ICUPrincessNurse

Strip them. Often.

I've done it both ways. Depending on how much time I have and if I'm giving a free water bolus as well. Neither is wrong. If I'm giving tube feed boluses which is basically almost never I'll use gravity. I've also taken the whole notebook writing thing both ways...as the "nervous need to remember things" kind of way AND the "I'm super litigious and going to sue the pants off all of you" way. Depends on the family!!

Depends. Through a PICC? Sometimes I'll use the pump if it doesn't flow. Mild hypotension/low UOP through a well flowing PIV or CVC? Gravity. Legit hypotension/code? Pressure bag. Code/trauma/bad GI bleed? Level I transfuser.

I was typing mine out. Then read the above. So yeah. What he said. There's something magical about a pH of 7.2 that seems to magically make meds work.

I'm mostly hoping the vasoactives are going through a CVC and not a PIV!!! I flush my PIVs and any ports on my CVC that I'm not currently using. If I have a drip running through it and my pump isn't beeping because flow is occluded- I let it go (Let it go...can't hold it back anymore...)!

I loathe DNI most of all when it comes to a code situation. We'll do Bi-Pap like whoa to try to avoid intubation but we try to be pretty clear to the patients/families that insist on full code but no intubation that in the event of a true cardiac arrest that it is basically impossible to effectively code someone without intubating them and we encourage them to consider what they really want out of a DNR status and what we can do for comfort instead of intubating. It's just a matter of education and expectation management sometimes.

All of our CVICU patients have them. Our MICU and SICU (mostly MICU) will get them if they are worried about Pulm HTN. I've floated them in organ donors before when the choice is "float a swan or go to cath lab" to look at numbers for lung transplant.

Oh. Hail. Naw.

We get "floated" to tele/pcu sometimes but lately our patients have been so sick and there have been so many of them that we've been overflowing ICU patients into PACU so NOOOO ONE has been floated to tele in years I think. But technically...we float there if we are overstaffed and they are short staffed.

Assess, turn, medicate, turn, chart, assess, turn, medicate, (eat????) turn, bathe, assess, turn, scramble, chart, turn. Somewhere in there are trachs, pegs, level 1 infusers, codes, poop, blood, drama, traction, labs, care rounds, labs, meds, daily wake up, codes, chest tubes, emergent "fill in the blank here". it's my favorite!!

My hospital gives a "shift diff" to ED and ICU. Mostly because we had the worst satisfaction scores in the whole hospital!!

When in doubt- record. Gives you a chance to learn the flow of experienced coders and know what comes next. Plus no one ever wants to record. Also...if the room is totally full- don't go in. They have enough people. It's already enough chaos. Check on the other patients in the area. I've walked in on a room where the patient was hypotensive because their levo ran out because that nurse was helping with a code. Plus...I HATE running a code with 87 bajillion people in the room. I can't hear anyone and the process isn't as smooth.

4 weeks once. Very unstable airway in a patient who needed a specially built trach with an extensive history of pulling out his ETT/trachs. Seriously. 4 weeks. He got his special airway, woke up and got sent out of the unit. I'm assuming there was quite a bit of muscle weakness. But 4 weeks.

What he said. We've done that in the middle of the night when we couldn't get a hold of the bed. Otherwise...we use the RotoProne pretty much exclusively. What about the RotoProne has been unfeasible for you? We've been pretty successful with them.

It's not unreasonable for a computer to be close by if they're on call covering the unit. When we went all computerized we got multiple computers at each alcove, extra COWs and extra desktops all over the place. They should understand that if they're on call for the ICU a computer should be close. Plus, theoretically, if your patient is sick enough to need 3 boluses and a levo gtt- your resident should be close. Like, at the bedside close. That said...We have a few attendings who still dictate their notes on principal and whom I'm certain are physically unable to enter an order. I'm not saying they get TORB'd a lot....but. For the most part though...these guys are rounding with residents who put in the orders and it's basically a non issue.