oneillk1

:uhoh3:We had this issue... admittedly some staff were seen by the family of the patient making a personal call on their phone. So now we have a blanket ban on cel phones in our unit. BUT! We received word in our communication book that if anyone (patients, visitors) asked why their cell phones would interfere with equipment and the doctor's cell phone would not, we were to say that they have a special chip in their phone that allows them to be used safely!! I think I could probably cough up my own lung before saying that to someone with a straight face!

Enough power so the fridge, toaster, sandwich press, dishwasher, hot water boiler and two microwaves can run at the same time without shorting anything out! And yes it was me that caused people to have no dinner by shorting out the appliances :uhoh21:

Could it have been for the comfort of the family rather than the comfort of teh patient?

I know that from a critical care perspective, if the MAP is below 50 then we are looking at ischaemia. Ie Uterus, placenta. And that is not even taking into account the resistance from these

I usually say something along the lines of "we are keeping a close eye on 'x' but at the moment we are a bit more concerned by y and z." And take it from there, sometimes the families accept that, othertimes they want a bigger explanation. My explanations do tend to get shorter though the more times people ask the same question! Also probably the obvious thing of the family becoming fixated on the aspect of the patient that they know something about, as a way of clinging to the last big of control. Good luck!

If there is concern about the FALSE eyelashes falling in the sterile field what abtout the natural ones... a hair from her eyebrow, a flake of skin..... Is she working in theatre??? On the other hald if she has hair that is faling over the patient that is a different story. I personally do not think that the overdone fake tan and makeup and hair is a good look anywhere but if she wants to drag herself out of bed that bit earlier in the morning it's her perogative. At the end of the day people could look at me and say "gosh she has no makeup on, she must not take very good care of herself and therefore she is not a good nurse" Works both ways doesn't it. I am learning that what is normal to me is not necessary normal to everyone else...

We get 1:1 ventilated, sometimes 2:1 unventilated, sometimes 3:2 unventilated or even 1:2 if the patient is really sick (that is patient : nurse) The only time we ever have more than 1 ventilated patient is when the nurse next door is on a break. In saying this, we don't have techs, we do everything ourselves

We get 1:1 ventilated, sometimes 2:1 unventilated, sometimes 3:2 unventilated or even 1:2 if the patient is really sick (that is patient : nurse) The only time we ever have more than 1 ventilated patient is when the nurse next door is on a break. In saying this, we don't have techs, we do everything ourselves

Australian, but I suppose we have the same system here as there (or similar) Thanks for that feedback, I just didn't know if perhaps I had overreacted. I personally thought I hadn't but I think a lot of things that aren't always totally accurate!!! Just wanted a fresh perspective, especially given that my fellow nursing staff were just so ambivalent about it. Also, when I said that there were no free beds, we are staffed to run up to 14 beds. In emergencies we can (and do) have up to 16 ventilated patients, so this patient was not going to prevent another patient from being admitted if necessary

Hi I would really like some feedback on an incident that occurred yesterday. I was looking after my non ventilated patient, 8 days post a vascular procedure who had been extubated for one day. When I arrived his RR was low 30s, chest sounded terrible, was on 50% o2 via venti mask, but Sao2 was in high 90s. Over the course of the afternoon his RR went up to mid 40s, he required increasing FiO2 (went onto NRB mask), ABG were very average (PaO2 =52), he complained that it was difficult to breathe and he didn't have strength to cough up his sectretions. I discussed with the registrar and we both were of the opinion that the patient was deteriorating and would more than likely need reintubation. Anyway, at about 5:30 the Consultant for our unit (who had not looked at the patient all day) decided he should go to the ward. He did not perform an assessment, just stood at the door and said "oh the monitor says his RR is 29, send him" I pointed out that he had deteriorated over the shift, the monitor was inaccurate due to the position of his patient and I had manually recorded his RR to be 42 within the last 5 minutes, and I felt it was unsafe to send him to an unmonitored bed where the staff to patient ration would be 1:10. He said that he was aware that the patient would more than likely bounce back, but send him as we did not have any spare beds in ICU, just in case we get an admission. I had a bit of a rant to the registrar, who said that he agreed with me but I had done all I could and we should send him because that was what the consultant said. I did not find this acceptable as I had real concerns for this patient's safety and well being, let alone his life, if he went to the ward at that point. Basically I got a bit angry and stroppy, told the in-charge nurse and the registrar that I did not think this was acceptable, we were not doing all we could for this patient, and we should not send him to the ward on the basis of what 'might' happen. Made a bit of a scene. So finally they each grew a spine and said ok don't send him. My problem is that I am so angry that I had to make a scene for my concerns to be listened to. I feel that this is really bordering on negligence by the consultant concerned, and it is a huge slap in the face for all of the RNs in the unit - why do we bother being there and going the extra mile for the patients if the medical staff will not pay attention to our patient assessment skills, particularly concerning unstable patients? I know that I did the right thing for the patient, but I feel really bad and very disilusioned by this. I think I will be seeing the nurse manager to discuss this with her (because I have had a similar problem with this consultant previously), but as it is now I don't really know if there is a point. Any feedback would be great!! Karen

