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Trauma, Critical Care
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Bec7074 has 3 years experience and specializes in Trauma, Critical Care.

Bec7074's Latest Activity

  1. Bec7074

    Acidotic Questions

    I'll speak to the second question. Read up on lactate, lactic acidosis, and base deficit. Those are related concepts especially in sepsis or after a cardiac arrest. It has to do with anaerobic metabolism (lack of O2 to tissues when you code). As a result, lactate builds up causing lactic acidosis. Fluids help flush out lactate and may also improve perfusion and cardiac output. Base deficit is a great way to know a patient's fluid status. Hope that helps!
  2. Bec7074

    PEA arrest

    It's hard to say....I think I would wonder the same thing. His SvO2 was 50 the day before...not fantastic so maybe an early indicator that he was going to get worse regardless of whether or not you took him to IR. I'd imagine all his body systems were under stress after the arrest. On a side note, I know what you are getting at. It seems that sometimes we (aka the doctors) get a little too excited and do things that don't make sense and possibly result in patient compromise. A few weeks ago, my unit had a multi-system trauma on the Rotoprone bed. His sats were in the 70-80s even prone. He had only been on the bed for a day. The docs talked to the family and we emergently transferred him (yes prone) to the CVICU for Ecmo. They had to supine him to insert the large catheter for Ecmo and he dropped his sats, coded, and died while they were working on it. When we found out about it, we were shocked. Clearly they knew they were going to have to supine him for the line. What was the rush? We've seen many people suck on the Rotoprone and then make a turn in a few days. He hadn't been on the bed that long and he wasn't getting any worse. How many ppl live with sats in the 80s? It just seemed like a gamble and an unnecessary rush. Thoughts???
  3. Bec7074

    Hypoglycemia Mystery Theater

    I'm kinda perplexed by a few things in this scenario. First, why does someone who got only 1 cardiac stent need Neo???? Was this a cath-lab patient? He sounds super stable given that he's eating and peeing and reading his Kindle....not the kinda patient I would expect to need a pressor especially after such a small procedure in which many ppl are D/C'd the next day. Had he had an MI? We're his troponins elevated or was this a scheduled thing after a positive stress test? Also if he was bradycardic all night i would have thought Neo wasnt the best pressor. Maybe dopamine or levo could have helped. It just seems strange to me. Regarding the sugar, maybe his body was in a higher metabolic state given the recent procedure and ?MI and therefore his body just handled his usual dose of Lantus differently.
  4. Bec7074

    May 2013 Caption Contest: Win $100!

    Nothing says 'Happy Nurses Week' like a few close calls with bodily fluids.
  5. Bec7074

    Advanced practice nurses in trauma?

    I worked in a Level 1 trauma center and we have all NPs at night and one attending in house. The NPs who work with the trauma service are all ACNPs (acute-care nurse practitioners). There are 4 of them at night and more during the day, so yes their degrees are put to use. If you're interested in trauma, go for your ACNP. On the downside, most ACNP programs won't let you in until you've had at least 2 years of ER or ICU experience. Work on that for now
  6. Bec7074

    Blue about Code Blue

    Medical staff and patients, and patients and their loved ones need to have clear ideas of the pt's end of life wishes whether the patient is coding or is just unable to make decisions on their own. I give kudos to all families/patients that know what they want, either way, from the start and aren't afraid to do it. If patients haven't talked about those kinda decisions with anyone before its too late, then that's just tragic. Had a wife once say, "we didn't put our dog with cancer down, I'm not going to do the same to him.". I disagree that making someone a DNR is "putting them down" but at least she knew what he would've wanted."
  7. Bec7074

    Increasing creatinine

    Not that it's a good answer, but did the lasix increase her UO? If so, then it was the right choice for her. I look at your patient Ike this...she was severely hypotension in OR. Kidneys are the most susceptible organ to hypoperfusion. Her kidneys took a hit during that. AND, not only did she have poor perfusion, but her hemoglobin was also probably low after the EBL of 4500 (holy crap) leading to poor oxygen delivery to her kidneys. Now you've hit 2/3 things that lead to organ damage. If she had any oxygenation issues, you'd hit a 3rd. Once damaged, sometimes the kidneys take a few to reflect the damage and no matter what you do, the kidneys need to heal and the only thing you can do is maintain good perfusion, oxygenation, and O2 delivery (hgb), and play the waiting game. Lasix is good for vascular volume overload as you know, which it appears this patient may have developed given the high CVP. I'd assume they would also check her I&Os (she has gotten like 15 blood products and has damaged kidneys so I would assume she'd be positive). So yeah, Lasix doesn't sound like a bad idea although it's not going to do much for the kidneys.
  8. Bec7074

