erniefu

Rainbow special for labs. So many differentials with this one. Blood cultures x2 Blue (INR/PTT, D-dimer) Yellow (viral and bacterial serology say HIV, STD) to query sepsis. Green (Lytes, Urea, Creatinine Troponin, CK) Lavender (CBC plus any addons) Heparin (Lactate, blood gases) Chest Xray, Chest CT pulmonary angio to rule out PE, pulmonary edema. Also we should get an O2 sat (not shown) and start oxygen and ventolin if indicated and per hospital policy.

I would ask the MD for a vitamin B and at thyroid panel, as well as an MRI, EEG, EMG if bloodwork is normal.

I see these kind of people all the time when I worked in a stroke unit. These families are usually not nice people and pardon the term, Karens in real life. Even if they consented to hospice care they will still demand you feed them, check their blood sugar, and all kinds of PT/OT. I believe that this situation will continue until legislation passes where elder abuse includes seeking overly aggressive medical treatment when it is not indicated (e.g. full code for a 99 year old bed bound dementia patient, family keeping patient alive to collect social security checks, family rescinding DNR order that was signed by a capable patient etc).

Nothing is going to change as long as board of directors collect their dividends and not be personally liable for the deaths. Boards of directors are more interested in " We are Heroes" billboards than providing proper PPE at hospitals. They spend millions on atriums than making sure each unit has more than 1 bladder scanner. And God forbid they redo the staffing matrix to show that more nurses and PCTs are needed due to increasing patient acuity from COVID!

I think that having experience with the patient population is important in managing the unit. A manager should have knowledge about the kind of patients coming to the unit, when to use authority to push patients out or keep patients and to manage expectations between staff, patients and executives. Bad managers don't get what is happening on the unit and can't get the resources from the executives (whether it be PPE, new bladder scanner etc). Nurses don't have to like managers, but nurses need to respect the manager to get things done. Some units may need less years to know the unit while it could take years to a decade to understand units like PACU, ICU and ER.

Yes. If people did proper social distancing and stayed home you are less likely to contract COVID-19. Have hand sanitizer ready and use it after you go touching things in public places. People hoarding masks and tossing them after their 30 min grocery trip, politicians tossing them after their 10 min photo op waste more necessary resources for healthcare workers. It's not your 30 min exposure that will kill you, it is the prolonged exposure that healthcare workers face that will kill them.

A lazy patient needs to be reminded that if they can't wipe their own *** then they can do it in a nursing home or a group home. If you can't show you can wipe your own *** inpatient or rehab, then why should the doctor feel safe about discharging them home?

The ANA approach is the acuity based staffing model. Guess what? Hospital employers will game the numbers and won't reassess the model once they get the numbers they want to show to the public. Show me one time where hospitals are doing seasonal or yearly audits of their staffing model and showing that they are staffing appropriately. Its always "the staffing grid shows we are fully staffed" even when all the patients need ICU levels of care.

Anything more than 4-5 cm out and you need to x-ray. The danger with it being that far out is that it can coil, rendering the PICC useless (its out of position) and can cause emboli. A PICC pulled out can be fixed by a PICC nurse with over the wire picc exchange.

Healthcare administration has no risk if a nurse is overworked with 10:1 ratios and a severe adverse event happens. In that situation the hospital is fined, the nurse is fired and suspended by the board of nursing. The nurse bears the brunt of the punishment for a systemic problem implemented by healthcare administration. Healthcare administration only answers to shareholders and no one else. Only when government law is enacted to provide for safe staffing for healthcare workers and real risk of termination for healthcare administration occurs government fines will just be the cost of doing business.

Companies usually budget for PTO so it wouldn't be a liability for vacation owing. That your manager denies your earned PTO means there are cash flow issues. This is just the beginning of more cuts and you should be prepared for the worst.

I think the most important emergency care you need is to not delay calling 911. Too many times families drive a stroke patient to ER when it was in the best interest to call 911 so an ambulance can take them to a stroke centre.

Very informative. In Canada in my academic hospital we have a dedicated stroke unit with a stepdown nurse from the hyperacute stroke unit that gives tPa (if indicated) and accompanies the patient to thrombectomy, freeing up the ER nurse for the next patient. It has helped free up nurses in ER, allows timely intervention if a hemorrhage occurs after tPa and provides better continuity of care while inpatient. Best of all inpatient strokes can also be handled by the same inpatient stroke team.

Until management gets hauled to a board of nursing/medicine disciplinary panel and faces charges of negligence and professional misconduct for chronic unsafe staffing ratios, staffing ratios will be treated as an afterthought by management. They get all the power but none of the responsibility or the accountability when something bad occurs. The lawyers always go after the nurse, never the management team for a lawsuit.

In Canada, a comprehensive stroke centre would be doing stuff like giving tPa, thrombectomies/embolectomies, along with providing stroke care for those outside the window. Patients that are given tPa/thrombectomies are admitted to a hyperacute stroke unit where they are at worst 2:1 with neuro checks to be done every hour at the minimum (a step down unit). Otherwise stroke patients are 4:1 on days and 6:1 on nights.