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Biffbradford specializes in ICU.

Biffbradford's Latest Activity

  1. Biffbradford

    Could anyone help me better understand this code ?

    Once had a VAD pt in slow VTach for a WEEK. Rhythm was unresponsive to all therapies, but the VAD still kept pumping so BP was fine. Final outcome not good. Crazy stuff.
  2. Biffbradford

    nursing care for chest tube of cabg patient

    Yeah, I refrain from 'stripping' but will resort to that if it means getting a big honking clot out of there and preventing sending the guy back to surgery for tamponade! I remember one nurse that spent her whole 12 hour shift milking and stripping chest tubes with due diligence trying to keep them patient, grabbing anyone she could to help out. What a nightmare! OP: check them frequently looking to make sure they still draing 'something', if not, then 'milk' it to see if there's a clot that can be worked free and out.
  3. Biffbradford

    Being a Dialysis Nurse

    From what I have read about acute dialysis - ON CALL. Some times >100 hrs/week. Even docs will say that it can suck the life from you. Clinic dialysis schedules would be more structured of course. Could be good or bad considering your point of view. :)
  4. Biffbradford

    Transvascular Aortic Valve Implantation

    Boy, if I ever face some time on the table, CUT ME OPEN. I want that surgeon looking and smelling with his own eyes and nose, cutting and sewing with his own talented hands. :)
  5. Biffbradford

    Most drips at once

    I don't remember what they all were, but I recall an ECMO patient that had 4 stacks of Baxter double pumpers. (not the official term) :) Two stacks on each side of the bed and prob. 4 high (you could go more but the pole got real unstable) so that would make 16 if they were all used (I don't recall) and prob. included a couple pressors, one or two for heart rate, sedative, analgesic, back up fluids, a paralytic, TPN, citrate for CVVH, you name it. That's one of those 2 nurses to 1 patient deals where you need a nurse functioning as a 'mechanic' to keep up with the chores. 12 running would certainly be possible. That's a lot of fluid!
  6. Biffbradford

    Insight for a successful transition from CCU to CVSICU?

    More like 'fight' the Grim Reaper, if he really want's 'em, he'll take 'em.
  7. Biffbradford

    Serious about critical care, RN

    Hard to say. Be courteous but curt with your time. Get in, get it done, and get out. Even in the ICU where you 'only' have 2 patients, you have to pick one to start with. Do you see the 'easy' one first? Or the 'hard' one? I usually go with the sickest, or busiest first so I don't get bit in the *** by something small now that can grow to major trouble later. Nip it in the bud! Then you can relax and get to the 'easier' of the patients.
  8. Biffbradford

    Your PROPOFOL stories wanted

    Nothing earth shattering to share from here. Stay on top of a spare bottle for the on coming shift and I'll change the tubing a little early if it's going to be due on the next shift (usually Q12hrs). Love it though!
  9. Biffbradford

    Serious about critical care, RN

    Welcome to Allnurses! :) Where do YOU feel that you can make some improvements? That would be a good place to start.
  10. Biffbradford

    Fluid bolus by gravity or pump?

    Have done it both ways. In a code situation we've even 'squeezed in' fluid or blood.
  11. Biffbradford

    Could anyone help me better understand this code ?

    Can you actually *FEEL* a pulse? Art lines are great, but they do go bad.
  12. Biffbradford

    Infective endocarditis, influenza, fully ventilated.

    His family will just have to corner the attending physician and bombard him/her with questions. Perhaps it's time for a family conference where you gather the docs and a nurse and talk about his current treatment and future plans. In 15 years of ICU care, I've seen people who we thought would fly through treatment, only to not make it one night ... and others who we thought would never make it, end up walking out of there. Sometimes we tune 'em up as best we can, looking pretty good, send them to LTAC (long term acute care) and they bounce right back to the ICU next day, or they die. Yet others you never hear about again. It's very hard to predict outcomes and you just have to take the ups with the downs, take it step by step. Hope that helps. Best of luck.
  13. Biffbradford

    Propofol Increasing HR?

    Interesting. I once had a heart patient on Dobutamine but the cardiac index was still a lousy 1.8. Surgeon suggested turning it off, that on rare occasion is has an opposite affect, I did ... and the index immediately came up to 2.5. Hah!
  14. Biffbradford

    UPS Drivers make HOW much????

    OKay, I didn't real all the responses, but I used to work for UPS - 9 years before nursing. Drivers usually work 10 hours a day minimum. During Thanksgiving and Christmas they work more. We used to stuff those delivery trucks SO full of packages we could BARELY close the doors ... and it was up to the driver to attempt to deliver EVERY ONE before they came back. Oh, you should see the MOUNTAINS of packages they have to deal with. The drivers I knew all had bad feet, wore custom made shoes, and my favorite driver was killed when his truck slid off the snowy road into a ditch. Feeder (semi-trucks) were the choice jobs but I chose to go to school. So, what area did I pick?? Nursing. As a part time job while you're going to school, it's not a bad gig. Used to be anyway. It kept you in great shape, but it was a very dirty job. No one box was that dirty, but the handling of hundreds and hundreds of them accumulated the grime. I used to wear 3 t-shirts and my stomach would still get black with grime. Oi! Then again, there were times I'd trade my ICU job in an instant for that. One can only deal with so much death, then it's enough. http://www.browncafe.com/community/
  15. Biffbradford

    How to do report or get report smoothy for Newbie?

    Does your unit have a standardized report sheet? My best unit had one that a committee came up with and everybody used for giving report. You just went from box to box - name, reason for admission, quick history, allergies, code status, docs, vitals, lines, supports, pulmonary, renal, yada yada yada, road trips. If for some reason you were picking up a patient and the nurse didn't have time to give you report until later, you could grab the board and have enough to go on. Even the docs would grab the clipboard and read it!
  16. Biffbradford

    Please explain fluid shifts post-op vascular surgery

    If you still need more, try searching "third spacing". Hope that helps.

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