    Pain management

    This almost sounds like a test question on therapeutic communication haha...I can hear my professor saying,"tell me why you feel that way?"
  9. Bec7074

    calcium chloride

    CaCl is also a buffer for acidosis if that's what they think part of the problem was. It's a typical part of the "high K" cocktail that coincides with acidosis. I had a patient so acidosis/hypotensive once that her pressure would bottom out the second the CaCl finished infusing (we use IVPB unless in codes).
  10. Bec7074

    Treating the ABG

    Peep and FiO2 will aid in oxygenation. If you have someone who is desatting or with a pO2 less than 60, you would increase one or both (need an order to increase PEEP). PEEP is great , but it may elicit higher peak pressures (pressures in the airway) and decrease venous return to the heart due to increased thoracic pressures (you may see a drop in their Bp) Tidal volume and RR aid in minute ventilation, or CO2 removal. If you have a CO2 greater than the normal range, you would increase one to increase minute ventilation and thus, CO2 removal. (think about it, the more times you breathe per minute, the more CO2 you will blow off). Of course, you will want to look at your patient and see if they are over breathing the vent at all, otherwise increasing the rate may be pointless if they are already over breathing. Also, high tidal volumes may cause volutrauma, so you can only increase it so high. the exact opposite is true if the patient has a low CO2. You may also want to increase sedation in this case to keep the pt from over breathing and thus, blowing off too much CO2. Sorry I don't have any references other than my brain which recently studied (and passed!) the CCRN. That's the basics for manipulating the vent. When the patient is having metabolic abnormalities, it gets more complicated than I can describe and you have to ask yourself if they are metabolic or respiratory (side note, if you are in doubt in your practice, just call the doc or ask another RN or RT). Overall, it sounds like you got a bad little education there. Refamiliarize yourself with the different forms of acidosis and alkalosis and know the normal ranges and go from there.
  11. Bec7074

    You know you're an ICU nurse when...

    Oh, and a favorite... When you forget your patient isn't intubated/sedated and you pass gas in their room. Not saying I've done this, of course.
  12. Bec7074

    You know you're an ICU nurse when...

    When you can't stand your patient not to look tidy and calm in the bed with all their lines neatly organized. When you get angry that a patient doesn't have a central line. When you see a bad car crash on the news and you think "Well, I guess we're getting an admission." (I work in trauma ICU) When you understand the saying "There are many things worse than death." When you put the code cart next to certain patient's rooms to ward off evil spirits. When you run down the hall yelling "I'll do compressions!"
  13. Bec7074

    What was the longest code you have been in?

    About an hour and a half. STEMI. Pt didn't make it. I would be interested in knowing if any of the above patients survived a 1 hour+ code. There would have to be anoxic injury involved at that point unless you have tons of proficient people doing chest compressions. The eICU docs in our unit usually chime in over the cameras during a code after an hour and make last-resort suggestions or ask if anyone has thought about pronouncing the patient.
  14. Bec7074

    Question about codes

    I used to worry about these situations when I was a new grad, but when they happen, it's almost natural how to react. The important thing is that you get the patient the help they need. Every situation is different and you won't be able to prepare for every situation. It's almost hard to tell you what to do because of the variation. Just trust your gut, don't panic, and call for back-up if you are questioning what to do (whether it be charge or RRT). Once you get a few emergencies under your belt, you will feel better. The first code I saw wasn't mine, but a nurse who is way older. Seeing her in action really helped. I still remember the details: pt in with foot ulcers, was hooked up to a continuous pulse ox. It started alarming. She went in and pulled the button because she found him not breathing and couldn't feel a pulse. Then the team showed up and took over. Moral of the story: I think you will just know how to handle it.
  15. I would think working as an EMT would be enough experience to make you valuable to ER/ICU. Where I work, new grads are more marketable to our ICU if they've worked there as students or did their Preceptorship Clinical in an ICU. ACLS/PALS is great, but I don't think there's any additional certifications that will help. Kudos to you for wanting to make yourself more marketable. If you get hired to ICU, you might work towards your CCRN certification after a year of working. Mentioning that in an interview might certainly be a good thing. In the meantime, you could also read critical care journal articles. I bought a book called Critical Care Nursing Secrets before starting ICU as a PCU nurse. I must admit though, some of it was challenging to understand until I actually got there and got hands-on experience with the stuff they were talking about in the book. Best wishes. :)
  16. Bec7074

    antibiotic administration

    I always choose a central line over peripheral any day. You can run fluids faster and don't have to worry about vesicants. It also gets distributed into circulation faster as the tip of the catheter is in or near the right atrium. So for things like pressors and colloids for unstable patients, of course it has clinical benefits. For antibiotics, I'm not sure seconds matter. Vanc isn't going to save someone's life if it's circulated 1 minute faster.