Alford

If someone is able to perform plantar and dorsi flexion, is it safe to say they would have a pedal pulse? Is it possible to perform plantar/dorsi flexion and not have a pedal pulse?

I didn't think it was likely, just trying to think of every possibility as to why the patient who arrested and subsequently intubated was only able to have a PO2 of 49, despite being on a PEEP of 12.

How likely is it to puncture a lung by inserting an OG tube in an intubated patient?

First and foremost, let the hate and anger go. Granted, I would be very jaded if I were in your situation. But in the final analysis, it's not going to solve or fix your problem and it's only going to drain you. Insead, understand that it is up to you to make this happen. Become an aide until you can find a nursing job. It's not ideal, but it's going to make you stronger in ways you can't even appreciate right now. If you want it bad enough, you will make the neccessary sacrifices.

I am trying to figure out how or why cardizem and even amio can cause a patient to go hypotensive. I know it causes vasodilaton, resutling in a drop in bp, but I would like to know how that occurs. Or if anyone could point me to a site or reference that would be great.

Your life is going to move in the direction of your most dominant thougts. Like the poster above mentioned, you need to quite these inner voices. Start seeing yourself exceling and thriving in this field. You passed nursing school and you past your boards. You have been in the field for 1 year. All of that undoubtedly means you are qualified. Stop dwelling on negative thoughts and scenerios. Sooner or later you will gravitate towards or attract such occurences. In regards to the nurse who stated she could write you up and have you before the board of nursing, ummmmmm...WHAAAAAAAAAT?!?!?!?!?!?!?!? Who would make an assinine comment like that. Are you serouis?!?!?!?!?!?! I'm not sure if being a guy makes me clueless but it wasn't until I got into nursing that I encountered such hostile, juvenile and catty attitudes. But whatever you do, quiet the thoughts and voices of defeat and despair by constantly seeing yourself succeeding. As soon as a thought of failure, of mistakes or misfortune enters your mind, immediately replace it with a thought of success.

I had a patient who came up from cath lab after having 2 stents placed to the circ and an IABP emergently placed (cath revelaed triple vessel disease). While in the field the patient went into pulseless VT three times, once in the cath lab and then 7 times while on my unit with one run of Toursades. The patient came up on a dopamine gtt @ 30mcg/kg/min and levo @ 20mcg/min, in addition to Reopro, Heparin and Versed. The patient was hypotensive and was only augmenting in the 40's via the IABP. Obviously, the patient was circling the drain. So thats the background. My question is, why did the doc want to switch the levo for neo? I understand levo is an alpha agonist with some beta effects and I realzie that neo is stictly an alpha agonist. Does levo increase myocardial oxygen demand more so than neo? This is the only thing I can think, however, I am just now begining to actually study things on a cellular level and would like to get some input from the people here. By the way, this is my first post and this looks like a place I will be visiting much more often. Glad to be here.