SLEEPERJC

Hi friends, Great post It really hit home. Was promoted to Nurse Educator and will now work 8 hour days. I loved 12 hours. it was beyond my wildest dream for many years. Now at 47(2 coronary stents last march) Im looking to slow it down a little. Looking foward to weekends and holidays off but not to the 5:30 alarm clock going off. It is nice getting out at 3:00 in the afternoon though. whatever floats you're boat!!!!:redbeathe JC

Hi friends, Great post It really hit home. Was promoted to Nurse Educator and will now work 8 hour days. I loved 12 hours. it was beyond my wildest dream for many years. Now at 47(2 coronary stents last march) Im looking to slow it down a little. Looking foward to weekends and holidays off but not to the 5:30 alarm clock going off. It is nice getting out at 3:00 in the afternoon though. whatever floats you're boat!!!!:redbeathe JC

When orders for diprivan are written they may state titrate to sedation ramsey 2-3 so for example. If the bottle runs dry as occasionally it runs dry even to the best of us. a pt may need a bolus to get them calmed down, they are left at the maintenance dose of say 20ml/hr. Also they grow acostomed to a set rate and need to be adjusted sometimes first giving a bolus of say 3-5mL. Some pts are very sensitive to the diprivan and 5ml would sink there BP it's all at the nurses discretion. That's how it was shown to me when I came to the SICU.

When orders for diprivan are written they may state titrate to sedation ramsey 2-3 so for example. If the bottle runs dry as occasionally it runs dry even to the best of us. a pt may need a bolus to get them calmed down, they are left at the maintenance dose of say 20ml/hr. Also they grow acostomed to a set rate and need to be adjusted sometimes first giving a bolus of say 3-5mL. Some pts are very sensitive to the diprivan and 5ml would sink there BP it's all at the nurses discretion. That's how it was shown to me when I came to the SICU.

Meandragonbrett, The iv (bolus) was the only way I could figure to calm him down. It's rarely given this way except for road trips to CT. Did you mean Vecuronium? Paralysis would have worked too. I hadn't thought of that. He had been kept paralized for days. At one point it occured to me that the Ativan was making him worse. Our docters are notorius for rounding in the morning and saying turn all the sedation off. What guidelines do you follow, if any regarding "weaning to off"? I read somewhere that narcotics be halfed each day untill 0. Sometimes we will start on methadone. Sorry for straying from the wonderous diprivan...

Meandragonbrett, The iv (bolus) was the only way I could figure to calm him down. It's rarely given this way except for road trips to CT. Did you mean Vecuronium? Paralysis would have worked too. I hadn't thought of that. He had been kept paralized for days. At one point it occured to me that the Ativan was making him worse. Our docters are notorius for rounding in the morning and saying turn all the sedation off. What guidelines do you follow, if any regarding "weaning to off"? I read somewhere that narcotics be halfed each day untill 0. Sometimes we will start on methadone. Sorry for straying from the wonderous diprivan...

Hi Everyone, I realy enjoyed this thread. We use "Mothers Milk" by the case. We are always stashing it away for future use. Yesterday infact, my patient was very restless indeed. With both fentanyl (250mcg/hr) and ativan infusing (2mg/hr) diprivan was at (30mcg/kg/min) (12.5 ml/hr) patient was tolerating vent. Turn off diprivan and the patient starts to climb out of bed so increased the ativan to 4mg/hr and gave two bolus does Ativan 2mg to no avail The patient was going to get a vena cava filter so I drew up 100mcg of diprivan, pushed 50mcg (5ml) and off he went to the OR. Upon his return I was faced with the same dilema. How do I keep this guy from desaturating to 88% because of his restlessness. He is 10 days post admission for stabbing/explap with non closure who Has now developed Multiple Resistant Pathogen (MRP). The point that the Attending was trying to make is that eventually the patient needs to come off sedation. I agree. I see that all but 1 post chose Versed as benzo over Ativan do you find that it works better and why. We use alot of versed as well. Some times I follow whats being done when I come in. Perhaps had I switched over to versed I would have not needed to place on diprivan. Pt. has hx. chronic alcohol use thanks for reminder to monitor triglycerides/amalase/lipase . Feedback :welcome:

