FLCheerChic86

Ok yeah thats a lot but I will respond just to the temperature management section. At the hospital I work at, we consider our patients febrile at 38.0. We are very agressive in our temperature management. At that point they start getting tylenol 650 mg q4 and probably a cooling blanket thrown on them, ice packs etc etc. If they don't respond to that, then we will insert a femoral coolguard cathetar to cool them. The lowest that we are cooling our TBI patients is to 35 degrees celcius (our fulminant liver failure pts are now getting cooled down to 33 degress... wow). Of course always watch your K levels when someone is being cooled this low so some resident doesn't come around and order to replace your pts K because when you reward them your K be WAY high.

Ok I'm still pretty new to neuro nursing but this is how I conceptualize "Triple H" therapy in my mind. After someone has been clipped or coiled they are at risk for going into vasospasm (we are becoming pretty conservative with this form of therapy at are hospital and are only implementing it if someone is actively in vasospasm). So if someone is in vasospasm, somewhere in there cerebral vasculature has clamped down and is not being perfused. I compare this with a a garden hose watering some plants.With a water spicket that is only slightly opened, with water just trickeling out of the hose are my plants going to get much water this way? No, they are going to die. So in order to get as much water to my plants as possible, we want to open that spicket up to have as much force as possible, pushing that water out with max force and max volume (Hypertensionand hypervolemia). Ha yeah the hemodilution part doesnt really work into this but I think that is kind of an easy one. Of course you want thinner blood as opposed to really think viscous blood if you are squeezing through something that is already clamped down.

I work in the neuro unit of a large, level I trauma center in Florida. We have an attending physician in the neurology dept that puts it best... "What's a body without a brain?" It is a constant struggle for Drs. on other services (ahem.... Cardiology) to understand that if you save the heart at the expence of the brain, you didn't save a person... you saved a BODY. Those are very different things. With the development of such advanced cardiopulmonary interventions (ECMO anyone?) we make it pretty hard for these pts to die. However, if the person doesn't have a brain... a mind to sustain them along the way then what good are we doing that person? The answer is simple... none.

I am a new grad at a large Level I trama hospital in Central Florida. My starting wage is $21.50/ hr. We have been told that we will get a raise after 6 months and then 1 year. We also have a clinical ladder system at our hospital and will be eligible for an additional 4% shift differential after one year if we choose to participate. Not as good as I was hoping for but the night shift differential is pretty good so I am trying to get on it as soon as possible.

I know that Tampa General Hospital has a critical care internship program. You spend one month (maybe 6 wks... not quite sure) in a classroom setting. Then you are assigned to a ICU for 6 months. You can orient for the enitre 6 months if you need it or get off earlier if you are ready. Then you are rotated every 10 wks to different units. I've heard of a lot of nurses just leaving the program if they get offered a job in a unit that they were in. The ICUs that it goes through include Surg/ Trauma ICU, Cardio-Thoracic Surgergy, MICU, Nero, Cardiac, and vascular.

Well I feel for you because I am just finishing up nursing school. There is no easy answer to your question because everyone learns at a different pace and by different ways. The one thing that I can say that will almost always help is doing NCLEX practice question before each exam. This might not be so relevant during your first semester, but definetely during Med Surg, Peds, & OB. There are TONS of books out there but I would say the safest one to go to would be Mosby's NCLEX study book. It comes with a CD that has thousands of questions that reinforce your knowledge before exams.