danmarin_99

Bravo fellow central Floridian... I work in a CCU in central FL and it's exactly as you describe. I was a brand new graduate and was hired on immediately out of school. All I want to do now is get away from bedside ASAP for the challenges I hear about at larger hospitals... Not because of the nature of the CCU, but because I feel like I am missing out on some huge experiences I could find at larger hospitals... I echo the previous posters suggestions to OP.

This is why I love coming here for info... All of these different perspectives are a great resource! I've never even heard of a rubbing alcohol bath! In my unit, we have pretty strict parameters for everything so we're rarely left trying to figure this sort of thing out. Anything over 101 gets Tylenol where I'm at. This seems like a good place to start a policy/procedure discussion with your unit manager if there's nothing on the books already so if a similar case appears in the future, there won't be any question about it maybe.

I don't know... As a new grad in my ccu, I'd be having the same reaction although, I would look for an alternative in this case such as a hyperthermia blanket. If the doc wants no pharmacological Tx, there must be a darn good reason with a fever at that level. I understand that they not want to mask it, but it's getting dangerous at that point.

Excellent! Thank you so much for this information. As I suspected, it is indeed drug induced.

First a little information about the patient: the patient is currently intubated receiving both propofol and Ativan. Among other medications; Dilantin and morphine. This patient is also a recreational drug user at home of both cocaine and Xanax. My question is: in assessing their neurological status, I was checking the response to light and the patient's pupils contract AND relax rhythmically several times until the light is taken away. They do not fix at a particular mm. I figure it is a response to the drugs and I received in report that this is a known thing, but I am curious if anyone else has seen this.

Under the circumstances, there may have been a need to keep the sedation down and use minimal pain medication due to renal failure secondary to the burn depending on how substantial it was. After fluid resusitation, I would be concerned with just how much output the patient had and what their chemistry looked like. I've never had a burn patient in my CCU, but from what I remember from nursing school and others' stories, they are very tricky to manage. Many of them are in constant pain from scrubbing the eschar off, to moving them so further skin breakdown doesn't occur. This patient sounds like they would be much more complicated than the initial picture anyhow with being on a vent and the fractures too. The patient's pain would certainly be one of the first things I would address, followed by the need for an MRI after the fractures seem to have been already identified by some other means. As for your facilities particular policies regarding the need for new tubing, a bath, and new leads prior to transport to your DI dept., I would think the second bath would be unneccessary as would the new leads. I could see the need for different tubing if they had different pumps in that department though... This would be a fascinating patient to have indeed. I pray they make a full recovery soon.

As a new grad going into the CCU, my opinion may not be worth much, but I've found so far that knowing your medications is a huge factor in being successful. Staying on top of education that your facility may offer or even independently studying certain recurring topics in your unit may help as well. Best of luck to you!