Trauma1RN

Applied to 3, got into the first two I interviewed at.

Because it's a Friday at 3:30pm and the MDA wants to go home...

On my unit we use mannitol for increased ICP's, not to prevent swelling. If a CT shows cerebral edema we hang a hypertonic saline like 3%, and in extreme cases I have seen 24% used. If a bone flap was removed soon enough I have seen good outcomes, but the majority of the time I see it major damage has been sustained and it significantly effects the patients quality of life.

If I were your friend I would take the extra learning opportunity and make the best of it. As long as she works hard her competence will show itself on its own. I doubt she will have to explain herself to anyone because most people will come up with their own conclusions. I remember new nurses staying late to finish things up and tidy up their assignment, and they end up being strong nurses. Its the ones who refuse to stay late and have that "shift worker" mentality that are the ones to be concerned about.

Typically before someone herniates their brainstem their HR with go through the roof along with their blood pressure. Your first instinct is to grab some labetalol, but if you push it you will be sorry in a few minutes. They will brady down shortly after usually.

What is the respiratory rate? Are they over loaded? Do they need lasix? Do they have COPD? If they have COPD you could knock out their respiratory drive with a NRB. Being a new grad in the ICU you need to ask questions, the ones who don't are the ones who get into trouble. Ask your respiratory therapist for suggestions, they may know the patient from previous hospitilizations, and should be aware of the problem if the patient is already on HiFlow. My suggestion is to find yourself a few reliable/knowledgable resources on your unit and develop a relationship with them. It takes a long time to be comfortable in the ICU as a RN, but keep at it and it will be rewarding.

I work at a 1,100 bed teaching hospital and I am good friends with a RRT nurse. We have 2-3 RRT RN's on at any given time. They go to codes, get rapid response calls, and a variety of other things. As an ICU nurse I call them to accompany my patients to CAT scan or when traveling, its hit or miss when they have the time, but it helps when they do. The help out a lot on the med surg floors, if a patient goes bad on the floor then 2 RRT's come and take them to where ever they need to go, they are not allowed to leave until the patient is in the hands of another ICU RN. They also responsible to go to every fall occurence in the hospital and take them to head CT ect. They are heavily untilized in my hospital and I really believe the positions are justified and profitable to a health system. RRT's in my hospital have been ICU RN's for a long time, usually over 10 years. They don't necessarily get paid for what they do, they get paid for what they know.

You know your a Neuro RN when: You SDH patient's BP sky rockets and their heart rate goes to about 180 and your first thought is "better get some Atropine"

I will have a year this week in the SICU at Royal Oak. I am happy with my unit and job. I see a lot, and the pay is competitive. My manager holds people accountable, is fair, and leaves you alone. At Royal Oak the critical care tower is as follows: 2 East is a 20 bed Cardiac SICU, 3 East is a 14 bed Neuro/Trauma SICU with 6 Surgical Progressive beds, 4 East is a 20 bed MICU, 5 East is a 20 bed Neuro/Trauma SICU, and 6 East is a 20 bed non-surgical CCU. We are a Level 1 Trauma center. There are plans to build a addition to the EC, a new OR, and a new 40 bed critical care area(so we hear). Oh yeah, midnight shift diff is $2.50. Weekends and Afternoon shift diff is $2.00. Hope this helps.

Do you have a large population of penetrating injuries? Thats the one thing I wish I saw more of.

My unit is a 20 bed Level 1 Neuro/Trauma unit. We use invasive monitoring such as swans, a-lines, bolts, caminos, continuous bladder pressures, CVP's etc. Our neuro patients seem to come in waves, summer is trauma season so we have more currently. We have our fair share of thoracic patients as well. Some of the more interesting things I have done is open bellys at the bedside, I have witnessed cardiac massage, ran two level one infusers at once(put about 30 units of blood and 30 liters of fluid), and have been in many codes. Some procedures are done at the bedside, such as trachs and pegs. However, its not always guts and glory. We have the patients that should have transfered days ago... and have people admitted that don't need the SICU, and get the medical overflow occasionally also. Our penetrating injury population is low, about 5%, because we are a suburban hospital. Thats mine, so whats your unit like?

