TakeBack

TakeBack

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All Content by TakeBack

  1. Spontaneous Awakening & Breathing Protocols?

    TakeBack replied to rikkemp's topic in MICU, SICU

    I wouldn't include vasopressor use as an exclusionary criteria. Patients may be on stable supportive doses of pressors and inotropes and be excellent candidates for extubation. Actively titrating gtts...

  2. Drawing blood from central lines

    TakeBack replied to Altra's topic in CCU, Coronary, Cardiac

    A saftey set, as described above, is best for this purpose. Even though you are keeping the system "closed" as you describe it, it DOES increase the infectious risk every time to access the line. The...

  3. Chest tubes: air leak or no air leak?

    TakeBack replied to ahicks's topic in CCU, Coronary, Cardiac

    To clarify- "Air leak" means there is a patent channel which is either 1. inside the chest- injury to the lung, ruptured bulla, s/p lung resection. Air is entering the pt's trachea, traveling into the...

  4. Doctoral degree to become an NP???

    TakeBack replied to VickyRN's topic in Doctoral Nursing Degrees

    I work w/ many NPs and they are great at practicing medicine. The only nursing I see practiced is by

  5. RAP/CVP measurement with a temp dialysis cath.

    TakeBack replied to juraviel's topic in CCU, Coronary, Cardiac

    It is acceptable short term but there are downsides. Infection, as mentioned above, is the first. Thrombosis of the line is second. HD lines are generally heparin flushed for this reason. The...

  6. CCU? What exactly is it?

    TakeBack replied to StayLost's topic in CCU, Coronary, Cardiac

    Yep the acronym varies. Our ICU is called a CCU but it holds a typical med-surg critical care mix, with MICU, SICU, and CTS patients. Step down- intermediate between ICU and floor in terms of...

  7. pressors and sepsis

    TakeBack replied to diosadelsol's topic in MICU, SICU

    I think the critical issue is that the SIRS-sepsis-septic shock cascade involves significant myocardial depression; whatever it is in the inflammatory process that causes vasodilation (cytokines etc),...

  8. Which parameter is elevated in right-sided heart failure?

    TakeBack replied to Misty1's topic in CCU, Coronary, Cardiac

    Yes CVP reflects right atrial/ventricular filling pressure, which goes up in RV failure. Wedge and LVEDP are left heart filling pressures. CO goes down in "typical" HF

  9. Confused patients and fem lines

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

    Assess the need for the line. IABPs at my institution get a leg brace and 4 points if they are that agitated, until we can control them pharmacologically. Fem A lines are a last resort of...

  10. NPP news from the PA side of the aisle

    TakeBack posted a topic in Nurse Practitioners, NP

    Nonphysician providers, on notice again. Dr Helene Pavlov, radiologist at HSS in NYC, has posted an opinion at Huffington Post regarding the degradation of the physician-patient relationship. We are...

  11. Heat/cool w/ CVC?

    TakeBack replied to MrBubbles's topic in CCU, Coronary, Cardiac

    Warming after hypothermia causes vasodilation of peripherally constricted tissue vascular beds, and resultant hypotension. Use of volume loading and tone agents (phenylephrine, vasopressin) can

  12. PICC Line Threading ANP (would this be valuable?)

    TakeBack replied to Born2BWild's topic in Nurse Practitioners, NP

    Any procedural skill is worthwhile. It adds to your skill set, and you will learn things that can likely apply to other areas of your

  13. Pulse ox and hematocrit

    TakeBack replied to TemperStripe's topic in MICU, SICU

    1. The waveform is from the measurement of pulsations; the value (%) comes from light absorbance by different states of hemoglobin. Your poor waveforms are due to peripheral vascular abnormality...

  14. Anyone NOT have enough exp before NP school?

    TakeBack replied to CrazyPremed's topic in Nurse Practitioners, NP

    No, I'd say you were addressing a primarily nurses forum- and felt you were "speaking to the base"- and got called on, IMHO, unnecessarily denigrating PAs. You feel that PAs are a lesser clinician due...

  15. Anyone NOT have enough exp before NP school?

    TakeBack replied to CrazyPremed's topic in Nurse Practitioners, NP

    I moderate at PA Forum, we have RN & NP members, and often have discussions on PA-NP issues. I read here to see another side of it- of course threads relevant to advance practice nursing and how...

  16. Anyone NOT have enough exp before NP school?

    TakeBack replied to CrazyPremed's topic in Nurse Practitioners, NP

    PAs - "Mid Level Practitioners" NPs - "Primary Providers of Health Care" Does a primary care PA deliver health care as a "primary" provider? What are the "levels" that the PA is in the "mid" of????...

  17. PA vs. ACNP

    TakeBack replied to ILoveIceCream's topic in Student Nurse Practitioner

    Actually the breakdown is about 60% Female, 40% Male:

  18. Hypothyroidism prolong weaning

    TakeBack replied to coffeekat's topic in General Nursing

    Not a common cause of weaning failure. Pts w/ critical illness may have occult hypothyroidism. http://chestjournal.chestpubs.org/content/126/4/1307.full Results: Of 140 patients studied, 67 were male...

  19. Calcium Chloride vs Calcium Gluconate

    TakeBack replied to Manurse715's topic in CCU, Coronary, Cardiac

    Ca is an inotrope and vasopressor- but notoriously short term. It is also a cofactor in the coag cascade, so it is useful in a postop heart, all of which are coagulaopathic. The hypoalbuminemia and...

  20. How to do Atrial ECG

    TakeBack replied to mfcheong's topic in CCU, Coronary, Cardiac

    My method: Take one of the A wires (either one) and attach it to MCL/V1. Make sure you have MCL and another lead (such as lead II) displayed on the monitor. Run a strip of the two leads on the same...

  21. dressing changes for OH patients

    TakeBack replied to Francesca RN's topic in CCU, Coronary, Cardiac

    Open to air starting POD#2; the incision is epithelialized by then. Postop wound infection is directly related to intraop technique and good closure, nutrition, adherent sternal prec etc. Do you have...

  22. CVP's before x-ray line confirmation

    TakeBack replied to JayVArn's topic in MICU, SICU

    This depends in part on the line insertion technique. If you are getting brisk blood return w/ syringe, then you're either in the IJ/right heart or the carotid. Pressure tubing manometry or looking at...

  23. b/p ?

    TakeBack replied to erin01's topic in CCU, Coronary, Cardiac

    First, get clear hold parameters from the covering provider. SBP - product of vasc tone and the ventricular upstroke (more dependent upon heart function) DBP - primarily from vasc tone (lower in...

  24. Nurse Practitioners ranked #4 by CNNMoney.com Best 50 jobs in America

    TakeBack replied to profstudent4life's topic in Nurse Practitioners, NP

    The article, much like other recent output from CNN regarding PAs, is sometimes misleading and sometimes flat out wrong (in this case- "In most states they can write prescriptions as well".....in...

  25. chest tube removal

    TakeBack replied to corkyrn's topic in CCU, Coronary, Cardiac

    Mediastinal tubes are generally inserted subxiphoid, and there is a soft tissue tract of 3-5 cm between the skin and the mediastinum. This tract will collapse down on itself after the tube is out. For...