etymed

Okay, thanks everyone for the great responses! :) I guess I should also specify that this scenario (in my mind) occurs in an ICU (since that's where I work). In our ICU, charge nurses always run the codes and closely monitor patient plan of care (rounding with the doctors, chart auditing, making sure nothing is missed by primary nurse). This ICU is also in a teaching hospital, so that's another reason why charge RNs are tasked with this additional responsibility of making sure everything runs smoothly.

Thanks, but that's not really the angle I'm trying to portray actually. The problem I see is that the charge needs to be objective on patient care. What if their family member codes? Are they going to be objective as the leader of that code (as well as be able to delegate needs for the entire floor) while their family member is dying? Besides an emergency scenario occurring, there is indeed the issue of nepotism. For all of those who don't see a problem, do you also not see a problem with the charge nurse as the primary nurse for their own family member? Charge nurses have to be just as objective and are just as able to influence care of patients in their unit. And yes, I understand that this scenario does take place in small towns where there isn't another charge nurse to take over while a family member is on the floor. This isn't a question of whether it exists, but whether it is best practice.

Just curious on peoples' views of this scenario: A charge nurse has a close family member admitted to their floor where they regularly function as charge. Should that charge nurse have his/her duty as charge suspended while their family member is a patient on that floor? Or, is this acceptable?

Coreg is non-cardioselective, though. Metoprolol, Esmolol, and Atenolol are the main cardioselecive BBs.

Kudos, bro!! Keep it up. :)

When I'm running Levo and Neo, the goal is usually to titrate one of them off first (typically Levo).. so I'd be curious what your institution's PhD/MDs say on this too.

Hi, I've been in the ICU for almost a year now, and I recently came across a concept that I am not clear on. When a ventilated patient's oxygen saturation starts dropping, or if a patient is experiencing respiratory arrest, an important part of our interventions is to immediately disconnect the ETT from the ventilator and connect an AMBU-bag to manually ventilate. I understand that this is to have more control over the pressure and rate so that we can adequately perfuse the lungs. I am simply not sure how that is the best method, though. It seems to me that a mechanical ventilator would be able to have much more control over a pressure through PEEP/vT. I guess what I'm asking is: how is AMBU still the best method vs. a mechanical breathing apparatus that can be 'tweaked' to any specification? I understand that before an RT arrives, it would not be appropriate for nurses to try and mess with the settings, so we simply bag. However, once the RT arrives, I believe that's their first move too. I apologize in advance if I'm a little incorrect about some of this. I'm still trying to completely grasp all of the RT components to the ICU! Hopefully my question makes sense to someone. If an RT sees this, perhaps if you could briefly compare the difference in pressures between AMBU and typical vent. modes that may clear it up. Thank you!

The three points gonzo mentioned above, are SPOT ON! It took me a while after becoming an RN to realize this, but that is really some true advice! Good luck on your decision.

In CV/CICU more so than any other unit, you will be watching a patient's hemodynamics like a hawk and titrating vasopressors to fix any issues during your shift. The other big hitter in my unit is knowing the various types of shock and how they influence hemodynamic parameters. Good luck! Sounds like you've got a lot going for you. Remember to breathe, lol.

Da_Milk is correct in saying that if you go Step-Down or Med-Surg first, you will have amazing time-management skills when you hit the ICU world. However, I will disagree that it is a make or break type of scenario. I think the most critical aspect of your succeeding in the ICU will be based on 1. the hospital's education (read: internship/orientation program), 2. your drive to learn and be successfull, and 3. (last but definitely not least) your co-workers/preceptor's attitudes towards you as you learn. I went straight into a CV/CICU from an ADN program and the medical center's internship prepared me adequately. I'm loving it. Good luck, friend!

I wish I could recall where I found it, but it was an actual case. That's true about IO being painful and only short-term, though. Might as well just put in a central. That would fix everything hah

Same here in my CVCICU. We had 3 out of 25 beds occupied at one point last month. Now we're back up to 90% and higher census.

Wouldn't it be better practice to just drill an EZ-IO in the ankle rather than start an IV on a vein? I've heard of cases of patients having IVs started in their lower extremities and then keeling over in a few days from a DVT.

Full reimbursement if you pass, can use it for career ladder ($$ incentives), and increase of $0.50/hr.

Don't worry, I've been right there with ya. I was helping admit a friend's patient and the alarm kept going off saying it was V-Tach when it wasn't. So everyone kept asking me to silence it. Finally, I silence it for the 10th time, and it was true V-Tach. =\ The physicians were in the room and caught it immediately right as I realized, so we saved the patient. Patient didn't last more than a day after that, though. Sometimes there's not too much we can do, even if we are perfectionists :)