markgolfa

Hello! The other night I had a pt with end stage renal failure, anuria, hemodialysis. He was on a vent, doing fine, and then his SaO2 dropped very fast and we had hard time to bring it back. He also had extensive cardiac history, including CHF. STAT CXR was mostly whited out. Weird, because he didn't even had any fluids going. I even stopped his sedation with KVO because we planned to extubate him in the morning. He also had dialysis that day. The doc gave a bunch of orders, including morphine (to calm him down and stop air hunger? the pt was somewhat awake by then), nitro drip (do dilate blood vessels in the lungs?) and Lasix IV push. With Lasix I was puzzled. I read that Lasix is contraindicated to pt with anuria. Besides, how would we get read of the fluids from the lungs if all the fluids are going to stay in his system anyway? He is not going to produce urine to get rid of his pulmonary edema. I asked the doc about it, but he only gave me the look as he is one of those who are too good to answer some nurse. I cannot find anything on-line and other nurses didn't know why either. My only guess is that Lasix would shift fluids from lungs into blood vessels and maybe the doc was planning to send request for a dialysis next day? Anybody has more clear understanding of it? I appreciate any reply!

Thank you so much! Your comments were very helpful!

So, it is because we think that anemia was caused by some kind of bleeding and then, of course, we don't want heparin. But what if anemia is caused by something other than bleeding? Autoimmune disease for example, or chronic kidney failure. Can heparin be administered then?

Hi, I cannot find reasons why heparin should not be administered to pt with anemia. How heparin can worsen anemia? Or is it because heparin increases risk of bleeding and the pt is anemic already? Is that the reason? Thank you!

Thank you! Your reply confirmed my understanding of it. I appreciate it :)

May 15 by markgolfa Hi everybody :) It is my first time to post a question, but I read many conversations here and found them super helpful! So, my question is: what is the difference between WAP and PAC? From what I understand, both are ectopic and produce el. signal earlier than SA would, therefore both produce disrythmia, in both P waves varies. Although, I am not sure about PR intervals, I think they both are unequal. So, are WAP and PAC two names of the same condition? I am getting ready for ECG test and need help with understanding it. Thank you!