aCRNAhopeful

aCRNAhopeful

CVICU

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All Content by aCRNAhopeful

  1. Fluid bolus by gravity or pump?

    aCRNAhopeful replied to delphine22's topic in MICU, SICU

    We are talking about different things. You are saying that if you give a medication through a central line it will reach its target tissue faster than if you had given that same medication via a PIV....

  2. Fluid bolus by gravity or pump?

    aCRNAhopeful replied to delphine22's topic in MICU, SICU

    I dont think anyone would deny that a central line is closer to the heart than a PIV but thats not the point. The most effective way to get volume into a patient fast is a large bore peripheral IV...

  3. Fluid bolus by gravity or pump?

    aCRNAhopeful replied to delphine22's topic in MICU, SICU

    See Poiseuille's law in the post above. In other words you can increase flow rate by decreasing length of the catheter, increasing the pressure on the IV bag, decreasing viscosity of the fluid, and...

  4. Cause of uneven pulse/ox wave form

    aCRNAhopeful replied to anon456's topic in PICU, Pediatric

    Not a PICU nurse but I had a couple thoughts. I am an anesthesia student with experience mostly in adult CVICU and now anesthesia FYI but I think the concept is relevant in pediatrics as well. I agree...

  5. Neo/Levo

    aCRNAhopeful replied to LNRN11's topic in CCU, Coronary, Cardiac

    That's incredibly stupid. If you really insisted that the patients hemodynamics dictated both drips with overlapping mechanisms of action then why wouldn't you infuse both separately so you could...

  6. Triple Lumen Cath anatomy

    aCRNAhopeful replied to NurseCollins799's topic in CCU, Coronary, Cardiac

    They are separate lumens each with their own size. The brown port is typically the largest and best for

  7. Leaving Phenylephrine on with an Epi Drip?

    aCRNAhopeful replied to Dodongo's topic in CCU, Coronary, Cardiac

    I agree but the point is you can still use neo with epi. It does work even if epi may have a stronger affinity for alpha1 receptors. So in my opinion it is reasonable in circumstances where you want...

  8. Leaving Phenylephrine on with an Epi Drip?

    aCRNAhopeful replied to Dodongo's topic in CCU, Coronary, Cardiac

    I wouldnt be so sure that everyone knows what receptors they work on... Yes there are situations where it is useful to have both drugs on. Unless the doses of epi were so high that they have saturated...

  9. Leaving Phenylephrine on with an Epi Drip?

    aCRNAhopeful replied to Dodongo's topic in CCU, Coronary, Cardiac

    When i worked in CVICU it was not uncommon to have both going at once but not for the rationale you're stating. First of all even if epi and neo are structurally similar they are night and day...

  10. Leveling art line to tragus for cpp???

    aCRNAhopeful replied to jimmy_hat's topic in Neuro Intensive Care, ICU

    I dont have any evidence to support the practice of leveling to the tragus but it makes sense. The perfusion pressure of any organ is going to be equal to the MAP minus the highest force opposing the...

  11. Stroke volume variance

    aCRNAhopeful replied to Lynda Lampert, RN's topic in MICU, SICU

    Regarding SVR - you have the basic idea but just remember you're not treating the actual SVR number. You're treating the hypotension or low cardiac output state or whatever. So yes if pt is...

  12. Stroke volume variance

    aCRNAhopeful replied to Lynda Lampert, RN's topic in MICU, SICU

    Other than the SVV they should want to know things like the CO/CI (or SV/SVI same concept) and the SVR/SVRI. Just like with a swan the goal being try to figure out how to fix a hemodynamic problem...

  13. CPR question

    aCRNAhopeful replied to Sand_Dollar's topic in CCU, Coronary, Cardiac

    Thats because there isn't one. The patients brain is literally dying rapidly during a code so trying to limit the blood pressure and perfusion is just silly. I can see not being over the top...

  14. Drips

    aCRNAhopeful replied to A_Simp's topic in CCU, Coronary, Cardiac

    Your pharmacy probably has a policy as far as "max" doses for pressors which should give you an idea of what high doses are. The typical dose ranges are just memorization info you can find anywhere....

  15. Drips

    aCRNAhopeful replied to A_Simp's topic in CCU, Coronary, Cardiac

    if the infusion is running in mcg/kg/min you could multiply mcg by kg to get mcg/min. Not sure what that would do for you though? Some hospitals run certain gtts like epi, levo, or neo in mcg/kg/min...

  16. IABP Mean Greater than Systolic?

    aCRNAhopeful replied to EtherFever's topic in CCU, Coronary, Cardiac

    I cant say for sure as I dont have experience with ECMO but yes the augmentation pressure is accounted for in the MAP. I have seen the MAP > assisted systolic before with severe cardiogenic shock....

  17. FFP off the pump?

    aCRNAhopeful replied to chris_mnd's topic in MICU, SICU

    Be sure the blood is high and the IV is low and that the IV isn't kinked if it's in the AC or something, really no reason why it shouldnt. If it's a perfectly patent IV that's 20g or greater I can't...

  18. The next pressor...

    aCRNAhopeful replied to MLB55's topic in MICU, SICU

    It depends what you need it for. You may see a lot of septic patients who are in a vasodistributive kind of shock and hence why you see a lot of powerful vasoconstrictors but there is no specific...

  19. Think Twice Before Becoming a "NURSE"

    aCRNAhopeful replied to mcrutRN's topic in Activism, Healthcare

    Go work in another institution in another setting. Sounds like your coworkers don't like you or don't like new nurses in general and you are having a hard time with it. Become a male nurse if you're...

  20. vasovagal post sheath removal

    aCRNAhopeful replied to vic_rn's topic in CCU, Coronary, Cardiac

    Hmm good question. I couldn't exactly say WHY it would happen that way without pressure, bleeding, or pt movement. I'm not too familiar with the intervention they did in the lab but could that have...

  21. Closed Units

    aCRNAhopeful replied to rnkitka's topic in General Nursing

    I work on a closed unit CVICU that also has the universal bed system for open hearts. Staff are required to take one on-call day per week on 3/4 weeks in a month. We rarely get called in but that's...

  22. Can I bolus this patient? A legal / practice question about sedatives and narcotics

    aCRNAhopeful replied to simvee's topic in MICU, SICU

    That's interesting there must have been more to the story. CRNA's, MD's, and Anesthesiologist Assistants can all push propofol and do so thousands of times a day (maybe even per hour) it just needs...

  23. ratio for fresh CABG pts

    aCRNAhopeful replied to bhrusa09's topic in MICU, SICU

    Stupid and ridiculous. Needs to be 1 on 1 for at least 4-6

  24. "If I Knew Then What I know Now" -Med/surg-to-CCU

    aCRNAhopeful replied to webmansx's topic in CCU, Coronary, Cardiac

    You only need 1 year of full time experience to pass ccrn. It has to be WITHIN the past two years though. I'd say study up on stemi and the differences between the different wall

  25. Potassium question...

    aCRNAhopeful replied to Soflo_RN's topic in General Nursing

    I dont know I'm surprised that there's people that would actually go out of their way for this. I wouldn't worry about it unless there was some unusual reason that it caused concern. Just take note of...