swolfe_2

swolfe_2 has 10 years experience and specializes in PACU, SICU, MICU, Stepdown.

Latest Activity

1. Airways in PACU

   swolfe_2 replied to kezza444's topic in PACU

   I work in an inpatient pacu, yes we extubate.......everything, and without anesthesiology. RT is usually around if they need to be connected to the vent. The exception is when the anesthesiologist is worried about something, or pt had a difficult ai...

2. Division of Phase 1 & 2 PACU need answers

   swolfe_2 replied to Yeehah's topic in PACU

   Shellabelle, Do you work in an inpatient hospital setting? We are getting ready to convert to phase I phase II in our inpatient pacu.

3. Using Propofol for conscious sedation

   swolfe_2 replied to wtbcrna's topic in Safety

   I'm glad you are learning about how to get your reimbursement. In the clinic, we reference MAC as a type of anesthesia and are not thinking in insurance terms. You know, like "nursing slang"....... Thanks for the info!

4. Using Propofol for conscious sedation

   swolfe_2 replied to wtbcrna's topic in Safety

   I am not disputing what MAC means.... As the link states, its not just for billing. In AZ both our hospital and outpatient surgery center policies clearly define that the use of propofol in a procedural setting requires "Monitored Anesthesia", becaus...

5. Using Propofol for conscious sedation

   swolfe_2 replied to wtbcrna's topic in Safety

   The choice of the physician to use propofol for consious sedation turns it into a MAC case. There is no way to tell at what dose the patient transitions from moderate to deep (until after the fact). All you OR/PACU nurses know that during a case th...

6. Using Propofol for conscious sedation

   swolfe_2 replied to wtbcrna's topic in Safety

   "The only time I was responsible for giving propfol was on the med-surg floor, where we were giving it to a young woman dying of cancer. Her pain was just terrible and her morphine tolerance was through the roof. It was the first time anyone had give...

7. Using Propofol for conscious sedation

   swolfe_2 replied to wtbcrna's topic in Safety

   "The best use I've ever see was a 19 year old male prostitute that was standing, naked, in the middle of his ICU bed. He was swinging his IV bag by the tubing and had already DC'd his Foley (bet THAT hurt the next time he had a trick!). He had his pu...

8. Curious... Why would an ICU pt go to PACU?

   swolfe_2 replied to Cschroy1's topic in PACU

   All of our ICU pts who are still intubated come directly to ICU. Something else to consider for some facilities is cost-sharing between departments, dont forget to think about the $$.

9. Attention Mayo Nurses...

   swolfe_2 replied to Codypatody's topic in Arizona

   The whole hospital is tele :) You should come check us out, it's really great. Our "cardiac" tele unit nurse to pt ratio is a max of 4:1 sometimes without an assistant though. I'm the only Sarah in the critical care unit if u ever want to call, ...

10. BP cuff or A line

    swolfe_2 replied to labman's topic in Neuro

    A “whip” is when any kind of invasive line either under or overestimates the actual sbp and underestimates the dbp because there is excessive catheter movement intra-vascularly (aka whip). “Whip” is artifact that under dampens your waveform and wi...

11. Attention Mayo Nurses...

    swolfe_2 replied to Codypatody's topic in Arizona

    At first I was bummed about the white, but I got use to it. Mayo is a great hospital to work for and the uniform is definitely not a reason to decline a position. Everyone always knows who the RN is :)

12. Attention Mayo Nurses...

    swolfe_2 replied to Codypatody's topic in Arizona

    NO- It seems to be cyclical. Arizona is a state that hospitals are difficult to staff related to the significant population changes from summer to winter. I was a traveler for 2 years at mayo clinic and have since signed on as a permanent emp...

13. Using Propofol for sedation on vented pts?

    swolfe_2 replied to Scrubz's topic in MICU

    We want a short half life so that we can turn it of to do "sedation vacations" and check pt's neuro status etc....... Also if your pt starts to dump their BP for any reason, you need to be able to lighten their sedation. Propofol can decrease cardi...

14. dumb conscious sedation questions

    swolfe_2 replied to julezzz26's topic in General Nursing

    UMMM.... you are not crazy! Propofol decreases cardiac output among other cardiac effects, they should definitely be on monitor....alll monitors! We would never use propofol for concious sedation.....they would not be conscious :) Only on vent...

15. BP cuff or A line

    swolfe_2 replied to labman's topic in Neuro

    I always check for corelation, if the values are significantly different then I take cuff pressures on other extremities. If my a-line is different then all of these, then I trust cuff. The reason why I check different cuff pressures is because it ...