Hi Everyone, I realy enjoyed this thread. We use "Mothers Milk" by the case. We are always stashing it away for future use. Yesterday infact, my patient was very restless indeed. With both fentanyl (250mcg/hr) and ativan infusing (2mg/hr) diprivan was at (30mcg/kg/min) (12.5 ml/hr) patient was tolerating vent. Turn off diprivan and the patient starts to climb out of bed so increased the ativan to 4mg/hr and gave two bolus does Ativan 2mg to no avail The patient was going to get a vena cava filter so I drew up 100mcg of diprivan, pushed 50mcg (5ml) and off he went to the OR. Upon his return I was faced with the same dilema. How do I keep this guy from desaturating to 88% because of his restlessness. He is 10 days post admission for stabbing/explap with non closure who Has now developed Multiple Resistant Pathogen (MRP). The point that the Attending was trying to make is that eventually the patient needs to come off sedation. I agree. I see that all but 1 post chose Versed as benzo over Ativan do you find that it works better and why. We use alot of versed as well. Some times I follow whats being done when I come in. Perhaps had I switched over to versed I would have not needed to place on diprivan. Pt. has hx. chronic alcohol use thanks for reminder to monitor triglycerides/amalase/lipase . Feedback :welcome:

Hi all, What is expected from the nurse preceptor? I've been doing it because I like it and and I have been getting positive feedback. However soon to take on a BSN student for 190 hrs. and dont belive I should just wing it. JC

You describe the ICU so, so well. LOL, good luck to all of you!

I think it was Trauma Tom who said he just got accepted at age 50 and is very excited about it. That helped me alot when I heard that. I understand where your coming from. At 43, I have the notion that I may be 50 too, when I start applying to schools. Maybe it will be sooner? I have 20 years vested in my state retirement system (not something to walk away from). Seven years from now i'm still going to be 50. Im told that life doesn't end at 50. In the mean time being a Wannabe has motivated me to: 1. leave the E.R. after 10 years level one trauma. I'm in SICU 2 mos. scared out of my mind, but loving it(stretching & growing). 2. finish up my BSN online, graduate in another year. 3. join AACN (attending a conference in Orlando in May). Most of the suggestions that were given to you also apply to me (I took A&P in 84). I'm lit with enthusiasm. Inch by inch it's a cinch, yard by yard it's hard. Good Luck JC

Congrats! Best of luck.

After 10 years in the ER I just transfered to the SICU. I know for me It is the right decision. I'll probably be here several years before I apply to CRNA school. Any way, my transition into the SICU has been made easier by my ER experience. I've never managed so many drips and used so much sedation!! I love it! The other day I counted 13 lines on a patient plus two chest tubes (L side draining about 2000/shift all of which was replaced with .9 saline) plus the hourly urine output, fingersticks and insulin protocols. I actually thought about a post that was made about taking on difficult cases and not coming all this way to sit in the coffee room so I tried to get as much as I could from whever I could get it. One day the Attending Surgeon decided to crack a chest open during a code on a 26 y.o. and I was the one to grab the cardiac chest tray and set up the internal paddles. Taking it ODAT JC

Trauma Tom, at 43 I'm still working on my BSN. You are a power of example to me. It looks like ill get the transfer to SICU I put in for. So I'm on my way. All of you have helped by your shared experience. You really give me encouragement. Thanks, JC

Hi everyone, I've been following the board for the last few weeks. It's great. Thanks to all for sharing your experiences. This thread struck a cord with me. I'm an E.R. nurse with 10 years experience(level one trauma center) that believes that I would benifit from some ICU experience prior to applying to CRNA school(yet another thread). Anyway, I just took the step of filling out the paperwork for a transfer to the SICU (big step). Now it's in their hands. I realize now that I gave the explanation of "needed at least one year experience in critical care for CRNA school may give them the impression that i'll do my year and than I'll be gone. So, i'll have to clarify that is not the case as my plans to go to school are sometime a little further off. JC