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 reputa...

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 futu...

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...

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...

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 talkin...

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...

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 paramete...

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...

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...

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 ...

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 resist...

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 als...

We break the entire process down into several elements. First are the goals. Door to Doctor( ER DOC )(10 minutes), Door to Labs/CT done (20 Minutes), Door to Labs/CT results/neuro consult (45 minutes), Door to drug. (60 Minutes) We allocate 15 min...

Your institution can establish their own "standard of practice". In the case of acute stroke we use it in two different time tables. If the pt received tpa we use it during the emergency workup, two hours post tpa, 24 post onset of symptoms and at d...

Misswoosie: Thank you for taking the time to respond to my request and a big hug and kiss for all the information! I have spent several hours reviewing the information and have to say I am envious. You guys have this down to a very simple but compr...

You might side step this issue with predetermined time frames to open to drain and in between monitoring the waveform. for example order open to drain q 15min for 5 minutes. could be q 30 or q 1hr but you get the idea. This allows for drainage and...

Neuro often suffers from poor recognition. I have worked in a multitude of positions, everything except peds and burns. I can honestly say that some of the sickest pts I have ever had have been neuro cases. Just because they have a neuro problem does...

Why do I Love Neuro? Boy, that is kinda like asking why you love your kids. I think it has to do with knowing that so few can help your pt but you can. It is seeing recovery from disaster. It is reaching into the dark and shinning a light. It is real...

It is really great to see so much interest in assessment of neuro pts. A neuro assessment is vital signs for the brain. As many are reporting, it can be done and with great accuracy/results. Stroke teams deserve all the credit they can get. Any o...

We use the complete set. We did work on so that it is a tri-fold with the directions/scoring on one side and the pictures/words/scentences on the other. There is an older model that has fewer instructions and a more streamlined scoring that is a on...

The NIHSS is a good scale but nurses don't like it. I personally think it is because they don't really understand a neuro exam and since this is a neuro exam bam they don't like it. Once you have it down pat it isn't any more difficult than shootin...

I like keeping pumps behind the head of the bed. Keep the vent to the pt's left and a little behind. Like you noted, harder for them to find the tubes and pull em out. Gives visitors more space and easy access for the nurses too. if you got the sp...