usalsfyre

usalsfyre

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All Content by usalsfyre

  1. Intubation Question

    usalsfyre replied to RN015's topic in Emergency

    The 7 P's of RSI 1. Preoxygentate. Place the patient on high concentration oxygen for at least 5 minutes. The goal is to wash out nitrogen from the patient's functional residual capacity (FRC)....

  2. The correct way to send a patient out to the hospital...

    usalsfyre replied to lvnnars1's topic in General Nursing

    I think we're probably closer than you think on this issue. I'm not a nurse, I'll state that upfront. The reason I describe this the way I do is that the most common mistake I see providers make is...

  3. The correct way to send a patient out to the hospital...

    usalsfyre replied to lvnnars1's topic in General Nursing

    Ehhh, I'll admit I swing towards the dramatic sometimes. But since ventilation is the driving factor in respiratory control of acid-base, at least in normal physiology, I stand by it somewhat, however...

  4. The correct way to send a patient out to the hospital...

    usalsfyre replied to lvnnars1's topic in General Nursing

    The poster I responded to was advocating exactly that, that's why I responded the way I did. Oxygen DOES only have a limited effect on pH. It's much easier to explain oxygenation and ventilation as...

  5. The correct way to send a patient out to the hospital...

    usalsfyre replied to lvnnars1's topic in General Nursing

    Agreed, but it's also important to understand which of those scientific principals have bearing on clinical practice. If your withholding O2 from a hypoxic patient because of the Haldane effect you've...

  6. The correct way to send a patient out to the hospital...

    usalsfyre replied to lvnnars1's topic in General Nursing

    Had I known, I would have expected better. The Haldane effect is not really clinically significant in the emergent setting. And acid base affects the oxyhemoglobin dissociation curve, not the other...

  7. The correct way to send a patient out to the hospital...

    usalsfyre replied to lvnnars1's topic in General Nursing

    To massively oversimplify things, respiratory acidosis/alkalosis is related to CO2 and resultant ventilation. NOT oxygen/hypoxia. It's possible to have a 100% SaO2, a Pa02 of 400 and still have...

  8. The correct way to send a patient out to the hospital...

    usalsfyre replied to lvnnars1's topic in General Nursing

    Considering that oxygen has very, very, very little to do with acid base, I would say THIS is poor nursing

  9. Large bore IV

    usalsfyre replied to remf3's topic in Emergency

    The reasoning behind the larger catheter sizes in trauma is not fluid, but blood. Blood is much more viscous and requires a larger size to be rapidly infused without hemolysis

  10. Jobs scarce for nurses

    usalsfyre replied to GLB_68's topic in General Nursing

    My gut feeling is rather than increasing staff, beds would be shut down and they would continue with the current staffing level and focus on discharging patients more quickly. Current hospital profit...

  11. Multiple Class Actions Against Hospitals for Missed Breaks

    usalsfyre replied to NRSKarenRN's topic in Activism, Healthcare

    You can unionize all you want, Texas law does not offer any protections to union vs non-union employees. If the nurses involved make enough of a stink, in the current surplus of employees they will be...

  12. Hyperkalemia and order of meds

    usalsfyre replied to RoyalNurse's topic in Emergency

    Calcium immediately if it is indicated. This is a do or die medication, delaying it in the emergent setting will cause negative outcomes. The effect on ECG is almost as profound on the effect of D50...

  13. Outraged by no more privacy

    usalsfyre replied to inquiringaide's topic in General Nursing

    The problem is that you see privacy and liberty as seperate concepts. In reality they are very much intertwined. I'll just have to agree to disagree with

  14. Outraged by no more privacy

    usalsfyre replied to inquiringaide's topic in General Nursing

    You have a profound, profound misunderstanding of the "freedom is not free" concept. The whole point is that sacrifices of personal security must be made to ensure liberty. Ben Franklin said it best....

  15. Orienting an experienced RN

    usalsfyre replied to SunDazed's topic in General Nursing

    So being able to "tell you in report about every wrinkle in a patient's body" and "counting how many floor tiles the patient soiled in a diahrrea explosion" is pretty well pointless if you can't...

  16. Orienting an experienced RN

    usalsfyre replied to SunDazed's topic in General Nursing

    There is a saying that it is possible to have 10 years of experience, or 1 year of experience 10 times. Just because someone is "experienced" does not mean they are competent. To defend a dangerous...

  17. What is the highest regular dose of Oxy that you have seen

    usalsfyre replied to ~Mi Vida Loca~RN's topic in Patient Medications

    THAT is pain

  18. What is the highest regular dose of Oxy that you have seen

    usalsfyre replied to ~Mi Vida Loca~RN's topic in Patient Medications

    400mgs of MS for pain related to mets from prostate cancer. 100 to 150 mcg of Fentanyl, especially through the transdermal route, is nothing. I regularly do IV doses around those

  19. confused by call in policy....

    usalsfyre replied to wanderinrn's topic in General Nursing

    It's a good idea to never assume anything when dealing with

  20. will ACLS/PALS boost resume of new grad

    usalsfyre replied to djmsailor's topic in Emergency

    Please don't take offense, but if you think ACLS teaches any real critical thinking skills your sadly

  21. IV start question.

    usalsfyre replied to cecilsgirl's topic in General Nursing

    It's entirely possible to establish patent venous access without a flash or being able to draw. In dry/low perfusion state patients there may not be enough pressure in the venous system to cause a...

  22. Pain Management - Is It An Important Focus Of Medical Care?

    usalsfyre replied to ParamedicFNPwantabe's topic in General Nursing

    Excelent post on the progression of out of hospital care. The only thing is 5mgs of morphine might as well be homeopathic in certain patients, but I'm sure you've seen that in your own practice. Me...

  23. Pain Management - Is It An Important Focus Of Medical Care?

    usalsfyre replied to ParamedicFNPwantabe's topic in General Nursing

    Every appy I've ever seen appropriately medicated for pain (see the snowed in comment above for an example of inapproprite) still went primate feces when you messed with there RLQ. All of them also...

  24. Pain Management - Is It An Important Focus Of Medical Care?

    usalsfyre replied to ParamedicFNPwantabe's topic in General Nursing

    Not trying to be rude, but can you name one example of a critical symptom that is masked by appropriate pain management that can NOT be discovered by other means which are routinely also done for the...

  25. Pain Management - Is It An Important Focus Of Medical Care?

    usalsfyre replied to ParamedicFNPwantabe's topic in General Nursing

    Somatic, visceral, nerve, sympathetic, ect all respond to opiates in the ACUTE phase of injury, which is what we are discussing here. I seriously doubt you will see spinal blocks, ect prior to surgery...