blucrna

First off congrats, getting into school is a huge accomplishment!!!! I always try to respect others opinions but let me put a Youngstown spin on things. I work at St E's in the cvicu and though I have elected to go to a different crna school I can tell you a few things about their program. IT'S Hard, but so is every other crna school out there. I don't believe any are for the faint of heart and they definitely aren't going to baby you. The staff will drill you because they expect a lot. This isn't a profession where you can afford to know the bare minimum. I have heard the added stress can get to you and some of it is unnecessary if you get on someone's bad side. However that's all hearsay and I can't verify that. All I've ever see when they come to drop off our hearts & vasculars is normal teacher / student interactions but things in the O.R, stay in the O.R. The faster you realize that the better! You will get to see just about everything though. Trauma, Neuro, hearts, ortho, etc types of surgeries are done the daily. Once you get done with your ysu portion of the curriculum you will be at the hospital full time, i.e 5+ days a week. By the time you graduate your #of anesthetic cases will be through the roof. I have a friend in the program now and two that I know of that will be in your class for sure for fall 14'.there are still a couple buddies of mine that are still interviewing and they are all cool people . If you have any other questions, send me a P.M

I've been meaning to grab one of our s/crna's about this. As soon as we get the pt post op we change all the dextrose bags to Ns. It just seems like a no brainer to start with NS given the need for tight glucose control

I agree. When money dictates patient care I think we all lose

I agree, having both gtts seems redundant. Any effects the neo is giving can easily be attained by simply going up on the epi.

Seems I'm too late but self extubation does wonders for these pts. Not that I advocate it but I've been there lol. This case does sound more like delirium than withdrawal. Your time frame would suggest he be past that point anyway. After 5 days your golden

I agree. The 3 L bolus and increased SVR (via pressors) are temp fixes but certainly enough to get you through until tPa busts up the clot. Levo is def a possibility worth considering but I guess you can also say that about dopamine/isoproterenol for the added beta support

I like that psu is trying to make you think. Simply put, lower bp (but not hypotension) is desirable because the heart doesn't have to work as hard to drive bp. This in turn decreases cardiac oxygen requirements. The lower o2 requirement helps combat angina as well. Adding to the pursuit of knowledge, what class of medications is usually prescribed to block the maladaptive compensatory mechanism seen in heart failure?

I've seen videos of this and its wild. We don't do it in my ICU (mixed ICU and CCU) but I've heard nothing but good things outcome wise as long as the pt can tolerate ambulation .

Congratulations

I agree. More info would definitely help answer the question. If its overload related a few days on a lasix or bumex may due the trick to alleviate that sob but if its ejection fraction related then it may take inotrops or vads So could the patient be weaned off the vent.. sure. Will they be able to sustain their airway capacity after.... depends

I'm pretty sure amio can be given in any case of vtach pulseless or not. Its an antiarrhythmic agent and per acls the dose is 300mg iv push for the first dose and 150 after.

Very true Esme. When I was in nursing school every semester that went by my classmates slowly figured out where they wanted to work. (The PEDs/ob semester especially) I thought I'd be a med/surg nurse until I hit my critical care clinical. To the op, keep your mind open to all the experiences and you'll fall in somewhere. Just keep in mind you might not get a position in that type of unit right out the gate.I had to work the ICU step down and transfered as soon as I could.

Ya neuro is a whole new world. I've been in the nicu for less than a month and probably learned more than I had in my entire critical care class for my bsn. You really have to stay on top of your assessments because the patients change fast

Good for you yshell. I agree that post did come off with a "chip on my shoulder" vibe. I'm new to icu nursing but I started off Tele . I've run into a bunch of icu-rns that give others a hard time. You just have to stick to your ground and give em what you got. My hospital uses online health records so in the time I could argue over moot info I could just as easily look it up

What's your background experience? I was a cardiac Tele nurse before starting nicu and the biggest thing for me was the terminology and common devices. know what a crani(otomy) is , subarachnoid hemorrhage ( SAH), types of icp monitoring devices , and of course pressors. It also wouldn't be a bad idea to go over your Neuro assessment and start to familiarize yourself with it because you'll do a lot of them and patients change on the drop of a dime

I agree. I would have pushed for an art line. It's in the best interest of the patient and provides you with up to the moment bps for titration

Ccrn is just a way to show your dedication and knowledge base when it comes to critical care nursing.. while it definately is nice to have, I haven't heard of any hospitals requiring it for employment

My advice is to apply to everything!! Being a fairly new RN (~1yr) I know plently of floor managers and the truth is nobdy really knows your appling to multiple jobs except HR. And they only care about filling slots, not the fact that you applied for 5 other positions. HR knows how it is for new grads and they dont consider it a knock against you for trying to get a job (unless you dont show for interviews).Its when you actually get an interview that you should portray your passion for the position you may be hired for. Good luck!

My hospital uses EPIC computer charting so the days of long narratives are just about over. Like prior posts we can chart progress notes in the notewriter for cya purposes. I don't do assessments unless an event happens like the time leading up to an RRT. Double charting is for the birds

Hmmm I never pondered about the "creepy" aspect of having cameras in the icu. When I went for my interview, they showed me the impressive 40+ inch screen with all the patient rooms broken up into little boxes I said "wow this could really be helpful for patient care ". I never thought they could be watching me . Now I feel overly paranoid lol!

I know you probably have decided which to take by now but I'm going to advise that you take the ICU position. For one thing it gets your clock started and it's experience that you can use to transfer to that bigger hospital in the future. Small ICU or not, you can still technically apply for anesthesia schools in one year if you feel comfortable doing so. Even if the step down position does have higher acuity, no crna school will accept it. And say you work in the step down and then want to transfer there has to A) be an opening for you to transfer 2 and B) the unit manager must actually hire you (remember you wont be the only one to apply for the spot). Always go with the sure thing! :cheers:

Im in the same boat. i got a few anesthesia books on my kindle that i've been reading off and on. I remember when you couldnt pay me to read a book either, oh how times have changed. Finally got my ICU job though so its t- minus 1 year before i get to see if it doing any good

I hear you CABGX4. I'm 23 now and start in the NICU at a lvl 1hospital nxt month with the goal of getting into school next fall and sometimes I wonder how admin boards really feels about us "youngins". I mean plenty of 20 somethings get in but it is a tremendous responsibility to be a competent practitioner. That being said I wish every crna hopeful the best regardless of age

some new grads dont make the jump staight into the icu well however many do. Most grads are willing to learn and are receptive to being taught because they know there is a ton of stuff they dont know. You take a med/surg nurse with 3+ yrs experience and tell them they arent doing something right i suggest you stand back because they arent going to take that well. Granted, alot can be learned from floor nursing but your not going to learn titrating drugs, monitoring hemo status, and other icu specific tasks anyway so why not just jump in and learn what you need to? Either way i hate making generalizations about which types of nurses do better and would rather base it off of individual traits/ willingness to learn. Truly blessed it seems like your taking the right steps in becoming a competent nurse in the ICU. Good luck.