deluded

thank you for the reply, my thinking is that confining the lung to half of its normal volume must change the flow of blood through it (and so the pressures)... not to mention that with the vq mismatch there is sure to be secondary chemical effects on the pulmonary vascularity of that side, too.

i was lucky enough to be accepted into a critical care internship following graduation two years ago and then hired to work in a unit that recovers two to three open heart cases each day. over the last year i've cared for a handful of patients who returned from surgery with shocked or paralyzed hemidiaphragms; these always seem to evolve into cases with multiple additional complications. this last week i had the same patient every day; the case involves a right-side elevated diaphragm to the mid-cardiac outline on cxr with the swan tip in that same side, of course. it is a very complicated case that has motivated me to study/research for several hours each night after my shift. the md continued to use the pad as a principle indication of fluid volume status, and with my lack of experience i kept my misgivings to myself (this is a doctor who i respect highly and who i generally am not afraid to prompt for bedside education, but with the delicate nature of the case i didn't feel comfortable taxing that relationship). i can not find information on how this particular pulmonary issue affects the reliability of the swan-ganz pressures or if the readings are useful at all. i can theorize on what the increased density of the pulmonary vasculature/tissue does to the pressures, but i'd like to hear what better educated/experienced nurses have seen or done in this not-too-infrequent set of circumstances. direction to any reference materials addressing this would be greatly appreciated, too. thank you for your help, v

be prepared; you will have teachers who write very bad questions and refuse to give rationales for their answers. that is a fact. having been a nurse does not necessarily make these people decent teachers. you will have teachers who were not particularly good nurses, either. your job is to negotiate this gauntlet knowing that the best revenge is to graduate and begin a career that is so rewarding that the few educators who stood in your path were marginally important and definitely not worth remembering. on the other hand, you will have teachers who will change your views and motivate your thinking in positive ways that never would have grown without them. be thankful for them and shine the rest! nursing school is difficult, so study hard and know every single test question is as important as the one that came before it. do not protest questions and don't be vocal about your disagreement with the teacher... you will not win, and you could lose a lot more once that teacher recognizes a personal issue with you. best of luck!

We use Precedex in our CVICU at o.2 to 1.2 for up to 24 hours on pts who are generally aggitated or as a bridge for those who need some help getting to extubation. I really like being able to wake the pt for assessment and still seeing genuine rest when they are not stimulated. Seems like less of a lingering med-hangover than Propofol, too. The ability to bolus Propofol is its one big upside for situations that require some extra sedation in a hurry. We use both, and each has its benifits in specific situations.