graciev

We really need to come up with a good way to teach sensitivity, it messes with peoples minds, even people who know what they mean to say cant explain it well. The brick wall is a good metaphor. I was trying to think of others, but have hit, pardon me, a brick wall.......... Grace:uhoh3:

Not the most "critical" topic, but what shoes/clogs/whatever have you found to be the most comfortable to wear on those long 12+ hr shifts? Thanks, Grace (whose feet are really starting to hurt)

Guess I should clarify, they request the DDD mode with just the atrial wire in the v port, I think they think that somehow the lone wire in the atrium is sensing the atrial and ventricular activity. Have never been able to figure this out, and can't really get it to work anyway...............................

One of the questions I have, is if the atrial wire is placed into the V port of the pacer, the the only electrical activity being sensed would be from the atrium. To program the pacer, then, because you are using the ventricular settings, you would put the pacer into VVI??? And then get the equivalent of AAI?????? What would happen if you put it in DDD (which is what the docs say to do). Sorry for being soo confused.....:uhoh21: Grace V

The reason that I submitted this questiton is because post open heart surgery we have quite a few instances where the atrial wires will just not work and the CT docs often have us try switching the atrial wires to the ventricular output port of the box in attempt to use a higer Ma and obtain capture. So I wonder if this is safe. The patient frequently needs pacing for only a short time so permanent pacing is not an option.

Does anyone have experience with placing an atrial pacing wire into the ventricular port of a pacer in order to increase the available output? Is there anything special we need to know about the rest of the settings after doing this? i.e. the pacer is now sensing the atrial activity I believe, but it "thinks" it's ventricular, is there a possibilty of inappropriate firing???

amiodarone, heparin, diltiazem, amicar sometimes, milrinone

Took the test last year, fortunately passed!!! Don't remember specific questions but it was almost all medical, i.e. what drips, vent settings, tx, etc. There seemed to be quite a few judgement calls that would differ between practitioners, and if you just stick with what the docs and NPs at your facility always do, you might get some questions wrong. There are several books available for interns/residents/critical care personnel:) on Amazon.com that were helpful studying, didnt have the CD from AACN then. Know differences between treating on pump and off pump hearts, that seemed to be very big with the testers. You will know if you passed when you walk out of the room, so that stress is eliminated. Good luck!

I think it depends on the staffing and longevity of the nurses in your unit. If you have a stable staff and don't desperately need new open heart trained nurses I suppose the feeling is that they can wait till you have proved yourself with other hemodynamically unstable patients before training you. Other situations would demand you be trained as soon as you could be. In our unit we wait a year before open heart training the new grads, more experienced nurses much sooner. CRRT as soon as they take the class and the same with IABP's (on the non-surg pts). Grace:rolleyes:

What do you think about ICU RN's being responsible for setting up, troubleshooting and maintaining CRRT devices? Do you do this in your ICU and if so, what is your staffing ratio? If there are not a large volume of patients requiring this therapy how do you maintain competency among the many staff?ThanksGrace V

Attractive people, nurses included, have an easier time of things in a wide variety of situations, including the healthcare setting. Although I have observed my more attractive colleagues being the object of sometimes unwanted attention from physicians, patients, other staff, they also use this attractiveness to get what they want from the very same people.... (just a bit bitter, I guess)

If you are AV pacing a patient (for example post cardiac surgery via epicardial leads) and the patient goes into afib with a slow ventric response, would you continue the AV or just use the V???? Several nurses I work with have given me several different answers.....:stone thanks, Gracie

I have heard that the Kaiser system here in California does NOT accept the non-AHA cards. A shame. Gracie

Is there a consensus on whether to do chest compressions during a code on a fresh open heart patient??? Or one who has had a sternectomy and "flap grafts"? We have been arguing over this for a while now. The doc's are also not consistent in their answers. Thanks, Gracie V:nurse:

Gomer, Thanks so much for your reply. I have tried to find a specific regulation on the internet, but I guess Im a hopeless searcher. Would you happen to have an idea on where to find some document that actually spells these regs out? Thanks again, Gracie I just found what I wanted, if anyone is interested it's on the California Department of Industrial Relations website http://www.dir.ca.gov and has quite a few versions. The part concerning maximum overtime is Section 3, (B) (9) .Its called the Industrial Welfare Commission Order (varies by date) Regulating Wages, Hours and Working Conditions in the Public Houskeeping Industry (I always knew nurses had to be housekeepers too!!) G.V.