BTBALL

I got my NPF after my NP lic# and DEA. I was informed to wait until after you have your DEA sched 2 certificate in CA to apply for your NPF because then your NPF has sched 2-5 privileges. If you get your NPF then your DEA after you have to submit a request for expanded prescription rights which can take time. You need your NP license to apply for DEA. You need your DEA to show sched 2 on NPF. Therefore, gets your NP license first, then DEA, when DEA is confirmed get your NPF. I'm sure it can be done a different way though.

Dermatology is a specialty. New Mexico has independent practicing rights sure but in their scope of practice (http://nmbon.sks.com/uploads/files/New%20Mexico%20Nursing%20Practice%20Act.pdf) it clearly says that an NP can: (3) serve as a primary acute, chronic long-term and end of life health care provider and as necessary collaborate with licensed medical doctors, osteopathic physicians or podiatrists. It makes no mention of dermatology specifically. One potential legal problem will be whether you can prove competency and specialization once you have graduated in order to justify your dermatology clinic. edit: specific section in the NPA regarding NPs is 61-3-23.2 on pg 16.

Yes the etCO2 and PaCO2 are very close. But the etCO2 is usually 3-5mmHg less than PaCO2. Therefore norm PaCO2 35-45, norm etCO2 30-40 or so. This happens because the total level of CO2 within the body measured by a PaCO2 takes into consideration the CO2 bound up as bicarbonate ions. The etCO2 looks only at exhaled CO2 levels and does not measure bicarbonate ions so you get a lower but still a very useful value.

"As for extra levo might "HELP" a patient in SVT??? Are you serious? So a medication thats a positive B1 agonist, hence positive chronotrope, is going to help supra-ventricular tachycardia (heightened AV conduction rate)." Not defending the original post or the idea that a pressor can help hypovolemia induced tachycardias but you atleast have to agree that Levophed's chronotropic effect is mild compared to other pressors such as epi or dopamine. :)

You had to do what you had to do. I'm glad it turned out alright this time. As others have stated... the blood can hemolyze from the osmotic pressures exerted from anything but NS. Levophed here is also mixed with D5W. However the effect in boluses might be minimal. It sounds like you needed a central line... badly. Most patients in an ICU deserve a central line after a 1L blood loss. Frequent blood draws, boluses, pressure measurements, and stable access are a necessity. But the line wasn't placed. Then the patient coded and access was lost. Yet the line was again not placed. Then you had to resort to throwing levo and blood as fast as you can through a peripheral. The risks were high: loss of limb, loss of life. The doc should have stepped up.

This will be a short answer. This question comes up often... Put on your chemistry hats... 1. Carbon dioxide enters the RBC and does two things: a. combines with hemoglobin CO2 + Hgb => HgbCO2 b. combines with water CO2 + H2O to form carbonic acid (H2CO3) this process is then enhanced by an enzyme within the RBC called carbonic anhydrase (CA) . CO2 + H2O + CA => H2CO3 2. The carbonic acid from step b disassociates into a bicarbonate ion and a hydrogen ion H2CO3 HCO3- + H+ 3. The bicarbonate ion leaves the RBC and enters the plasma, allowing the chloride ion to enter the RBC. 4. The hydrogen ion from step 2 binds with hemoglobin H + Hgb => HHgb To summarize. CO2 is a cellular waste product. When it's dissolved in water and not directly taken care of by the lungs (which 70% of the CO2 is) it forms carbonic acid. This process is quickened by carbonic anyhydrase. Once carbonic acid is formed it immediately breaks down into a bicarbonate ion that floats around extracellularly and a hydrogen ion. Using the measure of bicarbonate ion we can deduce a CO2 "value".

This was most likely caused by the presumed continuous SpO2 monitoring or Arterial BP monitoring. Newer monitors will correlate the SpO2/ART pulsations with the heart rate. If the pt was in PEA and still had a rhythm but their SpO2/ART monitor was set to alarm under a certain pulse rate (or no pulse rate, as it should) you'll get the asystole alarm. Therefore, if the monitors are configured this way, they will alarm asystole with either electrical standstill or pulsatile standstill.