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.

We commonly used them in EMS for peri-code and code situations with poor venous access. Many medics will go straight for IO for codes. It's an great intervention prehospital but it has not really caught on in the hospitals I have been. EZIOs are amazing.

Don't even let it bother you. Just be confident in who you are and the profession you have chosen. Those who mock are usually ignorant and know little about what nurses actually do. A lot of my friends gave me crap for going to nursing school but now I am the one about to graduate with a BSN with a great job and bright future ahead while most of them either A) Got some random degree and can't find a job or B) didn't graduate and still live off their parents with no real future. Oh and they hate when we are out at bars and all the girls love talking to me about wanting to go to nursing school and think its awesome that I will be a nurse. Let them talk ****, it doesn't bother me at all. "Haters gonna hate Brah"

Short answer: Yes, a BiV Pacemaker can have to ventricular pacer spikes. Long answer: A BiVentricular pacemaker, also know as a cardiac resynchronization device (CRT), has two pacing wires; one in the right ventricle and another resting in the coronary sinus which paces the ventricular septum (Next time take a look at your CHF patients Chest X-ray and see if you can identify the type of device : Dual chamber PM - AICD - CRT or CRT-D) Around here the CRT-D is becoming the most common. The purpose of this is to synchronize the contraction of the right and left ventricle therefore improving cardiac function. Ideally, both leads fire at the same time (or close enough that it is not noticeable on a surface EKG) resulting in what appears to be a single pacer spike (which in reality is two) kind of like how the QRS is actually each ventricle depolarizing separately but simultaneously. Just like with a bundle branch block when there is a conduction delay you start to see each independent depolarization (rabbit ears) there can be a delay between the two separate wires. This can happen for various reasons but I think the main reason is an alteration in cardiac structure like with a HCMO resulting in two separate spikes. If each ventricle depolarizes at a different speed then the pacer will pace each wire at different times to "synchronize" them. That is my understanding but I am in no way an expert so I may be wrong.

The QTc is the rate corrected QT interval. There are a few formulas but I think the most common is the QT divided by the square root of R-R. EKGs should automatically calculate it for you but on a telemetry monitor you should be able to use the electronic calipers. On Philips systems measure out the PR,QRS,QT like you normally would then add in the R-R and then click the QTc button and it will calculate it. Also, If you have centralized Tele with the Philips system you can have them put on continuous QT monitoring which will give you constant QT/QTc measurements. Check your floors policies because some require QTc off a 12 lead on high risk drugs.

If you are ever bored and want an interesting read search for some articles on "Double Sequential Extermal Defibriillation" or DSED. Pretty interesting concept of using two defibrillators for refractory VF.

Glad to see another EMTLIFE'r on here Akulahawk. Others have already answered your question but I just want to echo what they said, definitely not a stupid question. I have seen numerous people in the hospital slap a Non-inflated NRB on their patient and then sit there and wonder why the Sats are still low. Much better to ask on here then to do it the wrong way in real life.

I am just a student but I will offer my input. I have always been trained (In EMS, so probably different priorities) that analgesia should be the main priority followed by sedation. A patient properly medicated with analgesics should require less sedation. Sedatives only (Propofol/versed) does nothing for pain. Some people like to argue that the patient will not remember the pain so it is not a priority but I still think pain has a significant physiological effect and should be controlled. Some will even be as bold as to purposely not use analgesia as a way to maintain BP (Pain = catecholamine). Almost every intubated patient I have transported has been on a Fent/Morph drip (Usually Fentanyl). But, as I said I am just a student and do not have ICU experience so my comments may not really mean much. Here is a good link to an Emcrit post about post-intubation analgesia/sedation. http://emcrit.org/podcasts/post-intubation-sedation/

I have a 5.11 tactical backpack. It is awesome just like all of their products. RUSH 24 Backpack | Tactical Backpacks | 5.11 Tactical

I was thinking acute Cor Pulmonlae in relation to a PE. Athought it does not really fit the symptoms it is good to rule out.

To add a Zebra to the equation...Hypoglycemia can prolong the QT interval. Did his QT prolong as his heart rate dropped? It is good to know the QTc