rjrule

Recent articles have documented that intravenous diazepam should not be given diluted. However, we recently had a very aggressive psychiatric pt and the senior ER m.o instructed me to draw the 10mg ampoule to 10ml normal saline then give the medication into the iv cannula. I have had some nurses say yes and some say no re this procedure. I have always thought the medication will precipitate. Does anyone have the latest theory re this problem?

Hi, I always get the patients hand hanging over the bed whilst I prepare my IV stuff, this often brings the veins up nicely. If not remember patience is a virtue!!! Also if no veins are felt on the distal areas of the arm just go for the cubital and be done with it!!! Also say in your head (not out loud) "go in ya bugger!!!" this works great for me!!!

Hi, I am Ozzie also, we tend to give handover to the nurse who will be taking over your beds. This is done at the nurses station hence confidentiality maintained. We used to all get handover for the whole unit which took forever and by the time we finished the pts would of changed!!!

In our ED (NSW, Australia), we are encouraged to always insert 18 gauge intravenous cannulas. I have read that this could increase the chance of infection and irritation to the vein. I usually pop a 18 gauge in, however of course this is not always possible, what are your recommendations re gauge of IVC. Also I feel we tend to go "over the top" with IV cannulas and blood testing. If you score a bed in our ED you usually get cannulated, pathology tested and usually score some sort of xray, scan etc. Is it because of fear of litigation? Or are doctors becoming less skillfull on hands on assessment/diagnosis?

I work in ED in southern NSW Australia, we tend to give Morphine for moderate to severe pain and only in 2.5 increments IV until the pt is out of pain. By the sounds of the pain that your brother was experiencing, he may have been OK with some oral meds (assuming he had tolerated diet post op). We use Panadeine Forte for mild to mod. pain. I cannot understand why a student was giving a s8 medication. No student can give any S8 (narcotic) in our hospital or country for that matter. We do not have pre filled syringes. Was the morphine given IV or Im? And yes, In oz down south in NSW we too have to check narcotics with another nurse . The narcotics register is audited every month and checked each shift by two nurses.

Thankyou for responding. My answer so far is: Lung hyperinflation increases afterload of r)ventricle by increasing the length of the pulmonary vessels and by effects of alveolar cap. compression. Increasing intrathoracic pressure during forced exp. decreases venous return & R) vent. filling increases. Increase may cause intraventricular septum shift toward L) vent. resulting in diastolic dysfunction of L)ventricular filling (preload).Total effect of events is insp. increase in stroke volume and exp. decrease in stroke volume. Contractility is enhanced by circulating catacholamines and nebulised adrenaline etc. Bld gases are Ph: 7.25, PaO2: 55, PaCo2:65, HCO3:30, BE:-4. Hope to hear from you again. Thanks:D:D

Hi, I raised three boys and found nursing night shift 10 or 12 hr was a good option. The boys did not even realise I went to work half the time as I was there to kiss them goodnight and there when they woke up. Or I agree with the last reply that weekends is also a good option, less days and more money.

I wonder if anyone can help me. I am doing an essay and the patient is having a severe asthma attack. Can anyone predict what his preload, afterload, stroke volume , contractility would be like? His pulse is 150, bp 140/88, sats 90% with o2, he is 44 , has hx of childhood asthma and long term steriods. He is receiving iv salbutamol, iv hydrocortisone, nebulised adrenaline and nebulised vent/atrovent. His abg shows resp acidosis with metabolic compensation.