Dirk

Long time ago I made a sketch for me, to learn how ABG interpretation works. I hope, I translated everything correct. Perhaps you can use it ... Dirk

Thank you for your comment ! I have talked to many patients, and very often I heared horrible stories about nightmares, or unreal dreams. Very often, they can`t remember, what is dream, and what is reality. We are writing in the diary, what happens during the day, what we observe in the patients room, like the first time, he is breathing without the vent, or sitting outside the bed. It is an very good and interesting experience for us nurses ... Greetings Dirk

Not 5:1 - only 1.5:1 Means - 14 bed ICU morning shift : 10 nurses late shift : 9 nurses night shift : 8 nurses BUT in Germany the ratio is very often 4:1 on ICU`s

First - sorry for my english ... but I am from Germany (working in Switzerland), and I always try to improve my english ... A lot of patients, surviving the ICU, are suffering from PTSD-related symptoms like sleep-disturbances, flashbacks, depression and so on. Studies showed that up to 63% of all patients are affected, and one study asked for PTSD-Symptoms in relatives, and they found that 50% of them are affected. One possible help can be a diary, kept for the patient by the nurses, relatives and other visitors. Have you ever heared about keeping diaries ??? Greetings Dirk

Country Switzerland City Zurich Unit worked ICU Patient load 1,5:1 Shift

There is a very good article, written by Kimberley Litton. This article deals with the ICU delirium (not psychosis, because it is an acute confusion, not a psychiatric disorder) and shows, how you can reach the diagnosis of ICU elirium, and what are ways to treat that in a right way. Delirium in the Critical Care Patient CRITICAL CARE NURSING QUARTERLY, 2003, vol 26, no. 3, pp 208-213 Greetings Dirk

To question 2) Propofol is used on my ICU to some patients for a really lomg time, without any problems. But there are reports about people, have experienced severe problems because of propofol. One very critical thing, you have to look at is rhabdomyolysis, which can occur, because of a reduced energy production while there is a increased energy need in the heart- and skeleton muscles. The pharmacological commision of the german physicians provides the use of Propofol for not longer than 7 days. Greetings Dirk (http://www.akdae.de/20/20/Archiv/2004/200412101.pdf)

hmm .. just a little more ... Not only some patients after a stroke feel like this. Try following : You have to be with another (perhaps your friend or collegue) Take place on a chair sit on your hands, and stay sitting. This is like staying in bed - without moving. After some minutes, you loose your hands ! Now close your eyes, and hold your hands in front of you. Let your friend or collegue give one of your hands a form by holding and pressing. Now try to describe both of your hands - you will see, that you will have such a feeling without having a stroke. If you stay lying in your bed, without moving, you will loose your body-feeling. I hope, I told it the right way (and you can understand, what I mean) Greetings Dirk

... one new aspect : The potency-effct is only for the anti-diuretic-effect. The vasoconstriction is only 0,39 of vasopressin. So the use of desmopressin will take a very low effect while CPR. Hope this will help you .... Dirk

Hello Treboricunurse! I only know Desmopressin as a med, which we use to treat the insipidus too. It is, in comparison to vasopressin , only changed a little bit (it has a little different chemical formula). So the med is used ONLY for treatment of insipidus, or blood-clotting by activation of the factor VIII. I have never heard about using Desmopression for CPR. Vasopressin is here used very rarely. In germany, vasopression is not allowed to use while CPR (meds have to be registered for a special indication. CPR is not included in the list of indications). In switzerland, we haven´t vasopressin at all. Greetings Dirk

I try it in english .. Desmopressin is a Vasopressin-derivative with a potency-effect of more than 100. That means, that Desmopressin has a 100 times higher effect than Vasopressin. units are the only measurement of Vasopressin - or do you give Insulin in mg ? Greetings Dirk -------------- Sorry for my english - I just learn

http://content.nejm.org/cgi/content/abstract/346/8/549?hits=20&where=fulltext&andorexactfulltext=and&searchterm=hypothermia&sortspec=Score%2Bdesc%2BPUBDATE_SORTDATE%2Bdesc&excludeflag=TWEEK_element&searchid=1095459518145_11309&FIRSTINDEX=0&journalcode=nejm If you have the possibility to take a look in the New England Journal of Medicine, you will find the complete text. Just look for the paper with date : February, 21 2002. Greetings Dirk

First I have to apologize for my english. I try to describe things, if I don´t know the right english word. Please help me to learn - if you use special words, let me know ! - Thank you ! The constantly existing possibility for the independent movement makes it for us possible, always to notice our body as entireness. By the movement and the associated changes receive we differentiated information about our physical condition and environmental condition. In a condition, in which we cannot move any longer, reduces this information flow. The perception of the body, the body picture and the environment becomes ever more indistinct. (body picture : how we know our body ... how long are my legs, in which way I walk....) Measurement feelings can occur, those finally in orientation disturbances or even heavy identitycrises flow. Here I have copied a drawing out of the book " Basale Stimulation - Neue Wege in der Pflege Schwerstkranker" written by Peter Nydahl. The advice was, to draw, how the body feels like. Left you see a drawing before, in the middle after lying on a soft ground for 30 minutes without moving, and right the same on a hard ground. If you could read this - I will continue later ... Greetings Dirk

Hello ! Yes I will try - but you have to be patient with me, because I have to translate my knowledge - and it is very difficult for me. I only know school-english - but nursing-englisch is a little different. If it is OK, I will try to give little eamples. Especially for stroke patients this concept is very useful. The time, before I started at the ICU I worked in a neurology unit, where the most patients where stroke-patients. I try to wriete the first little example today. Take care Dirk

Yes - you are right - except some differents. I made the experince, that we some things do, because they have to be done, and the way we do, is the way we ever have done. I will write you more a little later, if I will be at home (now I`m at work). For now I copy a text, written by Peter Nydahl. This text describes with a few words, an example of BS : Here you have a link, for another text : http://www.basale-stimulation.de/DE02.HTM Greetings Dirk