Beentheredonethat

The mannitol is used to reduce cerebral edema. If the brain is swollen then it pushes in on the arteries. That reduces CBF. You are trying to increase CBF. Back to the garden hose. If you squeeze the hose you restrict the flow.

Critical care is very demanding and historically not a "good" place to start a career. With that said it is also a place where people need to support each other and understand that a new nurse is new to everything. Chances are the unit has a reputation for burning through staff. If the DON is good over time she/he will recognize that there is a problem with the unit, not the new staff. However, this process does not help you. Don't wait for the hospital to find you a new position look for one elsewhere. Given that you just got burned try for a postion that is less demanding in order to get your confidence back. Forgive yourself any mistakes and understand that you are not responsible for their bad behavior. Your number one goal is to take care of you first. Start with a list of what you did learn and what you did accomplish. Look for a new position as if it were your first. In the long haul you will do fine.

Skip S. Flordia. Came from a top ten dedicated neuro ICU and find S. Florida to be backward. Average care, not high tech, less than exciting hospital culture.

These are some great solutions/ideas. It is so nice to see people working to help each other or spread knowledge. I hope more folks present their ideas on how to proceed. You never know when the seeds you sow are the seeds you may need in the future. Sprinkle and nurture. Unemployement benefits may not be everything but they may just help you through the next step by providing the flexibility of schedule for your next step.

First, CONGRATULATIONS! Second, thank you for taking the time to let us all know how things turned out. I could not be happier for you. Your lay off may be good timing in disguise. Unless the board stipulated that you had to accomplish this prior to employment it will not hurt you to approach prospective employers with a request for training All they can do is say no. If they say yes you will save some time and money. If not you have already weathered a heavier storm and will survive until you are back in the fold. Make plans for the worst and start that process. Then anything that happens will not be a surprise or burden. I only say this due to the economic times. Maybe you will need to move back home for a while or in with friends. Check out the training programs and do what ever you have to do to get that accomplished. Remember, you are now on even footing with any new grad except that your life experience has made you tougher, more aware of your strengths and increased your recognition that bad things can happen to good people. This translates into mature knowledge and dedication for you and empathy for your pts. Those are your selling points so go out and sell yourself! Take care.

I did hearts and transplants as well. I have had many "neuro" cases who also developed comorbidities that lead to multiple system failures and the need for internal and external support. An advantage to hearts is the technology and the ability to measure what is going wrong and hardwire it so to speak. Buisy you bet, complex sure but frankly I left hearts because most of the cases are straight foreward and it was the same old drill. Only when you had a disaster case did you revert to even a few of your listed equipment. I think we both know that you don't use rvad, lvad, bivad, iabp, art hearts, ecmo and the old standards of pacing on each case. The bottom line and the point of my message is that we should always respect the knowledge base of another discipline rather than degrade it when compared to "our" own. Bottom line... respect lasts longer than technology.

In these cases most of the docs I have worked with wait three days to really sit down and talk to the family. It is of interest that Lazarus incurred the same three days. Perhaps it is a social custom that we don't recognize. I usually start talking to the family about what we would look for as signs of meaningful neurological activity and then let them spend some time checking for themselves. I also start to involve them with hygeine care of the patient. It is a subtle way to let them prepare their loved without being obvious. This seems to be appreciated later on and I have often had family tell me that they found themselves saying goodbye as they washed. They start to see that there are no reactions and the human touch connects them with the reality. I then start talking about how fortunate they are to have this time to be with their loved one as so many families are not with a loved one during "this time." I also start asking if there is extended family who might want to express their love and how long it might take for them to arrive and that even if it is late at night I will get them in. This process has always worked and is appreciated when the time comes to discuss if their loved one had ever considered gifting so that their loving spirit can go on. They always understand that gifiting is a reference to donation. After this I always assigned a newer nurse to the case. This helps the family to recognize that the aquity of care is changing without being blunt. In these cases you are really taking care of the family and helping them to heal.

Robi: You had a problem and you overcame it. Having a problem is part of being human, overcoming problems is what makes you an accomplished human. Put your shame in a letter, read it out loud, and then burn it. As the smoke rises to heaven so too does your spirit. The ash is what is left of your shame and that is washed away....stand proud and present yourself as whole. Mankind awaits your journey back to nursing.

Turning the alarm off should not be confused with silencing the alarm. I always keep the alarm on but may hit the silence button while turning, repositioning etc. The first thing I do is check the alarm parameters and make sure the silence parameter is set for no more than a minute or two. Using the silence doesn't set one up for a big surprise the way turning an alarm off can. Not all monitors allow fine tuning of the silence duration so if yours doesn't don't turn off the alarm for any reason.

Give your self time to learn and don't beat yourself up if you don't know something and someone thinks you should. It is easier to learn the numbers associated with invasive lines etc than it is to learn the nuances of a changed behavior or response to a neuro exam. You will spend a lot of time "just observing." In neuro observation is a science into itself. At first just focus on "the change" then work in the reasons behind the change and then what to do about it. Be quick to ask for another's opinion. The pts life is worth more than your pride. You will do just fine.

I think we (neuro folks) face the same predjudices. First, ignorance of how extensive neuro care really is and then organ priority. This seems to be especially a problem between brain vs heart. So answer this question. Whats the waiting list for a brain transplant vs other organ transplant?

With the advent of Primary and Comprehensive stroke centers starting to come into play and the evolution of a national standard such as Get With the Guidelines stroke is on the doorstep of being a subspecialty. It has had more time to evolve into a specialty for our physicians (USA) but has not made that transition for nursing. I couldn't agree more with a dedicated stroke forum. It would provide fast and more efficient searching for answers and sharing of the wealth. OK that may sound like a presidential political statement so I will clarify, the wealth of knowledge. By helping, supporting and sharing with each other we not only provide nuturing for the few who go into this field but improve the standards of care for our patients. Lets do it!

Sorry, the key board died so the rest of the message did not make it. I was going to say that it provides a common language between shift, departments and other facilities.

This is a good question and one that was asked by our staff after we instituted the same policy. First, you are right that the NIHS is used for stroke. What we found is that there has been resistance to using the NIHS and often the folks who resisted did not have the best neuro assessment skills. Neuro exams without a scale have often been subject to a wide range of subjective rather than objective interpretation and difficult for one person's assessment to be validated by anothers. In short, it helped to standardize everyones exam. It isn't perfect, but there aren't too many scales out there and it is the most used so it acility and another. Once you have it under your belt it won't take any time at all to perform.

I reviewed the ROSIER info you sent. It is similar to a screen that is now being taught to our EMS folks and I recently introduced to our ER and rapid response team. Called the MEND exam. Short for Miami Emergency Neurologic Diagnostic. It is also a yes/no format that is fast, simple to use and a good indicator of stroke and stroke snydrome. Our equivalent of your Bamford classification. Our staff is not as sophisticated so trying to wean them away from an alert and oriented, moves all extemities assessment meant we needed a common format for them to adhere to. For now we are using the NIHSS until they build their skill set and can move forward. I really was envious of the baseline level of care that your system has. In many areas in the US we are still fighting the old attitude of nothing can be done for stroke and bare bones neuro exams. The fastest way to clear a room of nurses here is to ask them to perform a neuro exam. Thanks again for your info and support.