focker14

agree with Wtbcrna....enjoy your freedom...Miller is a great book....read when bored and nothing better to do....work some overtime....drink a few....but in all honesty...just enjoy your free time...

Acutally pulling the midiastinal CT would make one be more cautious....pleural CT are not an issue whatsoever!

Hey there...I hate to burst your bubble but there are no Nurse Anesthesia programs that allow non-nurses in, even with your background. As a CRNA, your liscense is through your states Nursing Board. You must first have a nursing liscense prior to becoming an advanced practice nurse such as a CRNA, NP, etc.... There is a profession called Anesthesia Assistant (AA) which is similar to that of a PA and requires similar classes to that of which you have undertaken, however your scope is limited to the OR (i think). I don't know too much about their profession so i will refrain from talking about it. You are right though, there are in-fact accelerated programs to obtain your BSN in usually 16months....I believe you must have a prior 4 year degree though in something. Good luck in your path...

hahaha...get a plastic binder for it? Just remember the most important rule for an ICU nurse.....LEARN FROM YOUR MISTAKES and pray you don't make one that really harms a patient....In my 8 year career as an ICU nurse, I have made many mistakes and as a soon-to-be CRNA i'm sure i will make more. However, it's what you take from them that will allow you to practice safely....few other things to remember......keep em alive to 0645....you have to swell to get well....and when your crazy patient tells you he sees bugs in the room, look around just to make sure..

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.

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!

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!

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!

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...

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 [email protected]

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

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....

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

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

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.

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!

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...

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!

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....

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!

so does hypotension!!

I agree with wtbcrna. Your plan sounds great however VCU is an excellent school that accepts, in all honesty and as cliche as it sounds, the best of the best! I would seriously plan on applying elsewhere to increase your likelihood of getting accepted. If VCU is the only option I would encourage you to make an appointment with their admissions counselor or dean to get a detailed list of what you need to do to get in. I will say that if you do apply and do not get in, inquire about what would make you a better canidate and do EXACTLY what they recommend you do. Then apply again and hopefully they will recognize your efforts and reward you. In the mean time, i would gather as much ICU experience you can as well as take a lot of graduate level courses. CRNA admission committees, i would argue, would rather take someone with great grades and minimal experience over someone with average grades and lots of experience. If you can get both then you would be above the game. Seriously consider applying elsewhere though. But above all else, make sure you do well in your graduate level courses....That is a must. B's really don't cut it, especially when applying to VCU ( I would imagine). Good luck....

Yes a new graduate can become an ICU RN. I went straight into ICU after i graduated with my ADN. I continue to tell people whom pursue nursing as a career to not really worry about "what" school you get into as opposed to what works for you and your family should you have one. Reason being is that all nurses take the same exam. Doesn't matter if you graduate from Harvard, Yale, USC, Miami, a community college, etc...We all had to pass the same exam to obtain liscensure. On that note, I am honestly not knowlegable of any of the schools you were asking about. I will say though that I have not really heard of a nursing program "catering" to one specific area of nursing as their goal is to graduate a nurse who can function independently in a general setting. I would encourage you to find a hospital that offers new graduates ICU internship/externships. That way once you graduate from a program you could seek this opportunity out. Yes, with the current economy and the influx of nurses, landing a job in the ICU directly after graduating will most likely be tough however it can be done given the right place. As far as certifications go, most places will request that you have your ACLS/PALS certifications. Many nurses evenutally obtain what is called the CCRN (critical care registered nurse) however you must have well over (i think) 1500hrs of direct bedside care of an ICU patient before you can sit for this exam. There will be many people-instructors, other nurses, MD's, etc..--who will tell you that you should get a year's experience on the floor first. I strongly disagree with that as it is two different types of nursing. I graduated from an ADN program, went straight to the ICU doing an "ICU residency for RNs", then worked in a Surgical Trauma Neuro ICU for 7 years and now will be graduating from CRNA school in 10 months! The learning curve is steep and quick. But if you want to take care of critically ill patients then there is NO point in having to gain experience elsewhere. It does NOT make you a better nurse. However remember one thing, and i'll say it again....Floor nursing and ICU are two 100% different styles of nursing. You CANNOT HAVE ONE WITHOUT THE OTHER THOUGH!!! A floor nurse will be able to run circles around you with 8 patients and have their charting done before you gave your first patient meds! Whereas an ICU RN will find the gallop in heart sounds or notice the twitch of the patients left pinky (exaggeration but true). Sorry that i do not know more about the schools you wish to apply to however I am passionate about ICU nursing. Don't settle. Move if you have to. Best of luck to you.

Honestly, i really don't believe that the lung builds "collateral" circulation for purposes of getting O2 to the heart especially because there is only two routes really to and from it PA/PV...the lungs proabably can develop some small type of collateral circulation within themeselves such as additional veins/arterioles around aveloi however typically speaking the lungs in response to low oxygenated areas really just "shunt" blood away from low perfused areas...ie....if no oxygenation taking place over yonder why are we expending the energy to get the blood there....your basic V/Q mismatch....the only the other thing you would have to keep in mind is that if there were collateral circulation (hypothetically) it is in place to compensate for the "ongoing" hypoxia.....when you add a PE into this situation I would imagine that even the best collateral circulation wouldn't be able to compensate for such a drastic change in oxygenation....

Might have been that this wasn't a completely "acute" issue. Most likely developed over time and eventually got to the point where he had chest pain from his heart not getting the o2 it needed, got mad and went into RVR. Coronaries dilated with the Nitro supplying "more" o2 calming it down. just a temp fix though....but the PE kept on, most likely causing some muscles, organs, etc...to build up some acidosis due to hypoxia, hence another reason for the low bp and the reason why you gave some boluses too...Lungs usually the LAST to decompensate and thats most likely the reason why sats weren't as bad or RR effort not terrible.....RR rate was in the 20's to blow off the acidosis.....ABG/enzymes/ along with a CXR could've ruled out cardiac issues without even really doing an echo i would think....but given his cardiac hx I could see why one would think MI VS a million other things.....another thing that would've been interesting to see was if you had a CVP....