Cathlabnurse46

10 units R was what we routinly gave. It took a lot of insulin to draw the K+ back into the cell. We could alway correct the low BS with dextrose. The potassium was a much more difficult problem. Sorbatol was never given in a code.... only in chronic pts or afterwards.

The first question is "is it hemolysed". Repeat it or do an I-STAT durring the code or after wards and correct it. We use to correct high K+ levels durring codes with an amp of D50 and 100 units of insulin. The insulin draws the K+ back intra-cellular. Then give sorbatol (Kexalate). A good Dx tool is the ECG tracing. If the T waves are also peaked this would help to verify that the result is likely accurate.

Over the years, I have seen a few blown PA's. All died within hours. Still the hospital's never mandated that RN's not wedge. It's always a risk that every ICU nurse must understand that when they wedge, or even have a patient with a swan that an inadvertant wedge might happen and go unnoticed. I witnessed my own wife, some 18 years ago wedge a post open heart PT on IABP and vent. Blood filled the ET tube and she become very unstable (she already was unstable). I tried to help my wife, she felt responsible yet did nothing wrong. The patients name was "Sally" and her husband name was "Harry". The husband said thier marriage was just like the movie. We do proceedure all the time that have rick and complaicentcy is our biggest enemy. I do right heart cath every few days, sometimes daily in the cath lab. I still am cautious when advancing or wedging a swan.... even watch the Cardiologist doing it! I always have SALLY in the back of my mind. Another PA rupture was a CA mass on the bronchial tree. The man literally projected blood on my chest and died in my arms before I could lift him into bed for his chair. Oh the stories over 25 years!

We recently did something simular. I work in the cath lab where we implant ICD's. A pacer rep came into to change an algoryhtm on a DNR pt to "one shock only". There are many was to program an ICD not to fire or just to over drive pace VT first before it delivers a shock. Often they just disable the defib side but the devie will still train drive (pace) out the VT. It comes down to a pt's choice and a well informed family and making THEIR WISH KNOWN TO US.

After 232 years the full realization of the Constitution will happen. A President of the US will come from African American heritage and end what split this nation for over 200 years. Many died in the civil war (the war of states rights) when abolition was interjected (after near 100 years) for political gain to an unfavorable war. We forget about that. We forget about how many people of all colors suffered, women (1919), Chineese (didn't get the right to vote until 1954) white people died in ditches in Mississippi so all people in the US can cast a balot for who they want to led them. This is not "partisan" it is representation of all US citizens (I can't help it if the majority agrees with one political party... then the other side needs to become more palitable to more folks)! Go Obama! BTW, I voted for McCain in the 2000 primary because I didn't trust a Texas governor who put to death a born again Christian and MOCKER HER! I have no problem with fulfilling the law... it's how Bush mocked this woman that made me not trust him. But McCain has changed over the past year and I switched parties as the Republicans have left their conservative principles (smaller government, less intrussive government, budget conscious) for more radical ideas like spying on citizens, detaining people indeffinatle, torture, the suspention of habius corpus, spend on a war..... on and on! I look forward to the end of eight years of this! That and I lost my business, $400,000 this year due to a poor economy while we focused on a war in Iraq and not our oun Country. I was a republican.... now I just want my country back on track no mater who runs it or what color he is! 24 more hours and it's settled! Thank God!

was it consistant at .42 for several beats? how long did it last? Was it just a retrograde P (as you stated a junctional). Was it a WB? The SA has a recovery time (in EP called SNRT) in which the SA none in older hearts or deseased hearts can only recieve a signal so fast then it refuses to let out a P wave.... this is what is called a Weinke-Back. The SA node recovery acts as a gate for signal transmission and only "pulses" so fast until it "resets". What you might have seen was simply a Sinus arrest.

