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ilikesharpthings

ilikesharpthings

Med-Surg ICU
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ilikesharpthings's Latest Activity

  1. ilikesharpthings

    Meaning of your username?

    I played the tuba. Also, I was a 98 lb girl in high school. Awesome, nerdy combo.
  2. ilikesharpthings

    What are the top 5 medications YOU administer daily?

    I just made this same list (in a slightly different order)! Do we work together...? [emoji6]
  3. ilikesharpthings

    What are the top 5 medications YOU administer daily?

    Levophed, propofol, fentanyl, protonix, and lovenox. MSICU if you couldn't tell!
  4. ilikesharpthings

    What nursing task do you loathe???

    Ugh, i hate ears too!!
  5. ilikesharpthings

    Meaning of your username?

    I like sharp things...
  6. ilikesharpthings

    CPR on the floors

    You have intubated people on the floor?!
  7. ilikesharpthings

    What is your Nursing Kryptonite?

    For some reason, I cannot handle ear wax. Ugh. So gross.
  8. ilikesharpthings

    Is She Artistic or Autistic?

    What a lovely, beautifully-written tribute to your daughter, who sounds remarkable! She is fortunate to have parents who see her for who she is and recognize the many gifts she has to offer.
  9. ilikesharpthings

    delete

    The flow meter? However, it wouldn't be "breathing oxygen rhythmically" if it was just blow by O2 via a trach mask. Is the patient breathing on their own or are they on the vent?
  10. ilikesharpthings

    Reflections after my first code

    For some reason this person wasn't cooled per the therapeutic hypothermia protocol - as I understand it is was because he was a PEA arrest and very hemodynamically unstable - but I don't know for sure. I wonder if his outcome would have been different.
  11. ilikesharpthings

    Reflections after my first code

    I'm sure his death was very multifactorial. He had no CHF hx, and the echo tech was on their way when he coded, so the echo wasn't ever done to confirm that his heart was damaged. The rapid bedside echo in the ED was read as normal, but he had coded 2-3x since then, so I'm sure he had some wall motion abnormalities and the extra fluid probably didn't help but he wasn't sustaining a blood pressure and had no urine output with 4 pressors on board, so what else was to be done? I usually am under the impression that diuretics are held when someone is so drastically hypotensive, but if he had maxed out on starlings curve perhaps it would have helped. I'm not sure... At that point however, I was concerned that the neurological damage he had sustained would make his future very bleak, even if his heart somehow could have recovered. With 4 rounds of CPR, his brain perfusion couldn't have been all that great, even with the best compressions!
  12. ilikesharpthings

    Reflections after my first code

    Patient was scheduled for an elective, outpatient surgery. Woke up early to shower, and fell to the ground, breathless and weak. Wife called 911. Pt coded in ambulance. Coded again in ED. A third time in CT. Found a massive PE. tPA was given and pt was sent to ICU. When I assumed care, pt was on Levo, heparin, bicarbonate, MIVF. No UOP despite being 8L positive. Poor neuro exam. Became more hypotensive with stable H/H, and dobutamine was started. Then he became bradycardic and lost his pulse. I was the first on his chest. His ribs were already broken. 2 rounds of CPR, and some epi, and he went into VT. 1 shock brought a rhythm back. Started epi drip. Had to add vaso, as I couldn't keep his pressure up with everything else maxed. It looked like he was gonna code again, but I was able to speak to the family first and tell them that it wasn't a matter of if he would code again, but when. I told them that we would respect their wishes, but that we were doing our best to keep him alive and his heart couldn't take much more. And that even if we got him back he would never be the same. They decided against more CPR/shocks and elected to let him go as peacefully as possible (still intubated, sedated, and maxed on 4 pressors). He died shortly thereafter, his family surrounding him and holding his hands, instead of having his chest pounded on and electrical currents rip through his body. I'm 5 months in as an ICU nurse, and this was by far the most unstable patient I have cared for. While it is very sad that his life ended in such a tragic and unexpected way, I am glad that I was able to help this family accept their loved one's death and allow him to slip away with some semblance of dignity and comfort. I am not a a cryer, and maintain a healthy disconnect from my job, but as I held the wife of this man, I wept with her. As I watched his brothers say goodbye, I remember having to say goodbye to my husbands brother, who was taken from us all too quickly as well, and the tears came. I was in no way emotionally connected to this family, and my tears were not for me. I have now become a major player in the absolute worst day of their lives. They will remember my face, my words, my actions. My tears were for them. They will remember a nurse who was willing to grieve with them and recognize that my average day at work was the most horrific day they have ever experienced. I came home that night, took a bath, drank some wine, and went to bed. I will return to work, return to another sick person, and life will go on. They will return to an empty chair at the table, a vacant side of the bed, family photos where one is missing. This job is sacred. We are walking the line between life and death, between hope and hopelessness, between "do everything" and "let him go". I am proud to be an ICU nurse.
  13. ilikesharpthings

    When Should You Call Off Sick?

    I have called in sick 3 times since becoming a nurse 5 years ago: when I went into labor, when I had pneumonia, and once when my childcare provider was sick. But I really never get very sick.
  14. ilikesharpthings

    CRRT-effluent bag nightmare

    In my ICU, I rig up a IV pole near the in-cabinet toilet in the room. I tape a suction tubing up by the top hook and drape it into the toilet. Then I hang the effluent bag and hook the tubing to the drainage port, open it, and let it drain into the toilet. I have 2 bags going so that I can just change them whenever the bag fills and needs to be changed.
  15. ilikesharpthings

    IV PGB by gravity Q.

    Raise the ivpb higher or lower the maintenance. Also, sometimes maintenance fluid will back up into the piggyback tubing.
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