Blandini7

I think that this is an issue that nurses should consider changing. What other profession would permit this?

How much do you get for charge pay at the hospital in which you are employed?

That makes sense but after a period of time, shouldn't the quad work just as well as the single strength?

Thank you for responding. We considered the differences in flow and that the quad will be pushing in the normal at 1/4 the rate if it goes through the same line. This is why we initially augmented the volume by y-ing in a NS bag into the line that contained the quad levo. This allowed the levo to move at the same speed as the normal concentration but without changing the mcg/min. After we eventually stopped the saline bag, the pressure dropped and stayed down until we resumed the normal strength and stopped the quad strength. I was wondering if this is a situation like you see with Adenocard? If Adenocard is not pushed rapidly (and flushed), it will loose most of its potency by the time it reaches the heart.

Have any of you seen a precipitous drop in blood pressure when you switch from a normal (4mg/250ml) concentrate of Levophed to a quad strength (16mg/250ml)? I have a strong huntch that this is a half-life issue and not a volume issue. Please let me know what you think. I even tried Y-ing in saline to a quad strength line to offset the lack of volume. When I stopped the saline, the pressure dropped (even after several minutes it never came back up until I restarted the normal strength bag and stopped the quad).

I'm new to this forum but I really like it. I'm sure we see unique situations in our small circle of practice that are shared around the world by other clinicians. The left ventricular assist device (LVAD) might be the "device" that "rakcna" was thinking about. My pt was too sick for that; a trip to the cath lab was perhaps a missed opportunity at an earlier time.

Definitely wasn't a loose lead or monitor error. Pt had no pulse by palpation, ultrasound, or doppler. The "alternate mechanism for circulation" was chest compressions.

Very interesting! Really wish they would touch on this in BLS/ACLS courses.

That must have been very unsettling.

Our pt did not survive either. This probably should be addressed in BLS courses so that responders aren't quick to cease compressions when the pt becomes responsive.

I saw something this week in a code that is truly unique and a bit disturbing. We were doing CPR on a pt that coded and he started moving his arms purposefully. We stopped chest compressions and he was asystole and without a pulse. The ED doc that was running the code stated that he probably had enough cerebral perfusion during CPR to allow him to be responsive. I have seen this one other time (in my 14 years of critical care) but not as pronounced as in this case. Moral of the story, just because the pt is moving doesn't mean that spontaneous circulation has been restored. See link to abstract for more information: http://www.ncbi.nlm.nih.gov/pubmed/18483881 Has anyone else experienced this?

A couple of qualities that I find essential to doing critical care well are: 1. High attention to details 2. Ask lots of questions (and look for answers). No matter how long you've been a nurse Good luck. It's a great area of nursing.

I've been in critical care for 13 years. I've seen new grads make great ICU RNs if they have good support and ask LOTS of questions and are highly motivated (with attention to detail). I recommend that you start studying for the CCRN. It has lots of pertinent information that will help you. Don't forget...KEEP YOUR ALARMS PARAMETERS SET TIGHT!!!!

I started in the ICCU (intermediate critical care) then moved to SICU for about 7 years. I switched to MICU about 5 years ago. I really like it. You see a lot of different cases than SICU and the patients tend to hang out in the unit longer. Unlike the floors, you can get to know what's going on with the patient and truly make a difference in the outcome. I highly recommend studying for the CCRN as soon as possible; it will really help. Go for it! You won't regret it. Try to switch gears once you get there. Slow down and pay close attention to details; it could save a life. Also, keep your alarm parameters set TIGHT! Especially when titrating drips.