It's fairly easy. But take a 12 lead course. Your cath lab will usually have a few pocket guides. RCA = inf wall (70-80% of the time) leads II,III & AVF LAD & Diag's = Ant septal V1-V3 Circ and OM's= Ant lat V4-V6 (or Inf 20% of the time depending on if the RCA or the Circ give rise to the vessle called the PDA) STEMI = ST elevation MI in those leads mentioned with or without a Q wave. A Q wave is a perment scare and should not be present in any lead with the excemption of V1 (called a septal Q) and not deeper than 1/3 the hight of the R wave. Non-STEMI is T wave inversion or ST depression (ishemia) with corrolating trops.

Years ago (almost 20... dam it was at least 20 years) when I pulled sheaths for PTCA's I would totally sedate the patients with 5 -10 of valuim and 5 or Morphine. This was way before conscious sedation laws were around. I'd set up my AMBU bag, atropine and IV fluid and give the meds. Occassionally they would be so snowed that I might have to reverse them, but they never moved. This was "back in the day" when we used "perfussion balloons", "flow through balloons" and an agioplasty balloon was inflated for 20 minutes in a vessel, not 15 seconds! The sheaths were all 7-8 french or even 9-10 french! I always kept airways with me. I was glad when VERSED came around! Balloon pumps back then were long holds.... we still wrapped them and the sheath were 11 french. I never had problems "years ago". I see much more complications today then I did 15-20+ years ago. IDK if it's the training or if the patients are spred out in to many different units with too many people (Nurses and Techs) with too little experence. Now we have 4F and 5F and the complication rates seem higher? A few years ago we had a pt die a few days after a PCI cath when an ICU nursed failed to recognize a retroperotenial bleed. Complacentcy and common place is the biggest problem! Cath and pulls are viewed as "no big deal" anymore yet the Fem art can led to death if not handled properly. I think that is the problem. Complacentcy.

First lets discuss "dominace". The RCA gives rise to the PDA and PLV. In 75% of Patients the PDA arises from the RCA, the other 20-25% of the time the PDA comes off the Circ making the left system dominant. The size of the PDA often feeds the RV (right ventricle). In total RCA occussions in AMI's (inferior wall MI's) with 75% being dominate the chance of RV infarcts are high. With the RV unable to move blood forward to the Pulmonary art and to the LV the BP drops. The treatment is large volumes of FLUID and no nitrates. The symptoms are usually low BP and brady dysrythmias. The conus branch feeds the SA node and 95% of the time comes from the proximal or ostial RCA. Sometimes it is amomous and comes from the CIRC or has a separte ostium. The left main branches into 2 vessels, the LAD and the CIRC. in 20-25% of the population the CIRC feeds the PDA which feeds the RV and causes an INFEIROR WALL MI. Usually the Circ and margianals (OM's) cause lateral wall MI's). MI's on the Left cause ANTERIOR MI's either Anterior septial (LAD and diagionals) or Anterior lateral (circ and OM's). Posterior wall MI's (missed very frequently) are usually large circ's or large RCA's with a PLV. All MI's have high risk... even NON-STEMIS. Initially they are from sudden death but days out can still be from ventricular rupture, tamponade or papulary mussle rupture. However with the advent of inteventional cardiology over the past 15-20 years, mortality has dropped significantly.

