conditions at your fingertips. It's not for everyo...

The transition from peer to supervisor is a hard one. I went from staff nurse to unit manager in a unit with lots of friends. Unfortunately, you do need to separate to some degree. Your role needs to be clear all the time, whether you are doin ght su...

Hi All, This is a touchy subject, with a million different opinions and rationales for each side of the equation. Our policy is, open visitin 24 hrs a day within reason, limited to two at a time, and at the discretion of the nurse. To avoid the 50 ph...

First, take a deep beath. One of the hallmark signs of a good critical care nurse is that they are too hard on themselves. If you had no unansered questions, I'd suggest that you move on out of ICU:D . I still have lots and I've been in ICU/CCU for o...

Try Black Cohosh root. It was recommended to me and I had uneven results, but anything's better than "your own personal summer":p