MrBubbles

I went straight to a surgical/neuro icu in a level 1 trauma hospital from school with a 4mo residency. If I was able to handle it I'm sure you can. Just be careful, most ICU RNs are very type A personalities. So be very respectful, and don't go in acting like you know everything, even if you do. Just smile and say "Ok, thanks for the info" etc. I have never regretted going straight to the ICU, I love my work and my co-workers

I just had my first experience with a femoral CVC that has the ability to heat or cool the pt. I'm under the impression that they are usually used to induce hypothermia post MI to reduce metabolic demand on the heart. Or of course heating a pt who is very hypothermic. My concern is learning about the effects on hemodynamics and electrolytes when doing this. One RN did state that when bringing a pt back from hypothermia and heating them back up, the pt just went to crap fast. So I want to get educated on what exactly I need to be able to anticipate when heating or cooling these pts so as to prevent disaster. Any info is appreciated.

I have seen it have a positive result. Problem is, if you need to be proned, you are really sick, and usually the recognition that a pt needs to be proned comes too late. It's like stating that mortality is high in pts who get a SWAN, well yea, it's not the SWAN causing it, there's no correlation, it's just that they are sick. Proning is a last ditch effort, and yes, the rotoprone bed is Mutherf$%^&r to work with.

I just had my first experience with a femoral CVC that has the ability to heat or cool the pt. I'm under the impression that they are usually used to induce hypothermia post MI to reduce metabolic demand on the heart. Or of course heating a pt who is very hypothermic. My concern is learning about the effects on hemodynamics and electrolytes when doing this. One RN did state that when bringing a pt back from hypothermia and heating them back up, the pt just went to crap fast. So I want to get educated on what exactly I need to be able to anticipate when heating or cooling these pts so as to prevent disaster. Any info is appreciated.

I recently learned that PRBCs have citrate in them to prevent clotting, and that this citrate binds to the Cal in the pts blood thereby lowering the Cal level. And in some cases this can lower the Cal to the point that hyperexcitability of cardiac muscle occurs moving to arrhythmias. I was also informed that slower infusion of PRBC helps to prevent this from happening. So I was hoping to find a place that gives specifics on rate of infusion for PRBC to help prevent this from happening. I'm thinking of the level 1 infuser in these situations where multiple units are being infused usually 1 unit per minute etc. Any info or resourses would be appreciated.

That's hard to answer without getting a better pic of the pt. If a pt is on higher peep than their cvp will be elevated. If they have asities then I assume there is liver failure going on. You may have heard that we don't go clamping down on a pt with levo if they are dry. The cvp of 12 may be a cushion to make sure that is not happening. Often you may see an order for checking cvp Q4hr and if it's below X then treat with 250cc bolus. Then if it's low 4hrs later treat with albumin, and alternate these therapies as needed.

Yes I meant pedal. We do also use fem lines. Last resort seems to be a brachial, but only for use in the OR. At my hospital brachial a-lines must be DCed by an MD upon arrival to the ICU. An MD told me this is because of a higher incidence of amputation with brachial lines.

YOU MUST HAVE AN A-LINE! Any MD who does not say yes needs to be slapped, then call his upper to ask for an a-line. YOU MUST BE A PATIENT ADVOCATE! When the Dr. says no to an a-line when pressors are being run that is when you step up as the patient advocate and say "You are giving me an a-line!" If he can't get it on the R radius, then he needs to try the L radius, if that doesn't work, go to the R pedal, then the L pedal. Bottom line it needs to get done. Don't take no for an answer here. Now I say this because it sounds like you had multiple pressors running. And remember, anytime you access a central line/PICC, you have to stop everything running and pull up some waste. Look up your hospital's protocol on this. And always flush after getting your sample. And turn everything back on. And I'm with the others, don't turn off pressors.

I am trying to find like a database of mistakes. Nursing mistakes. I have always been very forward about any mistakes I make and make every effort to let everyone know what they are so that they don't have to make the same mistakes. So I am trying to find a place where I can go to read about others mistakes so that I don't have to repeat them. Any advice?

Don't do that to yourself. I'm guessing you've been told before, you're going to make mistakes, there's just no way around it. I've screwed up too, and it tears my guts up inside. But that means I care. We worked so hard for so long to make it through school, it was brutal. But you can't question whether you belong now. It's rough, it sucks sometimes, but you'll get through it. Nurses on my unit have said that it took 3 to 6 months to get to the point where they weren't scared to death when they came in. I was floating on air, thinking how amazing it was that I am on a trauma ICU. I see the most amazing things in a level 1 trauma hospital. And then it happened, I screwed up. It totally screwed me up. Never in my life had I experienced depression or really even fear of anything. BUt I spent the next 4 or 5 days wanting to do nothing but lay in the fetal position in bed. I lost 12 pounds in 7 days. And the mistake wasn't even that big, didn't put anyone's life in danger. But I feel better every day. Every day I spend on the unit I get better, and I feel better. You will do the same. You gotta put on your game face and say I am not going to screw up, take control of yourself. RECOGNIZE WHEN SOMETHING IS WRONG AND CALL FOR HELP! Be patient, you're going to get there, It just takes time.