Tzs1981rn

Orlando regional medical center (ormc) is a level 1 trauma center, teaching facility, and has ground and air transport teams. I am not sure about lift teams though.

I guess it's quite different in peds - we run propofol gtt for no more than 24 hours, but when we start we run at 75-125 mcg/kg/min and titrate from there (not unusual to see 175 mcg/kg/min in the smaller patients). Seems like the smaller they are, the quicker they metabolize it. I know it's not directly related to your question, but just an observation :)

I took the peds ccrn and we had a review course at my place of employment, and they also covered the cost of the test. I know the content is probably a bit different, but I honestly felt like the patients I had on a daily basis at work prepared me quite well. My exam was heavy on DI and SIADH which we commonly see.

We use the FLACC scale in these situations, but I also work peds.

We have a transport med box with epi and atropine, and we take a small tackle box with supplies (angiocaths, flushes, syringes, needles, etc), a monitor, ambu/anesthesia bag are on every transport. Obviously if the patient is ventilated, an RT comes too with either a transport vent or they just manually ventilate depending on where we are headed (and they bring the O2). If going to mri with a non-sedated patient, I'll bring whatever prn meds they have available in addition to all of the above just in case they can't stay still or have pain. It can be a lot to carry sometimes :) Usually it's just the RN and a tech, and An RT if needed, but I've had additional nurses, RT, residents, and intensivists go with if we think there may be a problem with the patient because they are very unstable but must go somewhere (this would typically be OR).

I'm not sure if your character is a minor or not, but if they are, I can offer some perspective as I work in the PICU (peds icu). We sedate with fentanyl and versed, and may add precedex for difficult to sedate kids. We only use propofol for planned extubation and for no more than 24 hours (risk of propofol infusion syndrome in kids is too great). You would also have child life specialists involved to work not only with the patient, but also siblings to help prepare them for what they will see, and to explain things on their age level. If your character has kids or young siblings, that might work to include. With car accidents you also may have psychosocial and legal ramifications that need to be explored. You can feel free to message me as well 😃

We have a dedicated peds cardiac ICU, so we don't get a lot of cardiac kids in our picu. We are a trauma center, and a freestanding children's hospital. We get traumas (car accidents, abuse), various causes of respiratory failure or distress (rsv, flu, etc), dka that have too low of a bicarb and too high of a blood glucose to go to step down, post op craniotimies, sepsis (meningococcal mephitis recently), stroke, ingestion, we do ecmo and crrt, end of life heme/onc kids that aren't dnr yet, sids, near drowns, and a whole host of rare disorders. We have ages newborn all the way up to 20. I'd say 75% of our kids are intubated and vented at any time.

I know this is a side topic, but propofol can be placed in a bag by pharmacy if the mL/hr is a high rate where you have to change the bottle frequently. If it's put in a bag, it's only good for 6 hours vs the 12 hours from the glass bottle (I think those numbers are correct. We tend to use fentanyl and versed drips with or without vec depending on the situation). To to the original poster, it sounds like you did everything right! Thank you for sharing :)

We recently started to use thoracic epidurals with a basal and patient control dose using fentanyl and ropivicaine for our pectus repairs. In addition, they also have scheduled iv toradol alternating with onfirmev (they get one or the other every 3 hours) for the first 24 hours. This provides awesome pain management and has greatly decreased the need for additional narcotics, and has resulted in increased mobility.

I maintain the following:CMSRN (certified med surg rn)ACLS (advanced cardio life support)PALS (peds advanced life support)BLS (basic life support)I will be adding CCRN (critical care rn) for peds in the next 6 months :)

What was the final solution, out of curiosity :)

If you can't get an order to reinsert and clamp, it might be worthwhile to try a urostomy bag if the drainage is thin enough. If it is a copious amount, you can connect the urostomy bag to a foley drainge bag. At least that way the patient's skin would not be exposed to the harsh fluids that are draining. Also a good way to provide concrete numbers regarding drainage rather than just telling the md it is draining a lot.

Thank you for the great articles. I now have a better understanding as to why her triponins were so high. She does have impaired renal function. Thank you again!

Thank you - I will read over the article :) I love that we have a forum where we can help each other out!

Could anyone offer any insight as to why a patint would have serum tiponin levels in the range of 40.4 to 76.3 without any EKG changes? On admission the levels were around 40, the next draw they were 60, the next they were 40, and then in the 70's. They were tested daily after this and never produced any type of trend. She never complains of any pain.The patient is an 82 year old female admitted with right lower lobe pneumonia, with spo2 says of 96% on room air and stable bp around 120-130/60-70 consistently. Pulse in the 80's. Her history includes dementia (and she is quite forgetful), HTN, high cholesterol, pacer placement (though she could not tell us why and no family was present or reachable by phone), and rheumatoid arthritis. She lives in an assisted living facility, though I think a SNF will be more appropriate on discharge given her confusion and disorientation if it doesn't improve. On prior admissions over the past 5 years, she had consistently high triponins with similar levels.Anyway, the cardiologists have ordered echo and her EF is 40% with no other major abnormalities. Ekg did not show anything suspicious per cardiologists. On telemetry she was running NSR 80's with occasional PAC's. No paced beats captured. I asked the hospitalist what would cause her symptoms an he said "some people just have high tripoonins." it sounded like an "i don't know" to me. I wasn't able to ask the cardiologist because he didn't come up on my shift.I work on a medical floor, but I figured I would get more responses on the cardiac board :)Thank you in advance for your input. Curiosity has gotten the better of me and I couldn't really find anything with a quick Internet search.