aeauooo

I realized your interest extends far beyond H1N1 after I posted my comment. I'm currently working for the Louisiana OPH in H1N1 (a job I don't expect to last much longer). I have to admit that, although flu is fascinating, it's really not my primary interest (as you can see from my profile). Nevertheless, my current position has allowed me to do a lot of reading on the subject, and your posts include some of my favorite sources and topics - I'm impressed! I have a stack of papers on my desk on H5N1, but I've had top set them aside while I work on our after-action report. The general public really has no idea how serious of a threat it is. Keep up the good work!

Indigo Girl (not to be confused with Indigo Mom): H1N1 warrior - and God bless you for it!

oh yeah! last week i had a patient who was admitted to the ccu in a hypertensive crisis. the guy weighed over 150 kg, had chf and a dissecting aortic aneurysm, and came in positive for cocaine. the guy started yelling at me because he hadn't gotten a breakfast tray. i told him that i really didn't care if he ate or not, my priority was to prevent him from dying on my shift.

I went to WWU for a couple of years back in the 80's and really liked Bellingham. My wife did a photo shoot up there a couple of years ago. From what I saw, Bellingham hadn't changed much - which is more than I can say for Seattle. Seattle seems to me to have gotten too big for its breeches and a lot less friendly than it was in the early 80's when my family moved there. I used to love Seattle, now I dread going back there.

I love it - I don't even have AC in my truck. I spend all day working in cold, dry hospital air then, when step outside in the evening and that warm, wet air hits my face, I take a deep breath and remember how much I love this city!

My wife and I moved from Seattle to New Orleans a few years ago. Today the weather was beautiful! Clear blue sky - a little chilly, down to the 60's - but I managed to bundle up and go for a nice long bike ride up on the levee. My wife misses Seattle. I don't!

[color=#74330b][color=#74330b][color=#74330b]i've dealt with this type of issue more times than i care to think about. [color=#74330b]i'm not sure if the law varies from state to state, but everywhere i've worked a determination of brain death is a declaration of death and the physicians either may, or are required to withdraw care. i'm catholic, and a good reference for people who are willing to accept catholic teaching is "why the concept of brain death is valid as a definition of death" from the pontifical academy of sciences http://www.vatican.va/roman_curia/pontifical_academies/acdscien/2008/excerpt_signs_of_death_4l_2.pdf - but know your audience before you refer to it. many people who "expect a miracle" are charismatic christians who may categorically reject anything that comes out of the vatican. http://www.catholicnews.com/data/stories/cns/0605285.htm

déjà vu! you don't happen to be working in seattle, do you? man, i got burned severely when i went from a neuro floor to a neuro icu in a toxic work environment. it was the lowest point in my career. i have since gone on to prove that all of the rotten things the nurse manager said about me were absolute bs (i was a "substandard nurse," i was going to kill a patient some day, that she would be afraid to be a patient on the floor i came from - she even asked me if i thought she was full of sh** - probably to use it against me. yes, you were fos, and you knew it too!). i'm inclined to tell you to get out before the final dump (my preceptor left a hand unrestrained on my intubated patient who had a history of self-extubation - i caught it). find a healthy work environment. yeah, nurses eat their young.

what, your docs don't know how to do a literature search? the aann has a clinical practice guideline on management of the patient with tbi. http://www.aann.org/pubs/guidelines.html click on the link. you'll be asked to answer a couple of question, then you can download the guideline free of charge. i used to love propofol, but i don't trust it anymore. it's meant for short-term use only, and too many times i've seen patients on it for several days who don't wake up for as many days after it's turned off. i prefer midazolam. i used to see thorazine used to treat neurogenic hyperthermia, but haven't seen that used in many years. i use a cooling blanket. use a rectal temperature probe if you can get one - it will prevent a lot of grief. i've been told that you can prevent shivering by keeping the hands warm (cover them with socks), but i've never tried it myself. i haven't put someone in a barb coma for many years. i remember one article a read within that last few years that said barb comas are considered a last-ditch effort. one thing i remember about keeping people in barb comas is to do meticulous mouth care - make sure you suction out the oropharynx and nasopharynx - otherwise the secretions pool and rot. h2o2 is your friend. good luck!

What the heck does 'SOS' stand for? Sack of sh**? I've worked in hospitals where the trauma docs wanted thier patients in the neuro ICU because the nurses had better skills.

In the most recent issue of the Journal of Neuroscience Nursing there is a review article comparing mannitol to hypertonic saline. One of the studies reviewed found that mannitol increases MAP - that, combined with decreased ICP significantly raises CPP. Infanti, J. L. (2008). Challenging the gold standard: should mannitol remain our first-line defense against intracranial hypertension. Journal of Neuroscience Nursing, 40(6), 362-368. Incidentally, does anyone remember the old definition of triple H? Hint: it had to do with the caudal end of the patient.

Been there, done that. You know you're a neuro nurse if... You've ever said, "Oh don't worry about it, he's just having a seizure." You've ever come to the uncomfortable realization that there are some people who really don't want to hear about GSW to the head. If you're ever had to explain to a neurosurgeon that your patient's bizarre behavior is a seizure.

