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Ahhh yes... The innocent and idealistic fantacy world of the nursing student rears it's pretty head once again! I remember those days!

Dear Noso, Sounds like your son needs an EP study to see whether or not the arrhythmia is reproducible in the lab. The fact that he had these symptoms at an early age would sugges the possibility of a congenital abnormality. There are several congenital tachy-arrhythmias which are curable. What is necessary is an EP study to see if an irritable focus can be identified and whether or not it would be amenable to radio frequency abblation. Good luck! TM

the use of enoxaparin IV is considered to be off-label, and as such, is not covered under the FDA approval of the drug. It should only be used in places where patient is enrolled in a clinical trial to study the efficacy of this route of administration, where there is a specific, IRB approved protocol and with the patient's informed consent. Off label use of any drug outside of a specific research protocol, could put you and the ordering physician at the defendant's table ALONE ! In my practice, I tend to stick with the more conventional, well studied, evidence-based approach to anti-platelet activity and anticoagulation. (GP IIb IIIa inhibition, ASA, SQ enoxaparin, unfractionated heparin,clopidigril, etc.). But that's just me....I'm funny that way! TM

Also, I am an LVAD coordinator for a large transplant program. I'd be happy to answer your Qs if you want to e-mail me. [email protected] tm

Girl, It depends on the stata and status. go to http://www.unos.org This wiil help. tm

In heart transplant, we use a solution containing high potassium and glucose at 0 degrees C. It is called UW as it was developed at the Univ. of Wisconson. Many CT surgeons prefer this as a cardioplegia solution. tm

With regard to the "CNA thing": I have been in practice for 23 (wow, that long???) years. I could not do my job with out the CNAs and techs that I work with. Of the many caveats I follow in my day to day practice, the one that is reinforced most often is the following: If the CNA comes to me and says "I just don't like the way that guy looks"...There is a pretty good chance I'll be transferring "that guy" to the ICU before the end of my shift! Oh.. and Cardio... Dixieland is lucky to have you! Tony

Zenman, If I ever make a concious decision to grow up....I want to be just like you!

Well... It is clear that the above statement was made totally unencumbered by any forethought. It is just absurd.

And to think... You have to take both a written and a practical exam...just to get a driver's license.

Wow!...Ouch! Well.. the frst thing I will say is that once again, my argument is supported! Hospitals that put new grads in critical care areas simply by virtue of the fact that they have a license and a pulse... may not be providing the best solution to staffing problems... Having said that, I will say that I feel for you as a colleague. As an earlier poster said, med errors are rampant. And unfortunately, if the order does not cover the full amount of the drug you signed out, and there is no record of waste, you are technically guilty of diverting controlled substances. Equally unfortunate is the fact that you are assumed to be intentionally deceptive until proven otherwise. The fact that you volunteered for a drug screen is a plus, but it does not prove a lack of criminal intent. If the institution has reported you to the BON, get a lawyer. If they have not reported you and they are going to handle it internally as an education issue, get a lawyer anyway. Prefereably on who is an RN,JD. Finally, no matter what, DO NOT LEAVE your position voluntarily. If you are reassigned, accept the reassignment continue to practice, and accept remediation as it is offered to you. I am sure that right now, you think that this is the worst thing that can possibly happen to you...But you will see, if you are truly innocent (and it's my hunch that you are).. this too shall pass. Tony

Are there any nurses out there who are working in the area of organ transplantation? I have been involved in heart transplant in one way or another for the past 8 years. I have written to alllnurses.com to ask if they would consider adding transplant nursing as a specialty forum. Just wanted to see if there were any others interested. Tony

What the heck is a quid???

"don't take my blood pressure in that arm!!!.. I got di-a-been-is in that arm!" "I ran out of dioxin and latex" "my cousin got the screamin-moanin' Jesus...(spinal meningitis)..and I wanna get checked out" Nurse: "Are you sexually active?" Patient: "Well.. I think I am...but my boyfriend says I just lay there."

I have 2 favorites: 1. The drunk who comes in with cops in handcuffs....who, by some miracle of having come through the doors of the ED, no longer needs police custody...or handcuffs! 2. The self proclamed "VIP" who works in the billing office and comes in with the 16 y/o daughter with a runny nose, and demands to be taken care of immediately.... when the Sh** is in the process of hitting the fan!... Hmm... this is Saturday night...Do you usually wear your hospital ID on your day off?

