shinerchia

Cardiogenic shock is pump failure and Vfib is an electrical problem. The two may be related for some reason, but you have to ask yourself more questions if you shock the same heart constantly. Like why am I refractory? Why I am I not getting better? What am I failing to treat? Is this all simple irritability and will resolve on its own? Am I ischemic...hypovolemic....hypervolemic? As one person mentioned...is my demand too high and I my SVO2 just too low and I need LVAD, RVAD, ECMO? There is no textbook answer...only reassessment...and intervention. Isn't it fun being forced to think and chew gum at the same time?:)

Judging by the question, I'll assume that you don't normally titrate drips. If you do, you'll find that you always have a backup fluid as your maintenance and even if the pt is on the brink of CHF every minute...you'll backup your drips with a maintenance line. NTG can go slow to prevent spasms after stents and the like (say..3cc/hr)...insulin as mentioned...although...the splenic basal rate is 3 units an hour and other highly concentrated drugs. Integrillin, nipride, levophed, etc can have slow rates. If yo9u lose a lumen on a central line because you ran a fluid too slow or don't flush often and I inherit the pt...you are gonna know about it.

the bullet story was on Myth Busters recently....good try....next

AF flight nurses transport wounded and sick on aircraft of opportunity. There are no longer and dedicated medical transport platforms since the retirement of the C-9 Nightingale. The Air Force does not operate from the FLOT to the rear for aircraft transport. The Army is responsible for low and slow transport for the first few miles from the battle front to the rear. The AF typically picks up troops at the next echelon of care where the pt has been stabilized and ready for intratheatre or intertheatre transfer. You have to be an Officer on Conditional Reserve Status which means you'll already be an AD nurse for at least two years before you start applying to a flight slot (a process that can take about 6 or 9 months). The bottom line is that you won't walk into the AF and take a flight slot. Get used to taking care of stable people...then crit care pts...then start looking at atmospheric pressure problems and disease affected by those. Most new grads can't manage chest tubes for 5 minutes on the ground - much less for 12 hours at altitude, never mind a Swan.

eat what you want, but remember that lance armstrong, inarguably one of the most physically fit people on the planet, consumes 70 to 80% carbs.

As a CNA you will have access to a lot of years of expert nursing knowledge. Tap that resource as often as possible. I was a CNA in a critical care unit while I got an ADN and got an education money cannot buy.

I say fine. Just understand that if we use "murses"...we are going to have "worses". Who's ready for that?

Any nursing 101 book should show what: IV IM SQ Z track Air Lock Injections are and why you would consider each. Please pay attention to needle length as well of you think you are giving true deep IM's with a 5/8 needle to an adult.

some meds do better if they are dissolved in water without being crushed. in fact they will just float if they've been crushed, but will be quite dissolved if simply placed in water first. you'll quickly find which is which.

Just have the doc write the order to say " per xxx protocol". You do it for standing sliding scale insulin, why not for Ativan.

Men invented nursing.

dale dubin's 12 lead book. acls will be mandatory no. no matter to whom you explain that their 2pm is your 2am...nobody will ever care. everyone will expect you to get up and be a part of the family no matter your hours. get used to hearing...."so...are you going to sleep all day?" spend 2 more years in school and get an ms in something that has good hours and makes $$$$. 3 years will get you're a jd. real estate is pretty hot now too. good luck in whatever you choose.

so you came from a critical care background where people had been (for the most part) diagnosed and where there for critical care. this is exactly the experience i suggest before someone walk into a job at her/his local ed. as for the "lots" of new grads with zippiddy doo experience that managed to not kill nor delay the correct treatment (honestly ask yourself is pts could have gotten better or faster tx with an experienced nurse that thinks 12 steps ahead)......i'm happy. as for the ones that didn't quite make it to the "most" category....shame, shame, shame on us for exposing our pts to them. disclaimer: if i made you feel uncomfortable in you abilities; i apologize. my posts are never intended to question you ability, your expertise, your thought process, nor you dedication. my posts never reflect the views of the usaf or any of its subsidiaries; they are my own thoughts and should be accounted for as such!

I've been polling military RNs everywhere I can and the common thread is that they have never worked in the real world. All they know is military nursing so all they know is what command tells them. Unfortunately, they've never worked in a civilian corporate run hospital that shoves law down your throat every day to make sure they don't get sued. I have the luxury of knowing the law since I worked as a civilian. If you are a military nurse and fill scripts, dispense, etc, please let me know. Our OI where I work addresses the subject and says it has to be an MD to send a pt home with meds. Local laws say they can do it if it is a manufacturer's sample pack. Let's not let ignorance rule while we break the law every few minutes. As officers we have to have integrity, which means we can't follow practice laws when they suit our command. My opinion is not meant to harm, discourage, nor inflame. Nothing I post is related to the official views of the U.S. Air Force. My views are my own!

Dear new grad: Going into an ED straight from school only places you and your pts at risk. It might not be fun to hear, but you are only taxing an already stressed system if you go directly to an ED from college. You will draw from the seasoned nurses, an invaluable and low-density-high-demand resource, which is in already understaffed. Some rare exceptions exist, but they most likely involve a very seasoned LPN from a sick-tele unit that is getting an RN lic. They shouldn't involve a tech that watched experienced nurses think and perform care. Watching me think and make life saving decisions for my pts does not qualify you to start out in the ED upon graduation; sorry. Go get day to day experience seeing every class of drug, with every disease process, in a stable controlled environment (you'll find this on a MedSurg floor). After you get comfortable with all of that, reevaluate if the ED is really what you want to do and use all of that knowledge to help people instinctively and without wondering...what is this disease and how will I be treating it. You may find that the well controlled MedSurg floor is a lot safer for you and more comfortable than the controlled chaos in a ED with multi pts not doing well. I understand the want to go into an ED and help, but as a new grad you aren't going to be much help. You'll simply have no clue about hemodynamics, swans, ful pulm edema, SIADH, HHNC, DKA, AMI, CVA, sub A. Hemorrhage, AAA, pylo, PID, Ectopics, etc. Granted, there is nothing magical about the ED. People think we work magic, but it's just simple ABCD (deffghhi) and CIAMPEDS. Those simple steps either turn folks around or don't, but you really should get comfortable and have a head packed full of experience before you start taking shifts in the ED. I know every unit in every hospital is understaffed and will only get worse in the coming years, but we cannot let the standard of care lapse simply because we don't have the nurses. If you find my remarks offense, I apologize in advance to any potential new grad, any person that precepts in the ED, anyone that reads this, or anyone else.