hepatocyte62

Karlie I know that if I want to work in Australia there are formalities to go through, most of which are about appropriate documentation rather than qualifications as I think our qualifications are more or less transferable. You'll need to start the process about 6 months - 1 year before you intend to come over anyway, as it takes that long to process all the required documents. I'm unclear exactly what it is you want to do - work as a general nurse ? Or train as a psychiatric nurse in this country ? Either way the NMC should be able to advise. Good luck Hep

Hi I always get confused between 'flow' and 'pressure' in relation to haemodynamics, what's really the difference please ? Many thanks

Thank you for replying but no sorry, I meant pts who are sedated and ventilated without a pain factor. I've been told several times that the opiates are causing the large tidal volumes (volumes of 900 1000mls for a 65kg person) but have failed to get a decent explanation why this might be the case.

I've been told recently that opiate sedation can cause large tidal volumes, do people agree ? and if so why does it happen ? Many thanks

What's the TCU anaesthesia program ? Is it like a nurse-come-anaesthetist ?

Depends what you mean by 'early signs'. If you mean a decreased GCS the answer is definitely no, a patient is not going to have a GCS above 3 (I'm not sure if they'd still be extending but I'm guesing not) and also manifest cushings triad as this is a sign that the brain stem is herniating. Dilated and unreactive pupils are a late sign of increased ICP and impending herniation; cushings triad is cardiovascular manifestation of the process of herniation it would be impossible for this to happen without other signs of increased ICP. If you don't have a bolt in and the patient is sedated you only have the pupils to go on, but as far as I'm aware these should blow before you get cushings triad. To make absolutely sure I will ask one of our neurosurgeons tomorrow.

Our very small neuro unit has visiting times of: 10.30-12.30; 15.30-17.30; 18.30-20.00hrs. I, and a number of my collegues, think this is too much. I understand the anguish of relatives when their loved one is critically ill but I also believe that too many people, frequently around the bedside, is too much stimulation for the patient; and a dangerous distraction for the nursing team, especially for a critical case. Our priority is the patient and I think we've gone too far in encouraging contact with relatives/friends to the detriment of patient care but I get the feeling my view is a politically incorrect one. I'd welcome your views and I'd be very interested to know how much visiting is permitted across other neuro units. Many thanks

Thanks for your reply Ghillbert. Yes I've spent quite a lot of time searching via 'pubmed' and various individual journal sites etc, I can find relevant articles but nothing that is very up-to-date and measures the relationship between high serum glucose and how this is metabolised in the brain - I mean, is high serum glucose causing ischemia, or is it simply a good prognostic indicator regardless of its effect on brain ? In some units microdialysis is used but to be honest although I have some vaguely relevant articles in this respect, the information is so complex it's difficult to unravel the facts for my purposes. Please let me know of any sources you've come across, all contributions welcome :-) Cheers H

I'm writing an assignment about glycemic control in traumatic head injury. Our guidelines are to keep blood sugars to 4.5-8.3mmol/L. This level concurs with the international guidelines recommended by the Surviving Sepsis Campaign 2008 but there seems to be very little research about the use of insulin in the context of head injury, i.e do high blood sugars cause, or simply reflect, bad outcome ? I understand the theory behind high glucose levels and secondary damage but is it actually happening ? Are these levels appropriate for head injury ? I'd be grateful if anyone could shine more light on the subject, particularly if you could point be in the direction of recent research. Many thanks.

How does higher patient/nurse ratio reduce the need for sedation ? We work one-to-one and use propofol for induction of anaesthesia and to control ICP, if we can reduce it or take it off we do. In critical head injuries (particularly in young people) it is not unusual to use propofol, midazolam, morphine, and a paralysing agent. We try to keep within the recommended 4mgs/kg/hr. I'd be interested to know what other units use as an alternative outside of the usual opiates and benzodiazepines for unstable ICP.

Yes but this does not stop relatives shouting. There was a time when there was more respect for nurses. Of course a genuine complaint needs attention but I've encountered 'difficult personalities' who (in my opinion) are seeking to fill a need for attention or are 'working-out' their feelings around the admission of their sick relative. Whichever way, they are a demoralising influence and not enough support is given to the staff in question.

Goodness me, that's harsh discipline but maybe deserved:)

This is outrageous ! They acted unprofessionally, moreover this is serious misconduct. In the NHS (we do not have computerised access to medical notes where I work, but we can retrieve notes manually) they would almost certainly be immediately suspended pending disciplinary action, and I imagine fired. You should definitely make a formal complaint and if you don't already belong to a union I suggest you join one. Good luck, these people are not nice work colleagues and if you're not supported I think you'd be better off finding a better work environment.

It happens in the UK as well. It seems to me that visitors and relatives often grasp the opportunity of this context to assert power that they lack elsewhere. It is mostly people who are not capable of understanding the nature of the work we do that complain in this way.