So...NPs go to NP school...not medical school... and practice advanced nursing.... not medicine. PAs go to PA school ...not medical school...and practice What???? Assisting? When an NP and a PA order a forearm x-ray for a kid who just fell off of his bike, they both do it for the same reason....to see if anything is broken!...And so that the Doc in the main ED doesn't have to leave the bedside of the guy with the acute MI to whom he is giving thrombolytics. We are all very smart people and, some of us, very good writers! In my opinion, some of the energy spent on the "my daddy can beat up your daddy" dissertations should go in to more clearly defining our roles and lobbying for legislation which will, among other things, provide all mid-levels with appropriate compensation and universal acceptance for reimbursement by insurance payors.

Canoe, North... Thanks! Tony

On a busy Sunday afternoon, 17 people in the waiting room. The main ED is swamped, every inch of hall space is used up. 3 people on stretchers outside triage with IVs running and being medicated for abdominal pain. ER doc coming out periodically to examine patients at my behest, and against his will as he thinks we should be on "divert"...and has spent the last 2 hours trying to sell that to the administrator on call... Get the picture? So, just when things could not get anymore out of hand, a 43 y/o guy comes to the desk and says he hit his head 3 days ago and is still "a little dizzy"...(big deal)..."take a seat...be with you in a minute." I watched him walk to his seat...his gait was ataxic...he "plopped" down in the chair. Something made me walk over to him and do a cursory neuro exam. I checked his hand grasps...right stronger than left...i took him to the triage room...looked at his eyes...right eye...ok.....left eye...not ok...divergent with minimally reactive pupil. I put him on a stretcher, pushed him to the ED and put him in front of the ED doc. Asked the clerk to call CT and tell them to expect me in 10 minutes... The CT showed a SDH...The guy was in the OR 25 minutes after he walked through the door...He's in the ICU...his eyes no longer move independently. He will go to rehab at the end of the week...hid daughter graduates from high school this June...he'll be there to see it. After I pushed the guy up to the OR...I went back to triage...on the way...I said a little prayer of thanks... Ok...who's next!

I work in a small community hospital with valet parking for ED patients...VALET FREAKING PARKING! There is a huge emphasis on the Press Gainey scores. Much of the time in satff meetings is dedicated to dicussion of the scores and how we can make them better.... My question is: If I am doing my best to provide competent care to the patients I have in front of me, and, at the end of my shift I can say I have achieved that goal.... Why should I care what the Press Gainey scores are? When I am taking care of 8 patients, 4 of whom are admitted and of the other 4, only 3 of them are breating with any regularity...and the medics are on the way with a 17 year-old, intubated drug OD...and I need to decide which of my telemetry patients I need to put in the hall on a portable monitor (and still have a license tomorrow)... It's a pretty good bet that I don't give a rats a** how long the person with a cold for 6 days is sitting in the lobby, waiting to see a doc...And, if you have any sense of self-preservation, DO NOT be the customer service rep who comes to me and asks how long URI boy has to wait...because you are concerned about some survey!.... Gainey-Shmainey... JUST GET AWAY FROM ME! Ok I feel better now....can you tell this just happened to me last night?

ruby... please tell me this is information you obtained after you married your "ex"..... yikes!

What???? Are you kidding???? Like... was he written up for cheating on her??? Please! :rotfl:

we have an interesting and effective way of dealing with these drug seeking, experienced consumers of healthcare services ( love that phrase!) after we determine they don't have pathology...and treat them with the nsaid dijour, we look at their face sheet and if they (invariably) live more than ten miles away from our ed, we put their address into mapquest, print up a map, and put little red dots on the map to indicate the approximate location of all of the hospitals they passed on the way to our ed.... this, all done with the highest degree of compassion( with a straight face) and, with the hope that their future care is not delayed due to their being unaware of the resources available to them closer to their home.

As a new nurse, what you have to hear is a whole lot more important than what you have to say. Don't talk when you should be listening.

What is a "seasoned" nurse??? Like... one with pepper on her/him?