OK me again, I know this is totally un on/gyn related but I loved this call. Had the 180kg man in ICU, on a ventilator for 3 days, basically had respiratory failure cos he was too fat to breathe... hx of permanent BiPap at home (like a ventilator but without the tube for those who don't know). Anyway he got extubated. The first two topics of conversation: 1. "I want a cheeseburger". Um I think that's what got you in here!! so wife runs off to get him a cheeseburger 2. while wife is away getting said burger: "Oh, my wife has really let herself go lately" Yes it must be so difficult for youwhen you look like Brad Pitt. After he ate Jennifer Aniston AND Angelina Jolie!!!

ROTFLMAO!!!! On a similar vein (gee I keep doing that on this thread!) is: When is my brother going to have his tracheomity?

yes and no... on one hand it is intensive care, I personally get very wound up and annoyed if the things that I need to do my job are not there. Such as the duck bill masks... my patient has Influenza... there are no masks in the hospital (I know I phoned everywhere!).... that pisses me off. Also, the consequences for the patient can be pretty extreme if things don't go right. I probably get a bit more short with people, supply, nurses who ring from other units with stupid questions (what are we, the help library, get off your a** and look it up) than I need to. On the other hand I think I actually work with some people who have genuine OCD. Such as, if you fill in their obs while they are on a break, they will redo the entire chart. For the whole day!!!! I think that saying you are at work to do your job and not to make friends is a bit short sighted though. If we get into trouble who is going to help us. Are you going to help the person who chats to you (at clinically appropriate times, before anyone gets on my case!) or the person who will not crack their face into a tiny smile. Why make life harder than it needs to be! There needs to be balance. Patient care CAN be balanced with a good working relationship with colleagues!

In the dark depths of australia we use heparinised saline for transduced art and cvp lines unles contraindicated ie pt has Hitts. However changes in practice seem to take a long time to get down here......

I agree, I am relatively newto ICU also, but by knowing why you are doing what you are doing you can potentially pick up mistakes before they happen. Also.... check the lines and the connections (why is my patient agitated? oh we have been giving M&M to the bed for the last 2 hours) Always check the pumps when you reset them... had a patient in our unit who ended up on 47 units of insulin per hour instead of 4.7 (not my patient thank god!) Always make sure you check the safety things... suction, oxygen, ambubag, masks. Think what is the worst that can happen and what will I use if it happens? Then forget about it. Do a thorough top to toe assessment. And don't overlook things because the patient is not in ICU for that.... I do vascular obs regardless but a lot of my colleagues don't. Ask questions!!! Ask the doctors why things are happening. Or why they are doing what they are doing. It is not outside the realms of possibility that you are right and the doctors are wrong. It's not too hard to phrase a question in a way that will save their ego. But generally the more questions I ask the more I learn, it is like fitting a jigsaw puzzle together. Check anything that feels wrong. Chances are it is. Talk to your workmates. My colleagues are generally fantastic people who will happily help with information etc. This is the best way to learn. The last thing is.. the thing that you feel is your weakness (mine is auscultating breath sounds), keep doing it until you feel confident! Oh this is the real last thing. With some relatives all you can do is smile and nod and wait for the shift to end. Good luck!

