kvsherry

Hi Guys- I work in a Trauma ICU and we frequently have patients who are either full axial or log roll spinal precautions. My question is this, when you turn your patient to the side, how do you prop them up? We have "Macgyvered" a set up by taking a heavy blanket, rolling it and taping it. This works, but is not ideal. Does anyone out there know of a commercial product that is used in Neuro/Trauma units to offload weight and maintain spinal alignment? Thanks! kvsherry

Along the same lines, from the surgeon... "you're not going to save him".

Regardless of the program requirements, it would be a good idea to have real world experience prior to the NP. Your chances of being taken seriously without it are slim.

I like working with other guys, until they start getting all bent out of shape and pissy about being called a 'male nurse'. That is what I am because I am trailblazing in a field in which I'm a minority. By the way, I love my "Rosie the Riveter" lunch box that my friends got me.

i hope this helps!

Do you belong to a union? If so, talk to your rep. Then, since I'm no expert on labor law, I would second the other posters advice about speaking to a lawyer and finding greener pastures right quick. You may not have done anything wrong, you may be the best new grad in the country, but that will be small consolation when this petty organization ruins you. Good luck, you have my best wishes.

First off, let me correct Mr. Singer's 'research'. ICU nurses do, in fact, know the difference between clinically dead/brain dead. Those of us that do talk to our dead patients do so for many of the reasons laid out below. However, the reason that I have seen is habit. We talk to our unresponsive patients all the time, see a body, talk to it. That is what we are trained to do and that is our knee jerk reaction. For what I do? I never talk to my dead patients, and I correct any staff members (tech, RN, RCP etc.) that do. I unfortunately can not find the article, but it reminds nurses that by talking to a brain dead patient, the family can be easily confused. They may already be having trouble reconciling the heart beat on the monitor with dead, and they can be made to wonder, "If he is dead, why is everyone talking to him?" I hope this helps.

With regard to the question about drainage and checking ICP. It depends on your surgeons preference for that particular patient. Some patients, the really sick ones, require having the ICP open to continuous drain at XXcmH2O. On these patients, we close it every hour to get an accurate ICP. On other patients, the surgeon may only order drainage of XmL for an ICP >YYcmH2O. Either way, we never record ICP on an open drain. It's off my about 15mmHg too low. I hope this answers your side question.

my family usually drops the RN bomb. I don't say anything personally unless I am asking for something like lab results. I like the staff to know that they can give me as much information as they are comfortable sharing and not have to worry about me misinterpreting it. Many docs I know treat RN family members more inclusively than non RN family members. I wait and see how the situation is going to shake out before I whip out the RN card, metaphorically speaking of course.

you can accurately predict a patients BAC by his breath.

yeah, sorry about that, I was trying to reply to something in the middle of the conversation.

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smartest thing would to say you misspoke and drop it. anyway, back to your original question...Dickie's scrubs work great for me. They sell Unisex (no flaring obviously woman's pants or plunging neck lines) and have some really nice scrub cargo pants, perfect for keeping those important things on your person. They run about $20/set I think.

I meant if the patient has a chest tube connected to Pleur evac and wall suction and the CXR showed no pneumothorax. The doctor writes and order saying to turn suction off. Do you just turn suction off and leave suction tubing connected to suction source/wall (isn't this the same concept of clamping?) or do you need to disconnect it from the suction source/wall so that air cannot build up (chest tube still connected to Pleur evac)? OK-I think I'm following you a little better now. The order says turn the suction off, then you can d/c the suction from the wall, but keep the chest tube connected to the pleur evac. This is different from clamping because air can still escape into the water. Also, I've found articles saying never to clamp chest tubes, but is this only if the pneumo is not resolved? Because I've also read that clamping is sometimes done for a few hours before taking out the chest tube to ensure that the pneumo will not come back once the chest tube is out???? I know that a tension pneumothorax is a risk, but only if air is still leaking into the pleural cavity? That is correct. You don't clamp a chest tube if the pneumo is not resolved, otherwise the air won't get out. Only clamp if you find an air leak (bubbling in the water chamber). The doc will may test clamp the tube if he thinks the pneumo resolved and wants to make sure. Other docs just leave it in until they are 100% sure that the lung fully re-expanded (good CXR/no fluctuations with resps etc.) and then pull it. I guess it's personal preference.

The risk of the chest tube being off of suction is that what ever is causing the pneumo won't get sucked out. If it's an empyema, blood or something else, it needs to come out, and the suction helps that. As far as your second question, I don't know if you misspoke or if you are confused. The chest tube should never be open to air. This is how air gets sucked into the pleural space causing a tensions pneumo. The chest tube can be off suction however. The MD may write to put the suction to water seal. This means it is hooked to a closed system but not hooked to suction. The water seal allows the lung to re-expand, air to escape, but no air to come in. Remember, if you see bubbling in the chamber, you have a leak and the tube is open to air somewhere. Clamp it immediately and find the source of the leak and fix it. I hope this helps.