labman

If you don't want to work ICU you getting your CCRN wouldn't be too useful. In your thread you seemed more interested in ER so go for your CEN or TNCC. CCRN doesn't have much content, but more information on cardiovascular (shocks), and pulmonary concepts. Good luck

Thanks guys and gals for the answers. The funny thing is when they did this thransfer they only had 3 other paitnets downstairs. I am just sick of the MD comming up to the unit asking why the patient is in the ICU when they didn't see them in the ER and the ER just sent them upstairs. We will see what the manager says. I am sick of staffing being adjusted and people getting called in wasting the hospital money when this doesn't happen and also not able to treat the patient (because the only ER order is an x-ray). I can do much with atleast is gander at that x-ray from the ER. And whoever wrote the enema every hour thanks. That made me laugh...

So I work in a medical ICU and there has been an ongoing issue where Emergency room will send up patients to our unit without their physician seeing the patient and them writing orders. So many times we will get a patient transfered up to the unit without orders... Many of times we will change staffing because of this and when the physician comes to see the patient they question why the patient is in the ICU (along with us). Can ER do this?? They are notorious of doing this on shift change or when the patient is particularly overbearing or a lot of physical work... What would you feel about a patient comming to your unit without orders. Without them even knowing the code status. Does anyone else have this issue and if you do what have you done about it because it is getting pretty obnoxious...

:up:My fiance did have my back. He totally understood and said hey I can understand your frusteration but I couldn't have done anything. Thanks for the input I felt bad and just wanted to put this through to other nurses to get your opinion. Thanks so much everyone you eased my mind

Thanks very much. If **** would have hit the fan I would have been there but she was stable. Was tachycardic and hypotensive (but as a nurse what could I have done). Thank so much

So I went to a going away party for one of my finaces best friends (she was going to India) her parents were there and alochol was involved (probibly a glass of wine and social anxiety). Well it happened she passed out (I had my back turned but she didn't look like she had distress (people asked her where she was and to move everything and didn't look to have any stroke symptoms and people were crowding her. She also appeard very stable (a clear airway and just a little pale) So they called paramedics and they came really quickly So I thought she had some social anxiety and let her be because the poor lady was embarassed so much and had her family next to her. The situation is she called my fiance and told me she was upset that I didn't intervine since I am neuro ICU / trauma nurse that has a years experence. What do you guys think? I thought the situation was handled and I wouldn't/ couldn't have done anything except take her pulse and talk to her. Give her some water possibly breathe into a paper bag What do you guys think??? Was I wrong for watching her from the distance?? Or should I have stepped in can you tell me why you feel the way you do?

Hey congrats on passing NCLEX Advice I have for you is not to be too suprized about what any head injury says (the craziest things). What vasospasm is for cerebral aneurisms rupturing. How to diffuse difficult situations... Take care good luck

here are two sites that I found helpful one is http://www.neuroland.com/- I would go under index and see what you can find Also too http://www.waiting.com/ (good site helped me deal with families) Also too I think under the top two forums there is a lot of websites dedicated to neruo http://www.icufaqs.org/ (A good general ICU site I loved it) Good luck with your internship and hope these help

I would imagine a paperclip would be good. It looks neat and easy to unclip all the papers. This is my assumption and how I think it would look best. And good luck with the interview. Take a deep breath before and be yourself. kent

I will say I know your feeling of getting placed somewhere you don't want to be for your senior internship. When I was a senior we had a lottery and I wanted ICU sooooo bad, but we had a lottery system and I picked the last number. I got stuck in rehab. I really wanted to be a cardiovascular ICU nurse and this experence made my change my mind and I chose Neuro ICU and love it. So keep your mind open. Some things that are good to learn is ventilator associated pneumonia, sepsis, septic shock, acute respiratory distress syndrome and CHF. Those are a couple of diagnosis I can think of kent

Well I am glad you love neuro as a pre nursing student!!! I picked neuro because it is the system I knew least about (I am truthful), I felt you never have two patients with the same type of stroke that are similar and it is developing field. The part with neuro is families (it is scary knowing that an injury could change the persons personality and there is a possibility of them never being the same) and when you can't reason with patients due to their injuries. I would recommend doin gsome CNA work in neuro or a rehab and see what it is like as a CNA. There is a book called stroke of insight and it explained a neuro antatomist with an AVM hemmorhage in the left side and explains her recovery. It is fasinating and a very easy read Good luck any more questions feel free to post or PM me kent

Anyone think of ICU psychosis, or UTI or constipation. I never know these situations unless I look at the patient myself. If he was on propofol I am guessing he was tubed and how do you know he is more confused??

