nurs1ng

Well initially I got 5 mg/ml (5 cc of 1% prop in 5 cc lido)...but may have misinterpreted your post and so my other answer concluded to 2 mg/ml (1 cc 1% prop divided by 5 cc lido = 2 mg/ml)

So that would give me 2 mg/ml? I know that 1% is 10 mg/ml.. what's confusing me is if there would be a difference with taking 1 cc of 1% vs 5 cc of 1% but from your post, seems like there is no difference as to how much you take out since 1% will be constant from the get go.

Putting 5 cc of 1% propofol into a 10 ml syringe and mixing it with 5 cc 1% lidocaine... what would that give me X mg/ml of propofol? Just wanna make sure I have my calculations right. Any help would be appreciated

How the heck do you read an atrial ECG? I know that doing this augments the atrial wave on ECG but how do you interpret the reading itself? Yes, I'm aware of comparing the atrial ECG with the normal ECG (with strips printed side by side on the same paper). But I'm just not understanding what I'm looking for.. do I just look for AV dyssynchrony? Whether it's really a fib, flutter or junctional? Which lead is preferable in connecting the atrial wire to (specifically, where do I hook up the negative and the positive)? Pretty lost at this. Any direction/guide would really help. Thanks!

Thanks for this. In our ICU, we utilize the EASI lead placement and though I know that back placement is not ideal for diagnostics, I wanted to make sure that this was still feasible. Thanks again.

TBH, I don't think the pt was in vent dyssynchrony / auto PEEP. I just wanted to make sure I'm not missing any other reason for why this drug is used aside from better controlling the pt's ventilation (ie. minimizing shivering in a hypothermic pt). Thanks for your input, guys.

Can anyone tell me how you would position each lead on a patient's back? Thanks.

We had a pt one time with very high PEEP (~20) and I remember the nurse giving NMBA to aid in the process. My question is, what exactly is the relation of giving a NMBA to PEEP? My colleague told me but totally forgot as this wasn't exactly my pt. Thanks for any info.

So to clarify -- is the tip of the arterial line alongside the tip of the balloon? We only get IABP so few times a year. We always place our hep bag in a pressure bag but again I've gotten various responses in that I should manually flush every hour no matter what. One nurse even told me that I should place the balloon pump on stand by prior to manually flushing and reasoning was that "if you manually flush while the balloon is inflating, you're just pushing that heparin back into the coronary arteries." I'm getting confused with different answers here. And I've looked up our policies and procedures and it says nothing about manual flush however all the heart nurses on my unit manually flush (maybe because of how it was done the old way?)

I've gotten different responses from our senior nurses, but I wanted to know what your guys' typical practice is: For the heparin flush going in the root line, do you manually flush every hour? And if so, do you place the machine on standby prior to flushing or no? And where is the tip of the root line on the balloon? Is the art line at the distal end where the balloon tip is or is the art line's tip (inside the pt) located elsewhere? Tried to look info in our policy but no information found regarding manually flushing the root line. If anyone has any recent evidence based study they'd like to share, please feel free. If it helps, I'm pertaining to the Autocat 2 WAVE machine. Thanks guys!

What day is your interview? How soon did you hear back after submitting your application? Thanks!

Had a discussion with a colleague regarding the use of NS preservative free vs regular NS to prime the ICP system. In my colleague's defense, regular NS can be used to prime the system because it is not "entering" the pt's brain since the whole system drains anyway. Regardless of this thought, I still think the use of NS preservative free is necessary because even though we're not "flushing" anything inside the brain + fluid drainage, you're still hooking up a tubing with preservative materials to an intraventricular catheter. Thoughts?

I get very wary about "minimal" chest tube outputs. Did your pt's chest tube output show a trend of decreasing drainage by the hour? Regardless of minimal chest tube outputs, I feel they should still be draining POD 1 and those tubes should always be left in until POD 2 or 3, maybe even up til day 4 but that's just my opinion (unless anyone can present with evidence based studies to show otherwise). I also had a pt who went into acute tamponade but there were no signs of suspicion until we looked at the trend of the chest tube output. It gets pretty tough but you did good and I'm glad you were a true advocate for your patient.

Don't be a know-it-all. Ask for help, but don't shop for answers. Do your own homework.

I really wish I could've messed with the box more but didn't as this wasn't my patient. Thank god the pacer didn't capture because some of those spikes were all over the place, including landing on T waves. Don't even remember now whether these spikes were firing at regular intervals or intermittently. Should've printed a strip for reference!

Pacer failing to sense completely. It was firing spikes everywhere. Def not failing to capture since pt has been having own sinus beats consistently.

Yes, mode was set to DDD.

My dearest cardiac nurses, I have a question that has gotten me stumped. My co-worker received a fresh CABG with epicardial AV wires. The pt brady's down to the 40s (non-sustained) and co-worker decided to place pt on the pacer box with a set rate of 60. On the monitor, I noticed that pt's pacer spikes were all over the place and not sensing the pt's own intrinsic rhythm. Went to the bedside and told my co-worker about this. I was adjusting the sensitivity setting to no avail - pacer spikes still not sensing pt's own rhythm?! We then decided to just unhook the wires to the box.. thank god the pt was maintaining with a HR of 50-60s with a stable BP. What else could we have done to have the box better sense the pt's own rhythm? Should I have unhooked the atrial wire from the box and see how the pacer would sense with only the V-wire? And/or vice versa? Thanks for any response!

For those of you saying that this is not considered a fall, go back to your hospital policy of how they define a "fall." I'm pretty sure this is considered an assisted fall in most hospitals, if not all. Regardless of whether the patient was A&O x3-4, every ICU patient is still considered at high risk for falls. Honestly, it looks like you were partially at fault for not utilizing a chair alarm. Having none to use is not an excuse. If this was the case, you should have assisted the patient to ambulate in the hall or room (or wherever to help your patient get mobile) and THEN put the patient back in bed. Also, prior to you documenting outside the room, you should have placed the patient back to bed. And then again, yes, it does look like your night shift nurse is throwing you under the bus. Because she was in the room with the patient, not you. If she knew the patient was being uncooperative and attempting to stand up, she should have yelled for help so as to prevent the fall from happening. Just my two cents.

What unit was he in? Regardless whether he was "'fixed", he still needed to be transferred to the ICU for observation, just in case. Also looking back at your post, it seemed like you got an order from the MD to transfer to the ICU but that order was ultimately defied. That's a big no no. A call back to the MD for an update should have been in order. But that's just me.

*Nurse charting at the nurse's station sees V-tach on the monitor* *Runs in the patient's room* Nurse: *Busts door open to see patient* Wait, woah, woah, woah!... Patient: OMG, couldn't you have knocked?! *tries to cover self with top sheet for the little privacy he has left*

HALLELUJAH, shift change is here! *mic drop*

More food requests when I was literally in the room a minute ago to give them (the patient and visitors) MORE food.

Actually, CRNAs deserve more. Don't belittle these nursing geniuses in the anesthesia profession.

My fellow nurses, i have been wondering about this for some time now.. What's the purpose of having a micro drip chamber if your flow rate is controlled via Alaris pump? Would the use of a micro drip chamber be, then, obsolete? thanks!