usalsfyre

usalsfyre

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All Content by usalsfyre

  1. What do you see in a Level 4 ER?

    usalsfyre replied to born2circulateRN's topic in Emergency

    Level IV essentially says "We recognize that on occasion people suffer serious traumatic injuries. We also recognize they don't need to be

  2. Why is it okay for Doctors to yell at Nurses?

    usalsfyre replied to GlowBear500's topic in Patient, Colleague Relations

    Granted I'm not a nurse, but I've never been yelled at by a physician, only nurses (yes, actually yelled at). I've also been accused of "yelling" at people,what I've found is usually any type of...

  3. Intraosseous Access - Have You Used It?

    usalsfyre replied to emerjensee's topic in Emergency

    I've done a fair number of IOs, to the point I can probably perform an IO faster than a peripheral line. Agree completely with Akulahawk's order of access preference. There's not a good reason to do a...

  4. Dopamine in cardiogenic shock

    usalsfyre replied to FF_RN's topic in MICU, SICU

    See above for a very good explanation. The issue with dopamine in MI is the increase in SVR that comes along with inotropic effect. Dobutamine would have been a better choice as it has vasodilatory...

  5. Etomidate medication

    usalsfyre replied to rnmomgcmc's topic in MICU, SICU

    Realistically?

  6. Manual Defribrillation in the OR

    usalsfyre replied to cardiacnurse9063's topic in Operating Room

    A 16 hour class does not a code manager make.... It's a skill. I could teach my four year old to do it in about 5 minutes. Not a big deal. The knowledge of WHEN to defib is the real

  7. Should I try and become a Nurse in a Naturopathic Clinic or a Naturopathic Doctor?

    usalsfyre replied to NenaRK's topic in Holistic

    Want to hit me with the literature I've missed? Cause I'm pretty sure the CAM folks would be crowing about something showing even minimal

  8. Should I try and become a Nurse in a Naturopathic Clinic or a Naturopathic Doctor?

    usalsfyre replied to NenaRK's topic in Holistic

    Rude and insensitive, but there is absoloutely ZERO good evidence that naturopathy works. If we were talking about someone peddling an allopathic treatment regimen with zero evidence as a "cure" we'd...

  9. Should I try and become a Nurse in a Naturopathic Clinic or a Naturopathic Doctor?

    usalsfyre replied to NenaRK's topic in Holistic

    If you wish to participate in quackery than why

  10. Why RNs cannot say 'That's not my job'

    usalsfyre replied to Dramqueenie1's topic in General Nursing

    Right, because you've got 20-30 patients of varrying acuity at any one time.For a profession that complains about getting disrespected by physicians, I sure see a lot of people willing to look down on...

  11. Why RNs cannot say 'That's not my job'

    usalsfyre replied to Dramqueenie1's topic in General Nursing

    Right, because you've got 30-40 patients of

  12. Why RNs cannot say 'That's not my job'

    usalsfyre replied to Dramqueenie1's topic in General Nursing

    Bull puckey. Horse manure. Rabbit scat. I run into RNs on a regular basis who throw out the "not my job" excuse. Two days ago I had to wait 20 minutes for an aide because per the LVN it was "not her...

  13. The best hairstyle for female student

    usalsfyre replied to Raewynv's topic in General Students

    Think of how much extra time you'll have to study if you go with the Sinead O'Connor

  14. metabolic acidosis and tachypnea

    usalsfyre replied to vic_rn's topic in MICU, SICU

    The patient had a definite respiratory acidosis, but without more information it's difficult to say if a given strategy makes sense or

  15. Max on Levophed?

    usalsfyre replied to Nurse_Sophia's topic in CCU, Coronary, Cardiac

    Better than having people's opinions to defend your actions have hard evidence, aka

  16. Ketamine during an emergent intubation

    usalsfyre replied to BelgianRN's topic in MICU, SICU

    Because in many parts of the US it's time to start thinking about surgical airway management when things get this bad...Sounds like you did the best you could with a bad circumstance. Upfront sedation...

  17. Max on Levophed?

    usalsfyre replied to Nurse_Sophia's topic in CCU, Coronary, Cardiac

    So then protecting policy is more important than patient advocacy? Matt, please don't take this as busting your chops too hard. Allied health and nursing educational institutions have a way of...

  18. Max on Levophed?

    usalsfyre replied to Nurse_Sophia's topic in CCU, Coronary, Cardiac

    It's not as clear cut as it seems. If you've been going up and the pressures still in the crapper, obviously it's time for a change. It's that difficult time when the pressures been coming up, just...

  19. Max on Levophed?

    usalsfyre replied to Nurse_Sophia's topic in CCU, Coronary, Cardiac

    Matt, is refusing to go from 40 to 45 mcg/min patient advocacy or advocacy for the facilities policies? Just a

  20. Ketamine during an emergent intubation

    usalsfyre replied to BelgianRN's topic in MICU, SICU

    It was a HUGE topic in airway management about two years ago, but seems to have died a quiet death. I haven't heard anything else about it except maybe we shouldn't use it in the septic patient and if...

  21. Max on Levophed?

    usalsfyre replied to Nurse_Sophia's topic in CCU, Coronary, Cardiac

    Esme, I would hope there's a difference between doing something like giving a med through an A-line (which your not going to find supported in medical literature anywhere) and giving a dose of...

  22. Ketamine during an emergent intubation

    usalsfyre replied to BelgianRN's topic in MICU, SICU

    Couple of thoughts. First, when and how much fent was given? This is as likely your reason for desaturation as the ketamine.Ketamine was an appropriate choice of induction agent in this case as one of...

  23. Self extubation

    usalsfyre replied to Jdalt10's topic in Neuro Intensive Care, ICU

    My understanding (I don't have the literature in front of me) is that dex showed a decrease in ventilator days over propofol due to faster weaning. I don't like propofol. At all. I'm not an ICU nurse...

  24. Max on Levophed?

    usalsfyre replied to Nurse_Sophia's topic in CCU, Coronary, Cardiac

    An endogenous hormone has a max? Nifty....Epinephrine, dopamine, norepinephrine, vasopressin, ect are generally not considered to have a physiologic max, only a point at which it's time to move on to...

  25. how quickly someone can go downhill.

    usalsfyre replied to locolorenzo22's topic in General Nursing

    I see your one study (granted this one is small and non-randomized): http://www.ferne.org/lectures/ema_2007_pdfs/htn_%20references/ferne_htn_emerg_levy_2007.pdf And raise you:...