Ya I remember calling the doctors about an issue. They would immediately go to so is the neuro status ok. I also forgot to say neuro exam is probibly the most subjective compared to hemodynamics which is totally objective I guess I agree with pts eating. we have spurts where everyone is eating then no one is... Well good luck

I think I am preaching to the choir about this one. I feel a new grad starting in the ICU- It depends on the person and situation. I had a 6 month oreantation which around 4 months I felt comfortable. We also had classes and preceptors who were great. With everyone I went through oreantation with you can tell others get a lot easier assignments and us who get tougher ones.

I do work in a level one trauma center in there neuro ICU. IABP- We never have to do any of that and that would be scary. Hemodynamic wise we do not have too many people with swans. My year and a half in neuro we have only had 2 people I know of with swans. The main hemodynamic montior we carry is ICP monitor (ventric) or a licox. Usually an ruptured cerebral aneurisms we do triple HHH therapy which requires CVP (but our unit rarely uses pressors) When the brain herniates that is a hemodynamic game because they have no sympathetic tone and are ususally on 4-5 pressors. I say if you want cardiac do cardiac go for another hospital or maybe a medical ICU because there is not too many hemodynamics involved with neuro. Don't want to be a troll but just my 2 cents.

I was thinking of the paralyzed pt sending him a text page saying pt slid out of chair because they are paralyzed:lol2: or something smart like that. The other one sending a text page to see if he could assist us with line management and lifting this guy into a chair.

Would you feel comfortable with this situation. In the teaching hospital I work at there is a resident who insists that his patients get up in a cardiac chair (we have chair mode in the beds which can halt a person in a chair position) -# 1 situation- Person post op day 2 from a basilar tip aneurism who is on a Nimbex/ cis. coma on PRVC with a ventric Otherwise regular IV fluids running no pressors no cooling issues. Bad idea because I feel she would just slide out especially with no muscle tone. - #2 situation This patient had an aneurism rupture. Went for 5 days in a row with verapamil treatments, Keep SBP 160-180 on levophed to maintain the BP. Thiopental turned off two days ago and he still has thio in his system and stiff like a board. Pt has an uncontrolled high temp which he has a coolguard in place, scheduled tylenol, scheduled demerol to prevent shivering, and is sanwiched in cooling blanket (temp is still 38.0), has a ventric, has small bore feeding tube and is mechanically vented. I personally think there would be a line that would be pulled and it isn't a good idea. -So what do you think of this situation?? Would you do it because I flat out refused.. Not out of laziness but because of patient saftey.

Thank you very much. I did mean the University of Minnesota when I said University of Minneapolis (opps)

I have one question and it is probibly repetitive, but I went on the website for St. Marys University, University of Minneapolis and Minneapolis school of anesthesia and was wondering if the GRE was required. When I looked under the admissions section they wanted references, transcripts, work experience and a letter saying why I would want to go into anesthesia. I only saw University of Minneapolis mentioned briefly about taking the GRE. Does anyone who applied let me know because I thought it would be required for all graduate schools and want to know if I need to start hittting the books :typing. Thanks kent

