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focker14

focker14

Anesthesia
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focker14 has 8 years experience and specializes in Anesthesia.

focker14's Latest Activity

  1. focker14

    Did I do enough?

    For starters...don't think you could have done more. Doesn't appear the patient was going to make it from the get go. Also people with anoxic brain injuries can develop cerebral edema enough to cause herniation which could have very well happened...The situation you described fits the symptoms...I know you said this was only your second patient to pass but I can tell you that even after your 100th, you still ask that question, it doesn't get easier.
  2. focker14

    Trendelenburg positioning

    That has been a debate for quite awhile. There are times when it is appropriate and times when it is not. If you need to buy yourself time until you can get a pressor started then by all means I would do it as long as it wasn't contraindicated such as increased ICP's, ARDS, etc...It is beneficial in practice when used appropriately. Doing open heart cases you can immediately seen an increase or decrease in BP and that is why it is used BUT it isn't used for more than a few minutes. I've sat there and argued with residents about NOT placing my patient in t-bird as the hypotension WAS NOT going to be fixed by just position alone! Your not "fixing" the problem just a temporary solution. Remember your body releases endogenous catecholamines in response to hypotension which is a good thing most of the time. Fooling your barorecptors into thinking everything is "ok" usually isn't the best option and regardless, the benefit of t-bird won't last but a few mintues anyways... Also as another poster mentioned T-bird is used A LOT in surgeries not just hernia repair though. Many laparoscopic cases utilize the position to get better views within the abdominal cavity....In robotic lap cases, sometimes our patients are in t-bird for over 6-7 hrs..... jus my 5cents!
  3. focker14

    Is this common practice?

    Most places do not practice like that espeically in a SICU....If you need some backup there are numerous articles about post-op pain and length of stay in ICU on both intubated and non-intubated patients....I'd much rather have the pain meds vs the sedation...Wow..however it seems as if that is the norm for you place and most likley won't get changed soon....I am a SRNA and have been to over 10 different clinical sites and can tell you that every one of them allowed more than adequate pain meds for their intubated patients, not just surgical....Sorry you even have to deal with that!
  4. focker14

    How would you handle this..?

    That's wrong. However, what were the patient's vitals like? If they were stable and he/she was intubated why not load up on narcs and sedation, especially if he/she was writhing in pain. Knock me out please! Understand the frustration as I know how long all that can take as well as the ignorance of the attending not understanding what just entailed. Unfortunately, not much you can do other than let the MD know what they just put the patient through. Also did he/she know that a bath was just given? Maybe the MRI might have been able to put off till later.....just my 5 cents... But again that must have been painful on both of you!
  5. focker14

    Raleigh School

    also, they hire new grads into ICU's here in Raleigh. there is 6 area hospitals...my wife works in a MSCIU at one of them and precepts new grads all the time...
  6. focker14

    Raleigh School

    Hey Chris, Well for starters, most programs look at grades and GRE scores. It appears as if your wife would have no problem on that end. RSNA, I would say looks at those more highly than someone with years of ICU experience. As far as age, Im 35 and graduating in August. There are about 4 or 5 classmates that are older than I. It's a good mix. As far as ICU experience as long as she gets the basics down she'll be fine anywhere she goes. ICU is ICU. There are some students in my class who never worked with SWANZ catheters (bascially a catheter inserted into the heart for monitoring) however they are doing just fine in clinical and in class. Level 2 is just fine as long as she gets to know the basics. HAHA....one thing that will be funny is to see how she feels about spinals/and epidurals.....I have a great UC-CH that swears he would NEVER NEVER let a drug enter his spinal column..she is entering a realm that more or less (at least I think, correct me if I'm wrong) goes against her training as a CH... At any rate if you have any other questions, please feel free to ask me. my email is focker0014@gmail.com
  7. focker14

    How old were you when you started CRNA school?

    34 when I started and will be 36 when I graduate....most in my class are 27-30...have some outliers both ways though...ie 23yr old and a couple of 40+
  8. focker14

    Rash of A-line dislodgements

    From an anesthesia point of view, No, most MDA/CRNA will not suture in the Aline as we only need it for the duration of the case. In addition, our patients are anesthetized so we do not have to worry about them moving around enough to dislodge it. We do tegaderm and tape the hell out it though..As a unit nurse I always wondered why they didn't suture them in, now being on the other side I see why...We do use 20g IV Caths at times however they typically are the type with a longer catheter. To my knowledge I don't know of any problem with those being placed as opposed to your common "radial" Aline Caths....
  9. focker14

    Raleigh School

    Chris, I heard that RSNA is going to $10,000 per year. That doesn't include UNCG fees, however I don't believe that it is close to $42 G. Thinking its about $9000-11,000 for UNCG for both years so that would put the cost around $29-31,000 total for two years.. The thing is though that you can take out student loans for the UNCG tuition/fees however that does not cover the $10,000 per year owed to RSNA. It is like a buisness school if you will. Goverment loans will not cover that cost as it goes to a "for-profit" organization. What some of my classmates do though is utilize the "refund" you get from your UNCG loans to help cover the amount owed to RSNA. Again, even the refund won't cover all the amount owed however it seems like you get around $4-5000 back each year. Hope this helps
  10. focker14

    Am I on the right track if I want to eventually work in SICU?

