clementinern

clementinern has 20+ years experience and specializes in Critical Care.

Latest Activity

1. May be repetitive thread;going to ICU from Medsurg

   clementinern replied to RNHURT's topic in CCU

   My best advice would be to NEVER NEVER NEVER be afraid to ask questions, even if you think it is a "stupid" question. Please, trust me when I say that most ICU nurses would much rather have you ask questions than do something that might be out of you...

2. How long do you apply pressure when d/c a balloon pump

   clementinern replied to faithmarie's topic in CCU

   In our facility manual pressure is held for at least 20 minutes, and then a femostop is applied for 1-3 hrs in most circumstances.

3. Advice on pt with open chest Please!

   clementinern replied to sweetart4988's topic in CCU

   You are correct that a pt with an open chest does bubble most of the time. It's precisely because the chest is open, so you pretty much always have a leak. Regarding Maevish's post about how there shouldn't be any leak in a mediastinal tube- while ...

4. therapeutic hypothermia

   clementinern replied to Phylis's topic in CCU

   Yes we use the Arctic Sun at my facility and I have seen no issues with skin integrity related to the pads.

5. SVR too low!!

   clementinern replied to HeartRN80's topic in CCU

   Also i wonder why the docs would have you go up so high on Epi and add vasopressin without increasing Dopa or adding Levophed first? Vasopressin usually works in conjunction with Levo....seems like increasing the Dopa to alpha doses or adding Levo wo...

6. SVR too low!!

   clementinern replied to HeartRN80's topic in CCU

   Was the pt an AVR in addition to CABG? Sometimes those pts are used to really high SVR's pre-op and the suddenly competent valve can have a hard time adapting to the decreased afterload. I also find the addition of the IABP odd, even though it will...

7. Blood pressure drop while giving albumin bolus

   clementinern replied to luckyou's topic in CCU

   My only thought is that you ran the albumin through the same line as propofol or something else that could drop bp and the sudden infusion of albumin gave them a little bolus. Otherwise, it just doesn't make any sense. If that is what happened- for...

8. IABP and CPR

   clementinern replied to Tornadochaser's topic in CCU

   Definitely don't need to shut off the IABP during a code. Generally we put it in pressure mode, as others have said. The only possible rationale I can think of to leave it in EKG mode is that the newer IABP's switch between modes automatically; perha...

9. PRN fluid boluses post open heart?

   clementinern replied to aCRNAhopeful's topic in CCU

   We have free reign to give up to a liter of LR and a liter of Albumin, and then we are supposed to call; but the understood rule of thumb is that up to 3 liters is generally considered ok. Our docs tend to prefer more fluids vs more pressors though.

10. Amiodarone and Lidocaine drips for VTach

    clementinern replied to deemo21's topic in CCU

    I don't actually recall running both together, but lidocaine is generally indicated for polymorphic VT over amio.

11. What is a good sedative for a hypotensive patient?

    clementinern replied to nursingdude78's topic in CCU

    I've found versed to be the best, but you said your facility doesn't use it. That's too bad; it works great. Fentanyl typically works well too. Also, 250cg of Neo is over the max dose! Yikes! I'm also curious about why you said pt wasn't hypovolem...

12. Lowest H/H I ever saw...

    clementinern replied to my2sons's topic in CCU

    Many years ago i had a pt who had a HCT of 9!! Yes, the HCT!!! He was a jehovah witness and was refusing blood products. I can't remember what happened to him or what the scenario was.

13. IABP blood pressure question

    clementinern replied to NeuroNP's topic in CCU

    It depends on the doc, some docs will titrate drips to augmented BP and some will titrate to IABP mean. We document all of the #'s on our sheet, including peripheral A line BP's. The IABP #'s will be most accurate though and all hemodynamic calcula...

14. Top 10 CT-ICU drugs

    clementinern replied to CABGx4's topic in CCU

    Well, I can't say specifically what drugs your unit will use- but I can take an educated guess based on what we use in our CVICU. Propofol Dopamine Lasix Neosynephrine Precedex Angiomax Calcium Gluconate Calcium Chloride Nitroglycerin Milrinone Dob...

15. IABP

    clementinern replied to BellaInBlueScrubsRN's topic in CCU

    Also, I think the first person to respond to your post- CABG patch kid- maybe have been confusing augmented diastolic with assisted diastolic. You WERE correct that assisted diastole should be lower. Augmented pressure, however, should be higher.