joeyzstj

Somewhere around there....for a 24 hour period. If you add in a vent and drips it can easily double. A vent runs about 1200-1500 a day. Consider that a bad of Cardene may run $500 or more. Saving someones life and sending them home to their family is expensive.

No offense, but most of that sounds like things that other people are already assigned to do. Checking on patients on the floor that might need to go back? Are the floor nurses or step down nurses not competent enough to determine that and call the doc for orders? For new nurses they usually have a preceptor then a resource person in addition to the shift coordinator and the education department to do their education??? IV insertions and Chest Tubes? This is pretty basic stuff that anyone applying for a critical care position should be very familiar with. I absolutely can see ER transports and being another set of hands if needed. We have positions called Critical Care Cordinators that are different from actual unit coordinators. They take patients if we get in a bind, transport to and from CT and MRI if we are busy and watch patients for lunch and such, but I dont think they would have a job due to annoyed staff if they were doing some of the things you mentioned above. Maybe its just a difference in hospital environments???

Robert Bojar's "Perioperative Care in Cardiac Surgery" should be given to every new person that comes into CVICU in my opinion. I had a CV Surgeon give it to me years ago and Ive convinced about 25 people in my unit to buy it, as well as the hospital to buy it for new employees/new grads. Its the best book Ive read. During orientation I try to get my orientees to udersand three basic receptors....Alpha-1, Beta-1 and Beta-2. Instead of memorizing up and down arrows in a book or note cards, it helps them learn it easier. If you can understand that a Beta-2 receptor causes peripheral and bronchodialation and that Alpha adrenergic drugs cause arterial constriction, and that Beta-- causes and increase in HR and contractility, you can figure out that Dobutrex, Epi, Dopamine, Neo, ect...........do X, Y, and Z because of the receptors they stimulate. Also, go to PACEP.org and register (its free). Do all the programs for Swans. You can train a monkey to learn paperwork, how to shoot numbers, how to titrate drips and such, however to understand the science is something that a majority of the people you work with dont understand, Im willing to be. Good luck.

I often reccomend that my new grads buy "Perioperative Care in Cardiac Surgery" by Robert Bojar. Its a great book that covers almost every aspect of what you need to know. One thing you can start on that is going to help you get ahead is to become familiar with the 15 or 20 common drugs you are going to see on a daily basis in any busy CVICU. Know Basic receptors such as Beta-1, Beta-2 and Alpha-1 and what response you get when you have a drug that either stiumulates (agonist) or blocks (antagonist). It might sounds difficult, but its really not. Some preceptors will have you spend a month learning paperwork. I dont do that. I try to mix in the stuff you need to know with the paperwork and polices from the beginning. Bojars book describes all of what Ive mentioned if very easy to understand terms. Look over drugs such as Dobutrex, Dopamine, Epi, Levophed, Primacor, Cardizem, Nipride, Nitroglycerin, Amiodarone, Neosynepherine, Vasopressin, and possibly a few drugs such as Diprivan and versed if your not familar with them. Good luck.

www.pacep.org has an entire hemodynamic quiz/education program. Im not sure if the administrators will allow you to view a link to another website in this reply, but if so check it out. Its very informative.

We have a CVICU, ICU and a CCU. CVICU takes all CVOR cases that our docs feel are too sick to be recovered in PACU. ICU takes Neurosurgical, trauma, ect. CCU is more of a medical management ICU for cardiac cases. Our heart program has about half of the surgical cases referred from other hospitals where they have been determined to be inoperable. The other hospital in our city has both CVICU and ICU combined.

Give me the CRNA any day. I work with many CRNAs and MDAs closely every day. I will take a CRNA over and MDA any day of the week. I always laugh when patients come in the the hosptial insisting on requesting their Anesthesiologist. Im having a simple hernia procedure done sometime. I dont care so much abou the surgeon........we have great surgeons, but I want to pick my CRNA.

Honestly, I just go by memory. I work with people who lose their minds if they misplace their "memory sheets". I orient a lot of new nurses. Some make up sheets based on body systems and some just jot down important notes. Meds are on the MAR, vent settings are something I remember, vitals, reding ect. If you are doing in depth assessments and making a mental not of what is going on it is usually to remember ..........my drips are set on x, my vent is set on y, my patients vitals and rhythm are x, and so on. We use shift kardex sheets for dates of procedures and to update drips during report sometimes. We also do 12 chart checks as well.

