RNAEMTCC

ahh I double shift. I've been mandated into many of these unfortunately....many many many of them. Thankfully the new law came through in NY that we can no longer be mandated and I will never ever work a 16 hour shift again, I felt unsafe, I had to pee. I was exhasuted, dehydrated, and didn't have a break the entire shift and that was most of the 16's I worked, because when you're mandated it's already short... so you're not going to get a break. Sigh... what they do to nurses.

So, I had a patient with a morphine PCA. he wasn't exactly the brightest bulb in the box. He would continually ask for boluses through the pca. except.... well he didn't call it a bolus it was a .... Bogus Bolo Golo Gogus Mogus molo Solo Sogus I then, got tired of trying to figure out what he was asking for, and wrote BOLUS in thick black permanant marker lettering and taped it to his overside table so he would just have to look at it. (and yes he could read) then then managed to come up with even more creative names for the bolus "double shot" "double pump" I gave up at that point... lol.

Hm. Well I don't entirely agree. I have seen irregular atrial flutter before. And a rapid atrial fib/flutter (where they go in and out of both) can come across your screen at 200bpm looking like flutter.... or SVT.... sometimes you just love your patients. I always slow the paper speed down (and then change it so you don't give the next nurse a heart attack) and then you can clearly see what you are looking at! as usual, the best is an EKG, or a trial dose of adenosine (it's kinda a diagnostic medication) that i've seen some docs use to slow it down long enough to see whats going on... of course it's acls, so depending on the hospital a decompensating patient will get it without an order anyhow. .... if not for that pesky "prolonged asystole" they warn about on the box it's a great drug.

don't be fooled! Breath sounds and end tidal co 2 measurment with a device can be decieving! By all means. WAVEFORM CAPNOGRAPHY is the best form folks. It's totally NON invasive, just ask the doc if you can monitor ETCO2 (they usually don't give a hoot if you want to) and you have a wonderful wave form of constant reassurance that your tube is in the right place. perhaps it's because i can also do pre hospital intubations and have come to love waveform capnography as a wonderful reminder of where my tube is. Given the wrong situation your color changer will be WRONG.... you can just barely right mainstem and still manage to get bilateral breath sounds. By all means, I still use breath sounds, but something about that waveform that comes up makes me feel so much better... besides it tells you so much about your patient! ok, i'm off my soap box now...

I am studying for them currently. If you have a chance to take the med-ed review, do it... she was amazing. My boss is even sending me back for a second review before I take my test. I worked in a cardiac step down unit for 2 years... but didn't have any swan/IABP experience (we did a lines, vents tho) so i moved to the CPICU recently, and am going to spend a few months with swans, fresh open hearts and the notorious off service "dump" to get the rest of the critical care managing knowledge I need and then take the test. I have a book also. but the class was by far the best thing I ever took! good luck to all!

I work on open heart ICU.... our gold standard is stable, extubated within 4 hours and up to chair within hour of extubation. of course that is the gold standard.... many many times... well it just doesn't go that way as we all know!. our patients also have extended stay in the ICU as the doc doesn't trust anyone but the icu to care for his patients. haha....