i'd be happy to reply. first a list here:religious affiliation of u.s. presidents * religion episcopalian george washington thomas jefferson james madison james monroe william henry harrison john tyler zachary taylor franklin pierce chester a. arthur theodore roosevelt * franklin delano roosevelt gerald ford george h. w. bush presbyterian andrew jackson james knox polk * ulysses s grant * rutherford b. hayes * james buchanan grover cleveland benjamin harrison woodrow wilson dwight d. eisenhower ronald reagan methodist james knox polk * ulysses s grant * rutherford b. hayes * william mckinley george w. bush baptist warren g. harding harry s. truman jimmy carter william jefferson clinton unitarian john adams john quincy adams millard fillmore william howard taft disciples of chris tjames a. garfield lyndon b. johnson ronald reagan no specific denomination thomas jefferson abraham lincoln andrew johnson dutch reformed martin van buren theodore roosevelt * quaker herbert hoover richard m. nixon congregationalist john adams * calvin coolidge catholic john f. kennedyj ehovah's witnesses dwight d. eisenhower * river brethren dwight d. eisenhower * second, an article on james madison who wrote the constitution. findlaw: u.s. constitution: first amendment: annotations pg. 1 of 21 the us clearly began as a place where people came to flee religious persicution (before it was the us). william penn established much of his view on this. now on the other hand i have a huge problem with what is happening today in this nation... especially in the bush administration and the justice dept under gonzales and monica goodling. the right wing christians have sought to rule this nation by the bench. since they can not get gay right's flat out banned, not abortion the seek to appoint judges and stack the justice department through a "religious test" and a "political test". i have a huge problem with this. jefferson's "wall of separation" is to keep government our of the churches business. you are free not to attend any church, you should also be free to obtain any job free of a "religious test" baised on your own beliefs. i do not condem you... in fect i stand for your rights not to believe.... but you must stand for my right to believe! but together we must stand up to a government that entwines the two... religion (pat robertson, liberty university, et al) and right wing republicans pandering to religious conserative that bring this to a dangerous level beyond what thomas jefferson stated... the "wall of separation"! you can believe in any view you want "the flying spagetti monster theroy" is my favorite.... but still our nation was built on the premise that people have freedoms, given to them by "their creator", a jeudo-christian principal based on an abrahamic faith but carefully worded not to allow for a tyranical government like what they faced in england. i fight conservatives too that say this nation is "christian"... it is not. it's deist founders thought carefully about it and thier view of a god and your right not to be persicuted by religion or government. that's my rant.

I work in an interventional lab. Previously it was a diagnostic lab and before that it was solely an out patient lab. I first went there in 1992 when it was an out patient lab. So I've seen the full gammit of nursing in labs as it has evolved. OP labs are very nice, laid back, no call, no weekend, no holidays. As we became IP/OP we did call for IABP insertion and pacemakers. Now were on call 15 days a month, every other weekend and most holidays. Pay is a little higher than other areas mostly because we have longer years of experance. We get call pay and 1.6X for call back for a min of 2 hours. so yeas I make about 20-30% more than if I work in the unit.... but in the Winter I have no life. What do we do? I have an extensive background in cardiac nursing. I started out in tele in 1985, moved to an ICU and a small ER. Eventually did open heart. I taught ACLS for 16 years. as a nurse in the CCL we do conscious sedation for PCI, dx caths, pacemakers, BiV's, EP studies. We monitor the patient AT ALL TIMES (as everyone does), we resuce patients with drugs, defib. Comfort the patient. We also circulate the case and get supplies, stents, guide caths, balloons. We rotate thru all postions in my lab. I scrub also devices, PCIs. I also record. I would be bored if I didn't. I spend a LOT OF TIME IN LEAD! Something that other ares never think about. We are on our feet for 12-14 hours a day with 10-15 lbs of lead on our backs. Radiation exposure is an occupational hazard. Back injuries are common. We do a lot of teaching in the hospital. We do a lot of IAPB instals and troublshooting of pacemakers. Some of us even interagate pacemakers.

The proceedure, from how I heard it was done went like this: You tied a string to the gerbils tail. Placed a tube, like a toilet paper roll in the rectum (I have no idea how you can dialate the rectum that big). The critter goes in the tube, like a habitrail! Once the tube is removed, the critter asphixiates. Apparently the movement stimulates the vagus nerve and gives the person an orgasam :loveya:. The string is then pulled to remove the animal.... HOPEFULLY . Still Gerbils have teeth and claws and how do you tie a string on thier tails? He must have failed his EAGLE SCOUT BADGE in KNOTT TYING!

