anne07

We have both continuous and intermittent sedation protocols. The intermittent protocol calls for morphine and Ativan IVP, dosed according to MAAS scoring. The continuous protocol is either fentanyl/versed or morphine/Ativan. Some patients do just fine with the intermittent protocol. But it should really be a clinical decision based on the patient's needs, not just what that doc prefers!

I think it depends on the institution and the unit... I worked in an SICU where we got CV surg, trauma, general surg, etc. All of our hearts came back with swans and we occasionally had a bad trauma or an ARDS or sepsis get swanned. We were pretty comfortable with them. We had the vigileos, but didn't really use them much. I just moved to a new state and am in an SICU, but we don't get CV surg patients. Our open AAA repairs come back swanned, but now much else. We actually just had a whole discussion about the fact that the docs will be swanning more patients because the nurses are becoming less comfortable managing swans and the docs (and nurses) don't know what to do with the data anymore. We use a LOT of Vigileos in my current unit. A couple notes on the vigileos (the device that attaches to the art line)... The accuracy of the readings depend on having a good arterial line waveform. If your waveform is off... so is your data. Also, the last hospital I was at trialed the vigileos, while simultaneously using a swan, in order to compare CO/CI data. We found that the numbers were pretty different. This isn't to say this could be due to "user error", or differences in injection technique, or arterial line waveform quality... But we pretty much stopped using the vigileos and stuck with the swans.

I've used the pagers when I worked at another hospital, and (big suprise) we hated them too. The pagers went off for just about everything, and rarely was there a real problem with the patient. Unfortunately, most people just started ignorning the pagers, silencing them without looking at the page. Not good practice, I know, but when you've got 5 patients in your pager (unless you were charge, then you had the whole floor on your pager) and the thing goes off everytime one of them scratches their chest or something, it gets kind of irritating after a while. We did not have monitor techs there, but we did have a central monitor at the front desk, so someone was usually able to look at the rhythms at all times. The hospital where I work now has monitor techs who monitor the patients' rhythms and post anything abnormal on the chart. Sometimes I think we're too dependent on them though. Guess nothing is perfect...

Hi all, I'm a cardiac nurse, so I have a decent background on what to say and what not to say to patients and their families as they are dealing with difficult diagnoses. However, I am now in somewhat of a different situation. I am dating a man whose mother has cancer and has not responded well to chemo (currently she is taking part in a clinical trial). Prognosis not really known at this time. To make a long story short, the family doesn't seem to be handling the situation all too well (emotionally). Is there any practical advice you can give to me on how to help/what to say? My boyfriend is a constant ball of anger. Nothing I say seems to be right... Adding to the situation is that this is a long-distance relationship. So "just being there" and "helping around the house" aren't always possibilities. Are there any tricks of the trade you've discovered when helping patients or family members deal with a diagnosis? Thanks so much.