It honestly surprises me how many people are losing respect for M.D's these days. Nurses especially, if you are going to act like you know everything a M.D does then go to medical school and stop complaining about you pay.

Hey guys and gals. I am a Macomb from 07'. My tip would be to get a N-CLEX review book and study the specific sections before your test i.e the Cardiac chapters for the Cardiac exams... duuh.:nuke: While I was studying for the N-CLEX I was slapping myself when I would read questions from the review books that were almost verbatem on the exam. Macomb is honestly the best school around, be proud that you are in the best school in southeast michigan.

I guess the way that I look at it is... you aren't going to solve their problem by not sending them home with a PICC line, and you most likely won't be able to find access when they need the abx if they didn't have the PICC. If they are not serious about giving up the drugs they will get high with a PICC, or without one.

I totally agree with the above poster. I started as a new grad in a neuro/trauma SICU in January as a GN. I did have two years prior experience on a med surg floor as a aide and then a tech. Seems like all of the staff is telling me that I am doing great and are impressed with me so far. However, another one of the GN's I started with on my unit was let go last week because they were not picking it up according to the higer ups. I think it depends on your personality and prior experience. There is no doubt that I am where I am supposed to be. I hope it works out for you.

Until you start just relax and get ready for an exciting challenge. I graduated in December and started as a new grad in a level 1 Neuro Trauma SICU and I absolutely love it. This week is my first week off orientation and I am on my own. It feels so great to be working as a RN and in a unit that I love. A bit of advice. Advocate for yourself for good experiences while on orientation. Take busy doubles to get your organization down, and then take the sickest patients to get your feet wet. I have seen some amazing patients since I have been here and I have only been here 4 months! Good luck and enjoy yourself. Tim

Don't believe everything you hear. I am at Royal Oak and love it. I just graduated and I don't think there is anyone in my graduating class making more money per hour. The Beaumont system has has the best nurse patient ratios I have seen yet. They encourage career growth, and help you out with tuition for school. Overtime is always available if you want it. Unless Kati is singled everyday in the Henry Ford SICU(which I doubt), her ratios are no better than ours.

No one?

My patient last night had a Swan-Ganz and I was getting cardiac indexes of 0.8 and a SVRI of 9700!! She was post op and had lost about 3 liters of blood, but received 6 units of PRBC's in the OR and upon return her hgb was 15.0. CVP was around 4-6 at the time. She was ST w/ PVC's , HR in the 120's to 130's and had 3 long runs of bigeminy for me. SBP 80-110. Post op CK-MB was 27.1, but had no ST segment elevation on the 12-lead, troponin was fine. Clamped down or what? I am not a cardiac nurse. I work in the neuro/trauma SICU. This patient was in for a corpectomy so she was on our unit.

I made the switch from a construction foreman to a nurse. Wow, what a difference. Seems like such a long time ago that I switched. Long story short, I love my career. I would do it all over again if I had the choice to go back. My biggest recommendation, get a job as a aide then a tech on a med surg floor while in school. It helps a lot.

When you help float a swan in your patient and the first time you shoot an output the cardiac index is 1.3, SVRI is 3,300, and the MVO2 is 41%. Came in the following morning and the "bereavement bagels" were in the break room, I didn't even have to ask who they were for.

Thats terrible!

Or says something like "I am going to get the car", "I need to get out of here", " I want to go home". All of those can be mistaken for confusion, but if they are talking about going anywhere... watch out.

I ask things like "What do you like to see from your employees?", "Do you promote advancement?" etc.

You check the labs of your trauma patient that is on the way up from OR: pH 6.92 and has a Hgb of 1.6 after 22 units of PRBC's, and then you see a med student running around the corner with a level I infuser yelling "where can I plug this in?".