sarahrain

As we can see the albumin is only 1.5, the reduction of oncotic pressure may further dry the patient intravascularly. The doctor should consider giving albumin to temporary bring up the level. However, the underlying cause should be pinned. I would also ponder the following.. 1. Septic workout 2. Coag profile to rule out DIC.. 3. An ABG.. chances of acidosis? 4. HGT level? 5. Likely to be adrenal insufficiency.. secondary to infection. 6. Any echogram done? 7. How is the LFT? As I can see that the levo was tirated from 5 to 2 then up to 15.. could it be too fast cutting it down? I hope we have CVP reading here.

8 hours. I prefer to have the balanced time distribution for everything in everyday.

i don't understand about how the mistake can take place.. about wrongly assumed that the art-line is cvl... the cvl and art-line normally is inserted in different part of the body. example the common practice are - sub-clavian cvl and radial art-line. cvl ports are well visualized. 3 way stop-cock used is either blue (indicate vein) or while (from the transducer set) connected directly to one of the safesite at the port. art-line will be connected to red-lined-extension-tubing with red3 way stop-cock at distal or the set from transducer.

A-line for major op patient, critical ill pt those who on inotrops (so that we can titrate).. if patients' BP is known to be stable, we would follow NIBP

That patient was so sepsis that he had to put back on CVVHDF again. Despite on various antibiotics namely cravit, fortum, cloxa, superazone.. His TWDC was still very high.. As the INR is 4.25 and the platelet only 29, the prisma was run without heparin.. During the priming, I saw column of air was trapped in the bottom of filter. The line was perfectly prime. My preceptor taught me to hit the filter gently to expel the air. Firstly, we would used the heparin 10k unit in 1L N/saline to prime, the we reprime with N/saline. But I still see the column of air there, not moving. And my seniors said is all rite. Isn't it that we need to see the whole filter being filled with the priming solution? Please Advise. Thanks

I was told that the best effect to transfuse DIVC set is to start with cryoprecipitate, followed by platelet then FFP. I couldn't find the reason behind it. Please advice. Thanks!

We should use new syringes/needle for each time. And not supposed to be kept. That's infection control rules for ISO.

It is only two hours late? It's indeed very scary but I tell you it happens anywhere to any new nurses around the world. You are not alone.. Trust me. There are people who makes bigger mistake than you. There is a trick to make you feel better - try to think that at least the patient's life is not jeopardized. When you get back on track,do make sure you be 101% careful next time. Check everything! Cos you can trust the pharmacy to check for you. But if you couldn't get over the stress around you, talk to your colleagues, manager or anybody you trust, at least don't have to bottle up all by your own. And I guess your manager will provide you more support.

We do have foreign nurses as well. I pity them cos they have to be by their own.. More stressful than the local staff nurses. For me I wouldn't want to go to be an immigrant nurse. but as a volunteer or traveling, it is ok for me.

Anything that caused GCS down.. Dextrose (increase cerebral edema), all drugs with sedative effects..

Ok, we don't equip any heating device in every bed, probably because Malaysia is hot and humid and the ICU is always regulated in room temperature. Thanks MNC_RN for your info. I just knew about it.

I got to work 15 hours once or twice in a week depends on the census. It does make me feel tired especially in the evening. And my night offs sometimes were substituted with overtime. Generally, I prefer to have quality of life rather than work and work.

We used the bair hugger. Light? what light? you mean the infra-red?

No warmer circuit. It is the conventional prisma dialysis machine. We are pretty sure that the hypothermia was due to the dialysis. His temperature picked up to above 36 deg after the completion. The surgical site is at the anterior Rt thigh. It should be hyperthermia the surgeon dislike right?

I was taking care of patient who is under CVVHDF. I am new at it and want to share to improve. Thanks. The 57 year old man was initially admitted for DKA, sepsis, chronic renal failure. Was ventilated and had his medical condition corrected. After extubated and transfer to medical ward, he was found later have hidden abscess at his Rt thigh, and drug-induced abnormal LFT- undergone op and came back to ICU and ventilated overnight. His BP dropped, given blood products, commerced inotrops and CVVFDF with zero extraction. Extubated the next day and on o2 FM.. The first post-op day, UF started at 50, then increased to 80 due to postive balance thousand plus with no unrine output and the BP is stablized. Input is 1L perday plus IV med. Predictably, he was shown to have hypoalbuminemia with anasarca. Third day with wheezing, put on HFM o2 12L, started prn Neb and increased UF to 120. The BP and CVP gradually came down with constant dopamine support and thus UF cut down to 100. As through out the few hours of removal of fluid, the wheezing and his upper limbs edema subsided. Question here : 1. He was always hypothermic 34c due to the CVVHDF.. -but he is not complaining of it cold or any sort. Why? -Should I put warmer-blanket for him? Why? -The orthopedic surgeon doesn't want us to involve warming the surgical site. Why?