aCRNAhopeful

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. No one would question that. The thread was about g...

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 hung by gravity (or pressure bag). Hang the same bag ...

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 most of all increasing radius of the catheter (incre...

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 with the previous poster regarding the pulsus par...

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 tailor the ratio based on changes in the patients cond...

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

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 more vascular tone without the increased myocardial...

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 all the alpha 1 receptors then neo is still going...

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 different as far as pressors go. Epi is a powerful Beta1,...

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 map. In the brain it could be ICP or CVP if that i...

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 hypotensive and has a low svr (sepsis for example) then a pr...

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 (fluids, pressors, inotropes). As far as which number...

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 aggressive with compressions but anything else doesnt make ...

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. There is no rule to know if it is too high or too l...

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 and others do mcg/min. The therapeutic dose is the ...

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. The patient's own pulse pressure was so terribly l...

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 see why it wouldnt free flow if you have it high en...

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 order in which you choose pressors. The one caveat is ...

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 not already. I seem to always get better treatment ...

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 something to do with the cause?

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 how we keep the unit staffed in case of call ins or ...

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 someone with advanced airway management skills to pu...

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

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 mi's.

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 it and make sure the proper orders/treatment plan...