    Not a problem...Hint of advice though. In all honesty, ICU patients are NOT all on the brink of death, many of them are there to PREVENT bad things from happening to them. I might even say that "most" of them do just fine and eventually get transferred out, and I come from a Level 1 trauma center that has 5 ICU's. As a new nurse, yes, you will be overwhelmed but over time that will subside and as a new ICU nurse you will be overwhelmed and that too will subside over time. Great that you already have ACLS. Your med/surg experience will be great. There were many times that i had not been exposed to something in the ICU that the floor nurses dealt with on a daily basis. Ask an ICU nurse the last time they had to discharge a patient=clueless!! :) Good luck
  11. focker14

    Am I on the right track if I want to eventually work in SICU?

    Honestly don't wait a couple of years, I would suggest get a year on the floor you are at then start applying as soon as you can. I also would not recommend attempting to get into a smaller ICU first, I would attempt to get right into the SICU. Reason being is that you really don't want to have to go through 2 different orientations ie....you might not use as much equipment in the small ICU or utilize many gtts, swans, etc...whereas if you started out in the SICU then you would get exposed to a lot of equipment the first time around. The other reason, which I might get chastized for, is you don't want to pick up bad habits along the way in which your ICU preceptor will have to address. I've seen it too many times. That is why some new nurses get the ICU job over experienced nurses. They sometimes are easier to train. Again, go for what you want. They isn't any reason not too. I started out in the ICU right after school and worked for 7 years in a Surgical Trauma Neuro as did my wife. You will hear a lot of nurses say that you should get 1-2 years experience on the floor prior to going to the ICU----honestly that's a bunch of BS...Being a floor nurse doesn't make you a better ICU nurse just as being a ICU nurse doesn't make you a better floor nurse. Two different styles of nursing and each cannot survive without the other. Good luck with your decision. ICU nursing is great and rewarding. Large learning curve at first but once you get the basics down you'll be ok to take any patient. I'd suggest getting your ACLS/PALS/TNCC prior to applying. It would allow your application to be stronger.
  12. focker14

    CCRN needed for SRNA?

    The thing you have to remember is that usually everyone else has a good GPA and GRE scores if they are applying. The CCRN can set you apart from them. Although many schools are now requiring it to even apply. Does it make you a better applicant? It won't hurt! I'd suggest just taking the test. It isn't extremely hard if you study for it. Good luck in your process!
  13. focker14

    Critical Care Tips

    Know these key points! Got to swell to get well. If your patient has no holes you create them, if they have holes you plug em... Steriods don't cure anything but they help everything. Propofol is the best glass of milk ANY patient can have. All bleeding eventually stops!! If in a code, do compressions....you can watch EVERYTHING ELSE.... Don't leave work for the next nurse to do (if it can be avoided) consciousness is overrated, unless your a neuro patient dont' ever get "comfortable"..... Keep em alive till 0645. hahah....lil humor....on that note, a lot of patients that come to the ICU are in some form of shock. I would know how each type is traditionally treated. Also just have a basic understanding of vasopressors. And you could always throw in a little bit about different ventilation modes. This should do you well in your rotation. Good luck...
  14. focker14

    Considering an ADN over a BSN but already have a bachelors

    You got me good itsnowornever.....however just for my own sanity and the fact that I only look a pictures in big books only because I don't need to read anymore....please tell me where I stated that I believe ADN's were prepared better in my original post....if you can find it, then I would argue you are not as illiterate as I thought.... don't do personal attacks on this forum...thats what FB is for!
  15. focker14

    Considering an ADN over a BSN but already have a bachelors

    Wow...didn't take long! :) Was going to right a rebuttal however by the number of responses, I'm sure you are smart enough to make a decision. Again bro, do what is best for your situation .....Good Luck....Keep in mind the accelrated and traditional BSN programs may present as a bit more difficult to work while going through. Sure there are people who have done it and have done fine. Just and FYI....
  16. focker14

    Considering an ADN over a BSN but already have a bachelors

    Hey man, you will hear a lot of varying ways to go about this. In all honesty, you really need to pursue the avenue that best suits your family, which usually is the cheapest route in my book. I graduated with a BA in psych, and then went back to school to get my ADN from a CC. Had no issue with getting hired, nor was there any stigma associated with my ADN vs BSN. In fact, many of the managers I knew "preferred" the ADN vs the BSN prepared RN's because they seemed better prepared clinically to take patients from the get-go. Usally this is the result of the BSN students having to devote time to non-clinical subjects such as Theory, Law/policy, etc...I then obtained my BSN via online at the University of NC at Chapel Hill. It took one year to get it and I was able to work full-time. It is extremely nice to have income coming in when your in school! I now am in CRNA school and will graduate with my MSN in 10 months. Did my BSN help me out with my job? NO. Did my BSN increase my pay? NO. Did my BSN change the way I practiced? NO. Will I most likely will get shunned by someone on allnurses. for saying that---yes....however it is the truth. A BSN most likely will get you into management positions quicker as opposed to an ADN. Although you already have 4 year degree, it unfortunately doesn't mean S*%T in the nursing world. Sad but true!! :) Unless you took a lot of pre req's already I would bet you are going to have to take some chemistries, math, biology, etc just to get into a program. Again, do this the cheapest way. Find a community college that you can take these classes at and many of them can be taken online...ie...easy to continue if you MOVE..... You said your end goal was to become a NP. Once you become a RN, there are numerous RN to MSN programs and even more BSN-MSN programs. Cannot stress it enough----find what will suit your needs accordingly. If your wife is still Active Duty, then online programs may be the best route for you. Hope this helps....i'd be glad to talk more if ya want to. Also, THANK YOU----to you and your wife for serving our country! i was a USAF brat.. (dad was a full-bird). I know what you go through!