Thank you so much for this, our unit protocol says hair wash MINIMUM of weekly, but whenever I ask my colleagues how to do it, the standard answer is 'oh don't worry about that". It just seems like not something that is worth bothering the educator about, but so far I haven't got my head around the logistics of vent, lines, water, bed....

I know where I work they wouldn't have.... anything under 25 weeks is considered a miscarriage. I have personally seen them pack up an OR that was set up for a c-section, after they recalculated the dates and found that the woman was 24 weeks + 5 days. Sad but I guess they have to draw the line somewhere.

I love the attempts at pronouncing medical terms. I recently had a relative phone the ICU and ask when her brother was getting his tracheomity. Fortunately it was a phone call because I'm not sure I could have kept a straight face in person. Also have hears some very amusing 'allergies' as a nurse in anaesthetics, always pays to ask what happens when the patient takes it. "I'm allergic to adrenaline because it makes my heart race" "I'm allergic to midazolam because it makes me feel light headed and I can't remember things" I have the upmost respect for my patients (well most of the time) but still find things like this very funny And there is also the constant amusement of female patients and relatives that come on to the young good looking doctors in the ICU. "When will I get my pills, sexy" was the most recent one. And no this patient was not confused!

Hmmm I knew I still lived in the 90s! We still have hand cranked beds in most wards in the hospital (though fortunately not in ICU) I wear tailored pants and shirt in ICU, although scrubs are an option. (Just so happened that the uniform supplier's scrub sizes cater only for Big Betsy or Tiny tina - not for me!) We still have drug keys for the narcotic cupboards, and manually count every time we remove a drug and at the end of every shift. And yes I think my fluoro bike shorts are the coolest things out....And loving that new band New Kids on the Block!

Exactly, the same thing happens where I work, (I am in ICU and have never worked in my hospital before this, my only ward experience was as a new grad for three months in an elective orthopaedic ward, and for the last 3 years worked in OR!!). Fortunately I have not been sent yet but if I am sent and am put into a situation where I feel unsafe, I will be telling everyone about it then and there because at the end of the day I am not prepared to risk my registration because the hospital has staffing issues. I have never been oriented to any of the wards. If worst comes to the worst, I would go off sick. I know that sounds like a terrible attitude but at the end of the day you have to put yourself first because noone else will!

I had a patient last week, really sad case actually, the father had been driving the two teenage daughters and wa sin MVA, he was fine but one daughter was brain dead, other daughter (16yo) was head injured in ICU. I had her post extubation and she was extremely agitated and took a lot of calming down (invluding IV meds), was vocalising but not understandable, and generally very confused all night. I spent my whole shift reassuring her every time she woke up... etc etc, had no idea what was happening in her head or if she understood a word I said. When handover came I said goodbye to her parents who were there and she waved goodbye to me. Brought a huge smile to my face and made the whole night worthwhile!

I totally, agree, when a man can come to me and show me his growing uterus, he can say "we're pregnant". Until then..... sorry mate! We are having a baby is ok.... If your partner broke her leg would you say "We have a broken leg"? "We're trying to get pregnant" is ok though. I'll admit there is just a little bit of two way interaction there! And I love Billary! LOL

Over 300 systolic on an arterial line... got to 300 then just said +++ (obviously the transducer won't read anything above that!). Don't know what it was on manual, we were kinda busy at that point! Tried every drug we have in ICU to bring his BP down, were just about to give him propofol when it dropped to a relatively low 220 systolic! Although not really surprising when you consider that he's been admitted with a cerebral haemorrhage from..... hypertension!!!

I am with you, I have had 2 flu shots in the past 10 years, both times I have had horrible fatigue, muscle aches, and susceptibility to every cold virus. The first time I thought it was just a bad year, but I tried it again last year and it got so bad that they were thinking I may have had chronic fatigue syndrome. This went on for the whole winter. I have never had the flu in my life and I can name times that I have definitely been exposed to it. It is also mandatory where I am (New South Wales, Australia) to have a flu shot, unless medically contraindicated. I have been told that I need to have a letter from a doctor or I must have it. I could quite happily put up with a week of fluish symptoms but not four or five months of being so tired that I physically can't get up in the morning