JSBSN

As it's been said over and over again... It's the whole picture. Experience, attitude, leadership, certifications, GPA, GRE, type of unit, communication skills, etc etc etc. But your GPA is fine if you want this specific question answered. Good luck.

It's 1mg/min x 6 hrs followed by 0.5. Not mg/kg/min. Weight based is 0.8mcg/kg/min usually and thats typically a more aggressive dose.

I was recently accepted. Unfortunately I can't speak from experience other then talking with current students and faculty, but they pride themselves in how they prepare their students to practice independently in all settings. TONS of lines, epidurals, regional experience. A student I spoke with has 20+ open hearts by her final year and is still doing her heart rotation. She does all her own lines and gives report to the CVICU at the end of the case. I am confident in my future education. I hope some current SRNAs and alumni can give some better insight for you!

Haha! I love this. Thanks all. CCRN-CSC-CMC..... sorry but you are all expiring in 1.5 years.

Any reason to maintain AACN membership or keep up with CCRN and other certs as an SRNA/CRNA?

I got in this week and I've told everyone including my manager. 9 months until the start of the program. She wrote me a letter of rec so she knows I applied. Fortunately I have a good relationship with those I work with. We've had several RN's go to school in the last couple of years and there is very rarely hard feelings. Most of us have been hard workers, involved in committees, and leaders in the unit. Hopefully you will have support.

1.5 cc air in, 1.5 cc air out... How can there be any residual air if the syringe passively fills back up to the 1.5 cc mark?

That's what I meant. I see I accidentally said supply greater then demand in code in my first post.

Oh and a grad level patho or pharm course wouldn't hurt! That's what I took to show my academic abilities NOW.

I got in with 3.1. High acuity CVICU, great GRE score, committees, charge nurse, CCRN-CSC-CMC... I'm a lot more mature then when I was 18-19 and they get that. Just keep moving forward towards your dreams. Make the grades happen now and own up to your mistakes. You'll be fine and above all, pray!

We do therapeutic hypothermia quite a bit in our unit. We mostly do it on out of hospital WITNESSED arrests. Those that were unwittnessed have had little success because no one knows how long the patient was down before resuscitation efforts were started. We have also done therapeutic hypothermia on in-hospital arrest patients as well, but generally these patients are MORE sick (because they are already in the hospital of course) and again may not have quite as good outcomes. It works best on those with witnessed arrests because generally CPR is started earlier and there is a rough idea of how long they were down. Our protocol is specifically for vtach/vfib arrest. The problem with trying to use it on a patient who has PEA is that PEA is usually caused by something else going on (sepsis, metabolic problems, kindey failure, shock, etc) that makes it more dangerous to cool them. The REASON for cooling is that it slows down metabolism and preserves brain function. Nothing can be done about the initial hypoxic event, but the SECONDAY injury (reperfusion injury, free radical damage, edema) can be limited by cooling them. We had a 29 year old patient who was down for approx 20 minutes WITHOUT CPR. We used our arctic sun machines and treated him with therapeutic hypothermia. He was even posturing for a day or so. He ended up going on CRRT and needed an oscilator for ARDS. He walked out of the hospital 3 weeks later completely neurologically intact!!! He's still doing great and back to work a couple months later.

What do you want to DO? You shouldn't pick a track because its easier/cheaper/faster. If you want to be a CRNA, get your BSN and get into a critical care area. If you want to do anesthesia without going to nursing school, go the premed route and apply to anesthesia assistant schools (however you won't have the degree of autonomy that many CRNA's enjoy). If you want to be an MD then go to med school.

My problem is I only have the one "nursing" chemistry that my school required of me. I wasn't planning on ever going back to school. I've already started applying and I've had a couple "not this year"s and an interview invite. Obviously if all goes well in the interview this won't be an issue, I just want to be prepared for if I have to reapply next year with more sciences. If that's the case looks like I might have to bite the bullet and do a year if gen chems so I'm prepared for ochem...

truly it comes down to who you know and making connections. ask to shadow in various units and find opportunities to talk with managers.

Exactly, you need to speak up when things aren't being done correctly, MD's make mistakes too even though they might disagree.

CRRT's in my hospital are 1:1 unless they aren't that sick (not vented or not on many pressors). HD nurses come to bedside when ever the kidney clots off/is due to be changed. Its such an easy thing (we use NxStage) but the dialysis company that our hospital contracts with make$ a killing each time they come to do that 45 minute process. Its terrible sometimes because in the middle of the night I've had patients wait for up to 6+ hours for the on-call dialysis nurse to get there and get the CRRT running again. I've worked at a facility (not in the ICU though) that keeps there CRRT patients as normal staffing (2 patients per nurse) AND they have to do all the setting up/etc themselves. It really just depends on where you work. The NxStage systems are so easy to run that its become much less labor intensive.

Were the classes you took "intro to...". Even at the community level you took a full 2 semesters of gen chem and then took your 1st of 2 semesters of ochem. These classes are stand alone "intro to..." classes not designed for multiple semesters or rigorous prerequisite requirements. Thoughts?

I've never done peds or neonatal in my life, just adult ICU... I have to say you NICU nurses are hardcore. Thanks for what you do. Sounds like you care and did everything right and just had a very sick patient. Sometimes despite out best efforts things go wrong. Thank you for wanting to improve yourself as a healthcare professional and for taking care of such little humans.

Oh! (Sorry I'll stop after this) if your patient had persistent metabolic acidosis despite treatment it's because she had inadequate perfusion. Yes epi increases O2 demand but she could be on an epi gtt all day long and experience no acidosis as long as her perfusion was ok. But from my experience with TAVR patients, they are sick as snot and this is a last ditch effort. So she probably could have used a lot more fluid (valves are always volume hungry!) and once optimum fluid status was achieved with continued poor CO a drug such as dobutrex to increase CO (as long as her BP could tolerate it) and attempt to wean off epi. But again this is only if she had persistent metabolic acidosis.

And for the fluid loss part of it: same concept Fluid deficit can cause poor perfusion. If this causes O2 demand to be greater the supply lactic acidosis will ensue. Also if kidneys stop making urine because of severe dehydration, the patient may experience a AKI resulting in metabolic acidosis since the kidneys stop excreting H+.

Code -> poor perfusion -> O2 supply greater then demand -> anaerobic metabolism -> lactic acidosis -> pH drops Epi -> increases O2 demand -> O2 supply already sucks because patient is coding -> potential increase in lactic acidosis. However Epi -> ROSC -> adequate o2 supply -> metabolic acidosis will fix itself Epi is not the problem, the patient coding was the problem. Treatment is ensuring adequate perfusion/O2 supply and give Nahco3 to buffer acid if it's causing further hemodynamics instability (in my experience it usually does because pressors are less effective in acidic blood) Hope this helps.

I agree with the above comment. In my experience though, those who have at least a year of step down experiences do better in the CC area. I did 1.5 years prior to but then again I know plenty if great nurses who did CC right out of school. Connections and personality are key.

Good job! That's an accomplishment!

You may have a hard time getting into an ICU right out of school no matter where you go. I went to a private school and did my time in the step down unit (1.5 years in my case) before I got a great opportunity to work in a CTICU/CCU and now I do open hearts all day long. I recommend applying for tele or step down unit jobs in a hospital that has the kind of ICU you want to work in. Then see about floating to the unit and make a GREAT impression and you will get a job there. Be humble and confident. These kinds of things are always about personality and connections. Your education background won't even be considered. Just as long as you have BSN behind your name.

Really encouraging thread! Making me very excited for school!