Think of preload in relation to a rubber band. If you remember back to Anatomy and Physiology class, there is an optimal point in which you can stretch a muscle fiber and it will have the most effiency. I belive its 120% of the orginal length of the muscle fiber. Sooooo..........think of a rubber band. You stretch it a little and let go and it barely moves. You pull it back farther and farther it really starts to snap back hard. You pull it back unti you cant pull it anymore and it snaps the strongest. This is the same concept as preload............you are Preloading the cardiac muscle sarcomere (muscle fibers) by giving volume we stretch the heart far enough that we get a good snap from the heart. Afterload is the resistance that the heart pumps against when it ejects the blood. Its actually the measurement of Left ventricular wall tension during systole. SO, we preload the heart with a certain volume and then we eject it. Now, afterload will be high if we have to eject that volume through something the size of a coffee stirer. Afterload will be low if we eject the volume through a vessel the size of a car tire. On a extra note, CHF is similar to us stretching that rubber band sooooo far that it loses its optimal stretch. We stretch it out so far that it is beyond that 120% point and is too lose and streched out to recoil well. That is CHF in essence.

Watch the Laura Gasparis disks and you will be fine. If you have worked the required amount of time to take the CCRN and watched the disks it really isnt that difficult.

DNPStudent........the more experienced nurse was possible right or wrong depending on what she was referring to as the method of tamponade. There are different types of chest tubes and drains. Pleural chest tubes sit in between the pleural space, Mediastinal Chest tubes sit in the mediastinum. MS chest tubes prevent cardiac tamponade by releasing a buildup of blood volume in the mediastinum after cardiac surgery or in the even that you caused enough bleeding to somehow fill up the mediastinum upon pulling the epicardial wires. As far as causing a tamponade in the PERICARDIUM......thats a different story. You must be trained to remove them and know what to look for prior to pulling them. It only takes around 100 ml's of blood in the pericardium to cause problems. Checking to make sure your INR isnt 2-3 before pulling them, electrolytes, bed rest for an hour or so, ect.........are good things to practice. Pericardial Tamponade is rare. I have seen multiple Mediastinal tamponades from clotted off chest tubes several hours after surgery.

Think of the drugs joining at the Y in the tubing as a fast moving river with someone standing on the side with a garden hose driping into the river at a specific rate. No matter how fast the river moves, the rate that you are driping the garden hose in doesnt have anything to do with the river at all. The rate that the garden hose drips doesnt change. Most central lines/PICC lines require 20-30 ml's an hour to keep the port open properly. As someone mentioned above, the carries has absolutely no effect on the amount of the drug being given......NONE. It is simple to help keep the port open and deliver volume.

I do agree with that

Think about the need for a specific knowledge base when considering the statement that you just made. The brain is a very important organ.......argueably the most vital in terms of keeping the body alive. I made a comment in another section of this site in regard to CRNA school. I have worked in both units and although the body is screwed without proper brain function, the comments that I keep reading prove my point. When the brain is sick, you have the option of a handful of drugs and surgical procedures as well as recognizing neurogenic shock. I think the reason that a lot of school prefer CVICU experience is due to the fact of all the varying conditions that you need to know how to treat. A sick heart, a dying heart, a newly transplanted heart, all the electrolyte abnormalities that go along with different heart conditions, the equipment that goes along with a good/bad/sick/dying/transplanted........adult/male/female/infant. The fact that a variety of different hearts can be transplanted, placed on various machines (RVAD, LVAD, BIVAD, IABP, Artificial Heart, ECMO, external/internal pacing, ect) means that knowledge base to properly care for a heart is huge. Not too mention the need to identify and treat a wide array of rhythms that can possibly be caused from other organs. SO, the statement of Whats the waiting list for a brain transplant vs other organ transplant? in my opinion shows that you either fix the brain or you dont. With the heart its not quite as cut and dry and "just transplant it" that fixes everything. I worked in neuro for 8 years and I definately have respect for unique circumstances that arise, however I have never felt like I need to be on my toes a majority of the time as I have being in CVICU. To each his own I guess.

Techinically anything 3 beats or over is a "run". Afib with RVR can turn into a run or a wide complex svt that is commonly mistaken for V-tach. Vtach is usually faster then 130 beats per minute. Im not sure what the patients history was, however aprox 30-40% of post bypass patients go into afib. Afib is the most common arrhythmia that you will see in and outside of a hospital. Aside from checking a mag and K level and replacing that if indicated, you could have started the patient on Amiodarone with a loading dose of 300 mg's and then a drip over 24 hours. We normally run 1 mg for 6 hours and then 0.5 mg for the remaining 18. This is normally followed up by PO amio. Lung patients can only have amiodarone in limited capacity. Amiodarone is better for conversion back to sinus rhythm, however you can also use Diltiazem which is great for slowing the rate in atrial arrythmias. I normally bolus at 20-25 and start the drip at 10, titrating to effect.