ChaseZ

Sounds like this patient went into a Pulseless VT that was below the detection rate of the AICD. Each AICD is programmed for a specific VT/VF "zone" that requires a specific rate and run count to activate the ACIDs set response. The patient can be running along in VT at 110bpm but if the low rate threshold is 120bpm the AICD will do nothing. Patients loaded up on antiarrhythmics can go into VT at slower rates. Most of the time this is fairly well tolerated but other times it can result in an arrest. Standard ACLS. Ask the MD about throwing a magnet on.

It is all supply and demand. If they can not staff Med/Surg floors then they are going to offer incentives. When an ICU position opens up and 20 people apply then there have no reason to offer high pay rates. It would be nice to have the job you want and be paid exceptionally well but it doesn't always work out that way.

Just be smart about the PIV you are using. Make sure it has a good blood return and will take a hard flush. If not, start a new one. I hate putting IVs in the AC but if the patient is getting Amio, Dobutrex, etc I will throw an 18 or 20 in the AC or Basilic if possible. There is a big difference between a 22 in the thumb and a 18 in a deep vein. As much as I love PICCs I do not think they are necessary solely for Amio.

You can attempt to cardiovert Torsades de Pointes but it will most likely fail. With a synchronized cardioversion the device tracks the R wave of the QRS complex in an attempt to precisely deliver the shock during depolarization and avoiding the refractory period. In Torsades or Polymorphic VT the axis is constantly changing, hence the "Twisting of the points", and only monomorphic for short periods of time which is usually not long enough for the device to synchronize and shock. Therefore the shock would be unsynchronized or defibrillation. Did the patient get any magnesium during that time? That is the first line treatment for TDP with a pulse. After that check electrolytes and QT prolonging drugs. Bonus: Anyone know the defining difference between polymorphic VT and TDP? In regards to compressions; The idea is that there is a minimum coronary perfusion pressure that must be met for a rhythm to be converted back into normal sinus rhythm. Anything below that will most likely result in V fib or Asystole post shock. This is why it is so important to provide quality compressions immediately before shocking. Continue compressions while charging and stop only briefly for the shock and continue immediately after. You will notice some people stop compressions after seeing a normal rhythm on the monitor only to lose pulses a few seconds later. This is because the heart is still stunned and can not maintain an acceptable CPP. Having said that, if the patient has a pulse then the CPP should be adequate and there is no reason to do compressions. Anesthesia is great to have for a cardioversion but in an emergent situation just shock them. The NP was at the bedside, could she not have ordered some IV versed? Even after the fact Versed can cause some retrograde amnesia. Most Elective cardioversions are done with Versed and Fentanyl. There shouldn't be an issue pushing that on the floor during an emergency.

Certification Verification Search Personally, the first name on my badge is not the same as my license. You would not find me if you searched using only that.

I took the exam yesterday and passed with a 90%. The test was very Cardio/Pulm heavy. Like a previous person mentioned I had a couple WPW, A few MI Location/Artery, Long QT, Electrolyte effects on EKG intervals, and anticoagulant questions. The only section I struggled with was the "Caring and Ethical principles"

Pacemakers themselves do not create abnormal heart sounds. What you most likely heard was a valve murmur in a patient who happened to also have a pacemaker. The majority of patients who get pacemakers have significant cardiac disease which causes various clicks, murmurs, and extra sounds. A pacemaker, specifically a Bi-Ventricular, may actually "fix" extra hear sounds. But in a patient who has a pacemaker and a structurally normal heart you should hear normal heart sounds. An example would be a person who got the pacemaker for a 3rd degree heart block. The only new heart sounds that would worry me would be a friction rub or muffled tones. But that is mostly for new pacemakers and if they did perforate something during the procedure they would likely be crashing and you would have more than heart tones to go on. With pacemaker it is always nice to know what kind of pacemaker it is and what mode it is in. Not everyone with a pacemaker 100% paces.

So are you implying that females' motivations for entering the profession are intrinsically more altruistic than their male counterparts? Many of my female coworkers would cite the reasons you stated above as their motivation for becoming a nurse. I think your impression is a bit of a generalization. Personally when I was considering career choices my thought process was not "Eh I need a job, I could probably do that nursing thing, and I can make less money than an engineer, accountant, or in business" What certain traditions and philosophies are you referring to? Again, are you implying that females are intrinsically more caring then males? Are you saying that men can not "care" the same way a female does? I have worked with many women who have never said "Aww, that patient is so sweet. Let me get her some juice!" Or anything to that affect.

But I like my pedestal....seriously. I do not think ADNs are any less competent than BSNs or vice versa but in today's economy and job market the BSN has a clear advantage (For new grads). My BSN classmates and I all had job offers prior to graduating whereas many of my ADN friends are 6 months post graduation and still unemployed, many without even getting interviews. The ones that do have jobs are at LTC or nursing homes. It just so happens these same friends are the ones who like to complain about BSNs claiming we are arrogant and don't deserve a job over them just because we took a few extra "worthless" classes. They have just as much of a chip in their shoulder as "BSNs on their pedestal". Should I stoop to the OP's level and start a thread "ADNs grab a step stool and step your game up". This hate fest is crazy.

The black edition is a very dark black with all the parts looking pretty much the same color. The smoke is a dark grey or gunmetal which is slightly lighter than the black tubing which adds a little contrast.

With any of the cardiology stethoscope I would definitely invest in a Batclip. They are very heavy and get annoying around your neck. Amazon.com: The BATCLIP (BLACK): Health & Personal Care

That is what we were all told when applying for jobs but me and many of my classmates have positions and start in January before passing boards. As far as the job market goes I was told by HR that they received way more applications than available jobs.

Congrats and good luck. I just graduated with my BSN and went through the new graduate application process. It can get complicated and stressful. Your best bet is to find personal contacts (floor managers) who will request your application from HR. If not, you will most likely get lost in the process. There were a lot of new grads and few positions at many hospitals.

It is normal for a person to freeze or feel overwhelmed the first time they do CPR outside of the hospital. If someone collapses in front of you then check a pulse, tell someone to call 911, tell someone else to look around for an AED, and then begin CPR. It helps if you tell someone specifically to call 911 instead of just shouting "someone call", point someone out and be direct about it. Do hands only CPR until EMS arrives or someone brings an AED. Open the airway with a quick head tilt chin lift if you want but don't bother with rescue breaths. If there are a lot of people around maybe ask if anyone else knows CPR to relieve you when you get exhausted. My first time doing CPR outside the hospital I checked the pulse way too many times since I didn't want to believe the guy was actually coding but after that initial few seconds of shock everything fell into place.

I have owned both the Master Cardiology and the Cardiology III. As far as sound quality goes I think they were pretty much even, both are fantastic. My problem with the Cardio III was the size/height of the dual head, it was cumbersome and awkward to handle. It was very hard to maneuver around chest tubes, drains, etc. The dual head did have some advantages and did work great though. You can't go wrong with either scope I just prefer the Master Cardio due to its single head design, if were in the ER or office setting I would probably stay with the Cardio III.