christophermiles

Thanks for the response, cowboyardee. Arterial sample was NOT used. Sample was mixed venous drawn from a PICC. After doing some Googling it appears functional and fractional hgb sat can be used interchangeably. For this pt, the results were separated by only 1-2 percentage points difference. To summarize I'm essentially asking can a fract hgb sat be used interchangeably with ScvO2? Sorry for my muddied post. I think the lack of clarity reflects my lack of understanding regarding the pathophysiology of this pt's condition.

Thanks for the reply, offlabel. I understand the role of dobutamine as it relates to this pt's scenario. My confusion arises from the apparent fact that the MICU team was using functional hgb sat from the co-ox panel as if it were ScvO2. Their progress note basically said dobutamine was uptitrated in an effort to raise the ScvO2, but a co-ox panel doesn't give you ScvO2 (right?). (A co-ox panel gives you the following: total hgb; O2 sat - fuctional and fractional; carboxyhemoglobin; methemoglobin; and O2 content.) I understand ScvO2 is used to gauge tissue perfusion. Does functional hgb sat basically tell you the same thing? If no, what role does this value play? More pt info: pt admitted for Rt-side HF 2/2 pulmonary htn and failed to respond to sildenafil and Remodulin. Listed for lung tx. SBPs 90-100. HR 90-100. SpO2 mid-90's on 2L NC. RR upper teens. On vasopressin at 0.02, Lasix 24mg/hr and dobutamine at 9mcg. Vasopressin was uptitrated unsuccessfully in an effort to improve ScvO2 and reduced back to 0.02. Pt seemed to modestly improve ScvO2 with increase of dobutamine.

In terms of addressing a pt's Rt sided HF and pulmonary htn, can ScvO2 and functional hgb sat be used interchangeably when titrating dobutamine? Background: pt is now listed for lung transplant and on Lasix, vasopressin and dobutamine gtts. MICU team seemed to be referring to functional hgb sat value as the ScvO2 when changing rate of dobutamine. Two hours after changing rate, team ordered mixed venous co-ox panel, which was drawn from pt's PICC. Any change in vasopressin or dobutamine rate was followed up two hours later with another co-ox panel. I was a floor care RN for 4 years and made the jump to MICU and BMT Onc ICU nearly 8 months ago. Respiratory concepts have BY FAR been the most difficult thing for me to wrap my head around. Any comments are appreciated. Thank you!

Thanks for all the suggestions and comments, everyone. I'm still waiting for my authorization to test, but, whatever I decide, I'll be sure to update this thread. Thanks again!

TheCommuter, $2,000 was the minimum goal; it'll probably be around $3,000. I agree with your comment, but I'll deliver pizzas if that's all I can find.

Hello everyone! OK, so I posted this in the General forum and am now posting here to see what Washingtonians think. I just graduated from an ASN program in Indiana and now have the perfect opportunity to leave and follow my lifelong dream of moving to Seattle or a surrounding city (anywhere from Bellingham to Tacoma). I'm a single, 33-year-old guy who has lived his entire life playing it safe, avoiding risk at all cost. I'm apprehensive about making the move because I've read countless posts here about how tight the Seattle nursing market is, especially for inexperienced RNs. But I'm afraid if I don't make the move now I'll end up taking a job and finding myself stuck in the Midwest. My greatest fear is looking back on my life and regretting my decision to play it safe and avoid the move. So what do you think? Any comments are appreciated! Thank you!

Thanks for the comment, PintheD! My goal was to leave with at least $2,000. Do you think that would be sufficient cushion?

Thanks, not.done.yet and TheCommuter. I'm now beginning to think it might be better to find something (assuming "something" exists) in Indianapolis, get at least a year under my belt, then move. I've read other posts in which applicants believed they were slighted because they did not live in the state they were applying. Is that accurate?

Hello, everyone! I've been a long time reader of allnurses.com but this is my first time posting. I'm looking for advice/suggestions. Here's my story: About three weeks ago I graduated from an ASN program in Indiana, and I'm looking to take NCLEX within 1-2 weeks (still waiting for my authorization to test). I'm a single, 33-year-old guy with no kids whose lifelong dream has been to live in the Seattle area (anywhere from Tacoma to Bellingham), and I feel I'm now in a unique position to finally make the move. Some of my friends and family think I'm crazy to make such a move without first visiting the area and lining things up, but here's my side: My entire life I've been a better-safe-than-sorry individual, afraid to take any risk without first knowing all the potential consequences and benefits. And I'm afraid if I find a job here in Indiana, I'll be stuck here. My greatest fear is looking back at my life and regretting I played it safe and ditched my dream. So what do you think? With the job market being what it is, am I setting myself up for failure? I feel as if I'm looking for someone to give me a reason to stay rather than go. ANY comments are appreciated!