OptimusPrime

Obviously, not all new grads are created equally. So it's not unheard of for a new nurse to be hired in the cath lab, pick it up and do well. However, I do not recommend it o the nurses that rotate through as students. I started out as a paramedic, worked in a CCU for 5 years and an ER for a year before going to cath lab. And let me tell ya, there was a steep learning curve for me. I am glad i started in the CCU, so much is to be learned from spending 12 hours a night with two sick patients that cannot be learned in cath lab by a new nurse. ICU's and Cath Labs are very, very different departments and most ICU nurses I worked with (myself included) knew very little of the cath lab when working on the floor and the nurses that have only worked cath lab know very, very little of floor nursing. It's only natural and it's ok. We try not to hire new grad RN's to the cath lab where I work. However, the RN that oriented me to cath lab has only worked in cath lab and is an amazing CL RN. But like I said, not all new grads are created equally. But as a general rule, I think it's a bad idea to start in a CL.

You'd be better off doing your own research http://www.datascope.com/ca/ed_materials.html

We used technetium almost exclusively, barring the times the nuclear reactor in Canada failed, then we used Thallium. I would personally do anywhere from 15-20 stress tests/day. Each receiving technetium. I would stand only a few feet from the person, as they were on the treadmill and I was next to them getting BP's/ using computer. I always wore a radiation badge to measure the amount of exposure and they were tested quarterly. My exposure levels were never high. So, 15/day, 5 days/week, 50 weeks/year = roughly 3,500 radiated people/year that I was in close proximity to for about 20 minutes at a time, and my exposure numbers were fine. I never suffered any short term effects, such as being sick more often or anything like that. As far as long term effects, I guess we'll see, but so far so good.

Contact the manufacturer and see if they'll send a rep out for an inservice. they are usually great about this. We had a VAD patient in the city I worked as a paramedic in and they sent out a rep and did one for all of our medics. Worth a shot.

Staying calm is great, if you're calm because you have a handle on whats going on. I've seen some very "funcionally frantic" nurses that are awesome, but there's not a calm bone in their body when it comes to emergencies, but they rock. I've also seen alot of "incompetently calm" nurses. You know who Im talking about. You walk in their room and they're staring at the monitor, which shows Vfib. But by god, they're as calm as the sloth. And they suck. Just keep your room clean, everything else will be fine

Keep the room clean... thats all I can think of

not true... The amount of radiation THEY are exposed to is usually about the same as an xray. And how could the amount they emit be dangerous for you, when the amount receive is so much larger, and it's safe for them? I worked in nuclear medicine doing adenosine stress test for years before becoming an RN. I was exposed to thousands of patients that had been emitting radiation, and we were all tested quarterly for our levels. We were always safe. You'll be fine. Also, I worked with a handful of pregnant nuclear techs over the years. Their pregnancys were uneventful and their kids are fine :)

Well, kinda and kinda not. A chest tube is placed to drain either fluid and/or air. Even after CABG's, you will see an air leak sometimes, and that is fine. You just need to be aware of it and make sure it doesn't get worse. It means that there is air in the cavity and the chest tube is doing it's job, by draining the air. Just make sure everything is hooked up correctly. If placing for a pneumothorax, ya, you want to see the air leak. If it's not there, then somethings wrong. Either your tubing is kinked, not hooked up to suction, no water in the suction port, chest tube placed incorrectly, mis-diagnosed pneumo, are some of the possibilities. Eventually, the air leaks should disappear as the pneumo resolves.

Thats lower than what I've seen. I've seen 4.8, and we were coding her. lab kept calling us wanting a re-draw. lol, bless their little hearts.

Assess your patient. o2 sats, WOB, lung sounds, HR, RR/min, and eye color... Maybe they're fine without being intubated and all they need is some oxygen. Maybe they need an ambu, maybe not. Why were they intubated initially? Where and how much of the balloon could you see? Lots of variables. I personally feel comfortable enough with ET tubes, that given the right situation, I would try to advance the tube and see what happens. Then call for CXR, if Im able to re-insert it. Since you're asking this question on here, you're probably better off, for now, having someone call RT and have them come assess the situation. BUT... If you're patient condition is deteriorating before the RT can get there, or they have a paralytic on board, don't be afraid to pull the tube, hook up to o2 and bag.

We very rarely use femoral A-lines. Infection being the biggest reason. Almost all of our post-op hearts have a radial A-line. But, occasionally they will come back with a femoral a-line. When this happens, most of the time it's fine, pt's wake up and it comes out after drips are off, or in AM. If the patient is confused, you can use some type of sedative, ie ativan, or Haldol/Diprivan, whatever your surgeons prefer. If the patient is off drips, just see how it correlates to your NIBP, then pull it (after ABG's of course). For caths, as soon as ACT is under 250, it's coming out. until then, if they're trying to crawl out of bed or do reverse crunches, it's ativan and morphine until ACT is under 250.

The pt is in a respiratory alkalosis. pH > 7.45 with a low pCO2. There's no such thing as overcompensating, the body just doesnt do it when it comes to acid/base and ABG's. Bicarb could be low d/t renal function.

Yes, the high potassium could have been a result of the code. Acidotic environments tend to draw K+ out of the cell and lead to hyperkalemia, and Im sure this pt was acidotic. Also, the sample may have been hemolyzed, but if that was the case, the lab should have called you or reported it.

hmmm, The only thing that is coming to my mind is with CABG pt's. These pt's might have a lower tidal volume and pain is the limiting factor with them. So, by giving them an opiate and relieving the pain, they're able to breathe deeper. Other than that, Im not aware of anything.

Well, it is a pretty simple explanation, it was a misunderstanding on my part. They were saying that on the newer models, there is no need to manually switch from EKG to pressure triggering, the IABP will do that automatically, if in the auto mode. Hence, just leave it in EKG trigger mode during a full arresst b/c it's going to switch for ya. :)