hey all! i'm trying to get my unit to step up tbi management. we need to take advantage of advances, but the mds won't make a move without evidence based practice. if i can figure out what the gold standard of treatment is, i can find the research to back it up to present to them. wow lots of question *please tell me about your standards of tbi management. if you have any article/research links, i'd love to have them. currently, we do ventric/codman wire/licox, but we don't do early decompression. we wait until they have icp problems to paralyze or barb them. we use neo to maintain cpps and vaso to treat di. *what is your first line pressor? phenylephrine is usually the first pressor we use. have you used a hemedex monitor? never used or heard of hemex monitor do you use continuous eeg monitoring? do you do spot eegs? the only time we use eeg is when someone is on a thiopental coma (to tirate for burst suppresions and when seizure is suspected) do you monitor icp wire vs a ventric and what is your gold standard for icp monitoring? our unit rarely uses a codman and almost 95% of the montiors are ventrics. do you follow tcds (trans-cranial dopplers)? at times we use tcds with big sah worried about vasospasms when do you do a decompressive crani? usually decompressive crani happens pretty quick. unless near the brain stem at what pbo2 do you make vent adjustments? we usually don't use pbo2 there is a study being done do you paralyze or barb them in prep for the swelling period? paralyzing occurs when icps are high or if they anticipate there will be a lot of swelling. usually with any brain injury we use 3% to help brain swelling where do you keep your patient's hct level? only time hct lvls are important is if they are doing hhh therapy for bad sah in vasospasm what drug(s) do you use for seizure prevention? if you use phenytoin or fosphenytoin do you monitor free dilantin levels? our unit currently uses keppra (levitricitam) to treat seizures. great because there is no toxic level, but not great in monotherapy. how cool do you keep your patients? what cooling system do you use? do you have a shiver protocol? patient are usually kept 37.1. currently the first line of shivering is demerol (other then that it is unclear on what they want to do for shivering) what other drugs do you use on your patients (benzos vs pain meds vs amnesics, etc.)? we usually are stingy on pain meds (usually morphine 2mg q 2 hours and oxycodone q 4). what is your max on propofol and do you use it in light of propofol syndrome findings? usually the highest i go no propofol is 50mcg/kg/min. if it is that high and the patient is almost scrambling out of bed, if they have pain or other they went to the bathroom peopel get super strengh when they are uncomfortable! do you have a protocol for treating fevers? -our unit if fevers are problems there is an order for 650mg tylenol and we use cooling blankets. if fever does not respond we use a coolguard system (which is a centeral line that cools iv fluids) and paralyze the patient with cis. do you treat central fevers (fever not induced by infection, multiple cultures clear)? what drugs do you use for that? we treat centeral fevers. ususally same mannor as above. how long before you respond to elevated icps? - we wait for the icp to hit 20. for 5 consecuative minutes. then we will page doctor and there is immediate action. hope some of this helps. currently i am going to head to work in 15 mins so i can only tell you this is how we do everything

The only unit where you put restraints on for patients that touch their rear then scratch their incision.

My understanding of septic shock. Septic- HUGE bacterial infection all over the body Shock- There is not enough nutrients/ oxygen for the bodys needs. So if there isn't enough oxygen/ blood flow to the tissues the body starts to use anerobic processes to create energy and dumping the lactic acid into the blood stream. So I think the doc was talking about the patient being in shock more then septic. Hope this helps kent

I like the working overtime. I wouldn't sign anything though because you would be there 24/7

Wow sounds like the little gals brain herniated. I am sorry to hear that this situation is happening to you and even worse having her family not accept her death. I say we have many specialities in the health care field and we should use them... -Ethics committee. This will meet and clear up familys expectations. - Nurse manager- Mine is really invovlved and will talk to upset families. She is so great. - Pastoral care I am sorry you are dealing with this and as I say try to use second opinions. Also sometimes how physician talks to the family can ease the decison on whether the family withdrawls. I remember a family once told a physician that I know nothing my mom wouldn't want to live like that but I can't make the decision. The physician said to the family knowing you want these wishes I will make the decision to discontinue support. It was great hearing the physician talk to the family like this because he is usually really mean. I wish you good luck. I would talk to your preceptor about this situation because she may be able to guide you in ways to make you feel better and he or she may have a similar experence Good luck Kent PS. We had a patient on our floor with a huge SAH and herniated. We waited 4 days for the family to come to peace and make their decision.

Hey everyone I work in a busy neuro ICU and was wondering if thee was a room where you get particularly bad admissions. So far in this one particular room I had to admit a guy with a Subarachnoid hemmorhage who stroked his brain stem (35 y/o), a 17 y/o who rolled an ATV who donated organs and a young guy 40 y/o who came in for a transphenoidal who had a basilar tip aneurism within the mass ruptured during surgery and the patients brain herniated. Do any of you guys have room where you cringe when you have it open...