prep8611

If pentobarbital isn't working to suppress burst activity then your probably not gonna stop the brain activity

Honestly doctor should have scanned him when he became lethargic. Vomiting and positive troponins from catecholamine release are easy indicators of hemorrhagic bleed but were more likely to be the AMI. Dont beat yourself up, you did nothing wrong. Life happens sometimes and you didnt make a mistake or anything.

The first one actually looks like it trying to be atrial bigeminy.

The first one is sinus arrhythmia and the second is a run of supraventricular tachycardia. It's not PACs because the underlying rhythm is irregular, with PACs u have extra p wave with a qrs following but the underlying rhythm must be regular.

I always wanted icu but started in med surg then went to stepdown then icu which is where im at now. I learned a lot in med surg and its invaluable from a time management perspective.

Ok I guess i took it the wrong way so I apologize but I'm going to argue with you again haha. Nursing skills in an ICU or any floor can be taught but you can't teach work ethic and personality. When they are hiring you they are hiring a personality and not your knowledge base and I see why that upsets people. However, I think nurses can be trained to be competent over time but someone's work ethic or personality can not be changed. When they ask these questions they are only trying to figure who you are... I dont think they truly cared about the answer you gave in reference to the WOW question just that you could acknowledge a time when you went out of the way for a patient which I'm sure was often. As we start our careers we know nothing and as we move onto different positions we are constantly learning something different so we are always hired by how we come off during an interview. And just to put this wayyyyy out there..... Would you want the smartest nurse in the entire world taking care of you if she doesn't answer your call light when you have to go to the bathroom? This is why hospitals ask these questions and dont hire off testing or any other measurable attribute.

I think you feel as though I'm directing comments towards you or the many great nurses in the field (many that I work with). I'm not, at all. I am just disgusted by the complaining that the OP made in his/her snarky post and everyone else who followed suit and complained. I work with many great nurses, some who are much better than me. I like you was offering my two cents and opinion into this long discussion. I was merely stating that i feel it is a growing thought amongst nurses that patient satisfaction is not as important as competent care. My suggestion would to be that you don't take what strangers say to heart and that the original poster probably has done something for a patient that wowed them and to recognize that the next time they go into an interview. It'll probably be more satisfying then smashing sour grapes and complaining on here about it afterwards.

Well I've worked in a lot of hospitals and a lot of floors and the only thing they have in common is that they're are lazy nurses that provide "ok" care but do nothing extra as well as many nurses who provide ok care and really go out of there way to make the patient feel special.Your not going to make every patient or family member happy but you can try. I dont bend over backwards for patients but i do go out of my way for things they need. I work in icu where there are clicks, beeps, and monitors going of all night yet i remember that there is still a patient and there family beneath it all so if i can take a shorter break and take the time to wash my patient or explain something I will. Every single time. All in all I think the problem lies in those complaining about the patients an not the other way around, i wouldn't have hired the OP either.

This is exactly what I'm talking about.... Good job.

I think wowing someone can be as simple as going to another floor to get the flavor of pudding someone likes or really taking time for education, if you can't see yourself doing that then your probably in the wrong field. I work in a busy icu and I find I do something every night that "wows" a patient although its just a simple task. I've had many job interviews and I get asked this every single time and a simple answer will usually suffice. You guys are making a mountain out of a mole hill and it must be a big joke.... 90 percent of American jobs are service based so don't you think customer service will remain important in our field. I suggest you get with the times or else you'll keep getting looked over for more qualified applicants.

Coding someone who is above 80 or cancer filled is a terrible experience for me but it happens once a month. What people also fail to think about is how the person will be if we do get them back... How long were they down? Were they receiving adequate CPR? Will this patient be trached and pegged a month from now? If the patient survives and leaves their mortality rate for the next year increases 60 percent, will they be back? I will personally be dnr when i hit 70 bc its all downhill from there if i code but people need to be more educated.

My guess is the nurse gave 1mg IV which is standard packaging for a code.

Your colleague is gonna feel worse when he/she gets brought to court.

My beef is that we did that before. We did a full neuro exam at shift change and introduced ourselves. Now we do a full report and go over orders ect and it all feels like its for customer satisfaction which is great but its killing our actual work flow. The physicians don't even assess the patients!!!!

Bump^

My hospital has just switched to bedside reporting in the icu which everyone besides ER and us has been doing. What I'm finding is that report takes 5 times as long as families ask questions and argue about past medical history and such. I have no problem answering questions but it seems like such a poor timing (ie i could do it during meds) and an invasion of privacy when a patient is sedated/vented. Anyone else's icu do this and are there ways to streamline it?

Ya usually they wait till after background check for that. You sound good but go in confident and humble.

This guy is very intelligent. What he said ^

From my experience temple pays the best while hahnemann is the worst.

That's what I was saying before, the d diner may be ordered but we rarely use it. D dimer will also be very elevated in CA patients who tend to have medical icu admissions.

I would say by their presentation yes they absolutely should have been scanned. The NP and other nurse mentioning vq scan both made solid points. Pt is post op with shortness of breath and tachycardia..... Could be PE, atelectasis, pna, sepsis Remember that assessment is always used before lab readings and the scan is just allowing you to a picture of whats going on.

From my experience d-dimers rarely mean anything anymore. My hospital barely does them, if we suspect PE the patient gets scanned. Sounds like ur docs need to implement better dvt prophylaxis

Glad I don't work with you although I'm married and faithful. You just sound like a pain in the you know what. Not a fact, just my opinion. Go to work, take care of your patients, go home.

Neurosx will usually try to coil asap and get a venticulostomy if pt is gonna have hydrocephalus(likely). I work neuroscience icu now and are treatments are rapid if the patients gcs is dropping but if a patient with a small sah comes in scaled at 15 they won't go in till the am( I work nights). All sah pts get put on nimotop for spasm as it is standard of care.