Sari2009

There is another serious issue at hand here. Any long time ICU nurse is familiar with "nurse dose" of sedation or narcotic. If a lot of nurses are doing this with a particular patient who is requiring a lot of narcotic/sedation and it is not ALL documented and reported on the up and up the MD does not have an accurate feel for total dosing. This can be a HUGE issue when it comes time for weaning. If they are completly underestimating how much sedation/narcotic a patient has requried that patient can look forward to a whole heck of a lot of withdrawl as they will not be properly weaned. So when we think we are helping a patient stay comfortable it may acutally hurt them in the end....not to mention our professional responsibility.

ABSOLUTELY! Why not? It is all in how your sell yourself. I will tell you that after being in pediatric criticial care for almost 20 years things have changed but if anything I think they have actually simplified a bit. Meningococcal disease is almost non existant in the US, hybrid procedures are replacing the Norwood and you almost never see a swan-ganz catheter anymore. But solid experienced nurses are hard to find and you would be welcomed. The most important thing is to believe in yourself. I would review...the CCRN for PICU is a good start. I say go for it.

In the several years I have used presedex I have always used standart tubing and either a bag or syringe pump depending on the rate. The only exception is if the kid still has a shunt or unrepaired cardiac defect then we filter everything.

I was staff in Vegas for a few years....I just left recently to travel again. Cross Country Trav Corps has many postings in Vegas. If you decide to go I have a furnished empty 2500 square foot home sitting there while I travel that I would be happy to rent out cheap if you want to take the stipend...just message me and good luck.

Be emotionally available to them and dont be afraid to show while still maintaining composure. It is painfull for everyone but still an honor to comfort a grieving family. Remember there is no right or wrong way to grief and you will see many different responses to that. I try to involve the family in all aspects of post mordem care if they are willing because you dont get those moments back. Momentos are important...hand and good prints and hair locks even in big kids. And if they dont want them store them for several months....they often call back asking for them. Remember to take care of yourself because it takes a toll and you cant give from an empty cup. After 21 years I can hardly remember all the children who have died on my watch but I know thier familes remember me. Just be present and remember parents are not supposed to watch thier children die....sometimes just validating that is enough.

I have had a lot of experience with precedex gtts in the PICU. I personally have not seen much bradycardia and have used it in many post op hearts. You may see some hypotension at higher doses however the half life is so short that if you titrate down or just put it on hold for a moment it is very transient. Remember precedex is meant to work as adjunct to opiate and even benzo not as single agent sedation. It helps to use a loading dose over 15 minutes and then titrate from 0.2 all the way to 1 mcg/kg/minute although the package insert will say you max out at 0.7mcg/kg/minute. It will definately potentiate opiate effect so once you have it going you will need to titrate down your opiate. It causes almost no resp depression so it is helpfull in painfull yet not intubated patients such as spinal fusion and craniofacial surgeries. It is not the end all be all but when it works it works. Good luck with it.

I have cared for many, many norwoods over the years but have just begun working in a PICU that has a very sucsessfull hybrid approach to many congential heart defects. For HLHS babies they stent open the PDA to mantain flow and place bilat PA bands to limit overflow to the lungs. This is sometimes combined with a septostomy depending on the size of the septal defect. The goal is to allow the infant to gain and grow and gain strength prior to proceeding with the Glenn. I find it facinating. I have seen one done in the short time I have been there and am anxious to see how these kids progress.