clementinern

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...

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.

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 ...

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

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...

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...

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...

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...

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.

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

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...

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.

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...

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...

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.

I think the way you worded your question made it a little tricky to understand what you were asking. You didn't actually have a "negative afterload reduction", but you are correct in saying that you were making the pts heart work harder. You actually...

Wow, I guess we have it made in MA. I live south of Boston and at the top of the payscale (15 plus years experience) our base pay is $48/hr. I believe the scale for new grads starts around $23. Critical care does not get more money- it is based o...

the hypocalcemia you see with post op cardiac surgery pts is related to fluid shifting from the actual bypass pump and, as you mentioned, from blood products. also being cold can alter electrolytes. calcium works by increasing the "squeeze" and con...

In my facility, we typically use Calcium Gluconate to replace a low ionized ca of

I always say, simply, "pt is resting quietly".

To be honest with you, I think I would have looked to treat the cause of the rate- despite the AFib, the pt had a lot of other potential reasons to be tachycardic and hypotensive. Was it anesthesia effect causing the low bp? Pain or fever causing t...