Wow... best of luck RNtraining. I have over the years seen, like many just about everything. When taking my first travel asignment in Bradenton Florida (won't say which hospital) I caught my charge nurse after only being in the unit (and meeting her on the second day) with a syringe of MSO4 in her arm while she was recovering a fresh heart! I didn't know what to do or say! I needed the narc keys, she was standing in the bathroom infront of the mirror with the door open (it was a little 4 bed pod). She was breaking the other nurse out for lunch. Being a traveler and not knowing anyone... I didn't say anything. I went home to my then girlfrind (now and still my wife.. this was 19 years ago) a drive of over 60 miles. I decided the next night to confront this nurse, who was my charge nurse and well know, a long time employee. That night I got a trauma that got creamed (pedistrian vs auto) on US 41 and I was too busy pouring blood products, putting in a swan and working my butt off to talk to her at the begining of the shift..... well within 2 hours she OD in the bathroom. The staff took her too the ER thinking she was hypoglycemic. After a day or two they ran a drug tox. I never had to tell. When my 13 weeks was up and I extended another 6 week I told my manager what happened. To this day the nurse still works at that hospital. I heard that she went throught the IP program. My suggestion: Notify the director of Pharmacy if the DON won't do anything. The DEA with eventually find out and fine the hospital. Or confront the nurse as a group and say that it will not be tolerated... you are calling the DEA on her as you will not share in her responsibility. I once had my lab broken into and the narc box was bopened... all the demerol was taken. A detective came in and fingerprinter all of us. Stupid... of course our fingerprints are on the narc box! Turned out to be a contract RT breaking into departments. The nurse impairment program is the only solution to keep a nurse working. Acess to narcs might never workout again for her. It's like letting an alcoholic be a bar tender!

I just took a $10,000 sign on 2 1/2 years ago. I get the last installment ($5,000) in Feb. This was because my hospital was starting a new open heart program and need experenced nurses. You had to have over 15 years in critical care and work in the CV service department. It has been no problem. In fact I was just returning to this hospital after being away for 9 years (I own 2 car washes). I since transfered back to the cath lab were I worked before I left in 97'. But, when I was a traveler, I look for my next assignment based on 3 factors; highest pay, higest bonus, where I wanted to go next. I then started to ask other travelers about the hospital with the higest bonus. They "usually" had a big problem. Years ago, it was Chapel Hill NC offering a $5000 sign on for a 13 week travel assign. I head that many nurse never completed the assignment from my agency.... so I went to my next pick, a $3000 bonus completion. A few years back, my local hospital lost 4 employees to a Texas hospital on a $25K bonus... 2 stayed, 2 came back within one year.

Great hospital. I have an employee that is attending U-Penn this fall at Warton Business. I own a Car wash down here. He was Vald. of our local HS. That's a great area with Drexel, Prysby, HUP.... lot's of college kids! Some of the local college put on great plays. I use to go to Villanova occassionally for plays with my girlfriend. They all have schedules in playbill. Check that out. The zoo is alway cool. If you like to walk or hike go to Wisahiccon park up in Roxborough or up Lincholn drive by East Falls. They have nice paths to ride a bike. If you like to fish for trout it's PACKED! Biking along BOAT HOUSE ROW on KELLY DRIVE (named for Jack Kelly Princess Grace Kelly's brother who was president of the US omplymic commette who died while jogging on what was called EAST RIVER DRIVE). Grace Kelly grew up in EAST FALLS. MY family goes back to Philly over 300 years. Manayunk is Indian (lenipee) for "many came to drink". It's the site of an international bike race like the tour d'France because of it's difficult hills to climb. The girls of Manayuunk were known for their GREAT LEGS! Betsy Ross's house and Elis Ally. Thomas Jeffersons home. Edger Allen Poes House.... Wow I forget how much was there! Have a great time traveling... I traveled for 2 years when I was single...20 years ago! It was great.