Exactly, your "badge of honor." Relevance? You're blowing smoke. Go back and re-read that definition: regulated discussion, according to the rules of parliamentary procedure. What is it you'd like me to source? What claims have I made, other than about first-generation immigrants? FYI, the source is the sociology course I took as a prereq for my BSN. Pardon me if I don't haul that heavy box off of the shelf to cite chapter & verse, but it's there. Thanks for making me feel like the $700 I spent on that class wasn't completely wasted. By the way, what's your source for your 'badge of honor' statement. You made several claims in your responses to my posts for which you have not in any way provided sources. I don't have to source my opinions which, unless I'm mistaken, are pretty much all that I've posted on this thread so far - you don't have to agree with them. How is it relevant? By itself, which is all you've provided, it means nothing. To quote Monty Python, "An argument is a connected series of statements to establish a definite proposition." This isn't an argument.

Or, I could interpret your statement to mean that the effect of illegal immigration really doesn't make a dent in our economy anyway, so why worry?

How is that a response to what I wrote? You throw a number at me and expect me to accept that it's even relevent to the topic - it doesn't work that way. You don't even have a weak argument.

Excuse me - that's exactly what I said. You're too busy sniping to bother to read and understand what I wrote to make a valid point in return. I've made the points I wanted to make. I don't have problem with you disagreeing with me, but I'm not going to engage you in dialog if you're going to reflexively gainsay everything I say without providing evidence to support your claims. Cool it, or forget it.

Can you provide objective data to support your claims? All of the statements I made began with "I wonder...," but you claim to know the answers to those questions - how? What's your source? If you can't provide the evidence to support your claims, your argument is weaker than mine.

As I understand it, the first generation of immigrants (from anywhere in the world to anywhere in the world) usually don't learn the native language, or "learn just enough to get around" (having lived and travelled in a number of countries where English is not the primary language, I know "just enough" Farsi, French, Amharic, and Arabic "to get around"). Successive generations of descendants learn the language of the country and become assimilated into the culture of the country to which their parents immigrated. I live in New Orleans and have lived in Philadelphia, and in both cities you will find very proud Irish-Americans, Italian-Americans, German-American, African-Americans, and a smattering of others.

Thanks. I'd like to believe we can have a discussion about a subject with which we have disagreements without becoming hostile - as we've seen on other threads. I've acknowledged that I don't know much about economics, but there's no shame in that. Seeing as this is a nursing forum, I suspect there are few, if any, reading this thread who have a significantly better grasp of economics than I do. I think it's safe to assume that most of us have a fundamental understanding of supply side economics - the law of supply and demand. I think most of us agree that there is an abundance of illegal immigrants in this country supplying cheap labor. What would happen if there was no demand for cheap, albeit illegal, labor? A lot of cyber ink has been spilled making the point that illegal immigrants have committed a crime by crossing the border into this country. As I understand it, knowingly employing an illegal immigrant is also a crime. If you watch the show COPS, you might easily draw the conclusion that criminals are really stupid people, but let's give the people who hire illegal immigrants the benefit of the doubt and assume they are not acting impulsively, they are aware they are committing a crime, and are aware of the risks of committing that crime. Why would anyone hire an illegal immigrant? $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ Obviously, if we're talking about rational people, the benefits of hiring illegal immigrants must outweigh the risks. So instead of pointing to illegal immigrants as the problem, why don't we instead blame the people who hire them? What are we doing by rounding up illegal immigrants, shipping them across the border, knowing full well that they have the incentive and the means to turn right around and come back again? Why is our government so willing to spend your tax dollars on manpower, fuel, and wear and tear on the vehicles used to transport illegal immigrants across the border when they know it doesn't have any effect on the supply of cheap, illegal labor? I'm just speculating here: Maybe it's because the government really doesn't want to solve the "problem" of illegal immigration. ($) Maybe it's because it's much easier to go after people who have no legal representation than it is to prosecute the other criminals - those who create the demand. Maybe the problem isn't as black & white as we've been led to believe.

Exactly! Debate: a: the formal discussion of a motion before a deliberative body according to the rules of parliamentary procedure. b: a regulated discussion of a proposition between two matched sides - Webster's

not at all. as i said, i don't have the answers, but i think we need to take two very large steps back from the emotionalism of this issue and look at every aspect of it before we draw any conclusions about what the problem really is and how to solve it. i know very little about economics, but i believe that pointing to one side of illegal immigration and say, "this is a problem that we need to correct" blinds us to the fact it is an extremely complex situation for which a simple solution would probably have disasterous consequences - both economic and humanitarian.

the status quo doesn't (directly) force people to come here, but it certainly welcomes them when they get here.

Thanks. We have created most of our monsters, then we blame other people for our problems. I don't have the answers. I don't pretend to. I just try to do what I can and know how to do to make life better my family, others with whom I share this planet, and myself. I also have a pretty good sense for when I am being lied to: everytime I turn on the TV or open the paper. I don't apologize for my perspective. I lived in Tehran in 1978, and I've spent a total of two years in Africa (so far). The rest of the world doesn't see things the way most Americans seem to, and neither do I.

status quo.

loss of wages spent in this country by the laborers, loss of taxes paid by the laborers (yes, they do pay taxes!) and the business, loss of the contribution of that business to the gross national product. hey, i'm not an economist, but there are two sides to every coin.