clarkheart

It's plain insane to use Precedex as an induction drug. Etomidate and versed/fentanyl usually work much better with another paralytic if needed. Precedex can be hit and miss but we use it exclusively to wean and extubate our open hearts. We also use Precedex when we want to change to shorter acting sedation in anticipation of weaning to extubation on our med/surg patients. Have extubated many times while still on Precedex and even continued while patient was either on BIPAP or on simple mask. It doesn't suppress respiratory drive and can seems to be the right combination for patients who are still anxious or going through drug withdraws.

milrinone ntg nipride levophed dopamine dobutamine insulin albumin amiodarone lasix hard to keep it at just 10--off the top of my head these are the meds I use the most

Wouldn't cheat on tests for a number of reasons: The ethical side of me felt that if I wasn't prepared enough for a test and ended up getting substandard results then that was my fault and hopefully next time I can do better. My practical side always said the possible ramifications of getting caught would never justify the cheating. I also could never trust someones work over my own. I know some won't confess to their practical side, but lets be honest, it's true. Not every issue has to come down to morality.

Our hospital has a policy that requires the admitting physician to acknowledge and actually sign off on a list of their home meds that was obtained at admission. The pharmacy follows up on this and flags the physician if there any interactions or questions regarding past home meds and current inpatient meds. When the patient is discharged the discharging physician and nurse have to sign off on a list of those active home meds again. This policy can be a real pain sometimes but it has maintained better consistent care.

Lighten up people--we all knew the gist of what the nurse was saying about choosing becoming a nurse over a doctor. Anyway, for all we know he was misquoted to begin with. For the record, I chose nursing because I no longer wanted to pursue pharmacy school!!

RN's only--I am ultimately responsible for that line-not a tech. Where I work only RN's can get blood samples from art and central lines. This makes sense to me--I have the experience to troubleshoot that line not a tech.

All of our open hearts come back with swans that we attach to a Vigilance monitor for continuous CI and we also have been using the Vigileo attached to the art line. The CI between the two can be dramatically different at times. In that case we usually rely on the Vigilance reading. For the Vigileo to be effective you must have perfect conditions: acceptable art wave form, regular rhythm with no ectopy, (can't use with IABP), and little or no spontaneous respirations! About the only thing we are using the Vigileo for right now is to measure stroke volume variance (SVV) to help assess volume requirements. We can have some real sick hearts so our swans can stay in for 3-4 days if needed. I still believe swans are valuable tools for measuring CI and assessing volume states.

Reno1978-thanks for the tip!

Has anyone found any new study resources reflecting the new CCRN format?

I've worked in critical care for the last six years and exclusively in a CVICU for the last three. Open heart surgery patients can develop multisystem complaints quite quickly re: renal failure, electrolyte and metabolic imbalances, neurological deficits, respiratory concerns, and of course cardiac or hemodynamic concerns. I find these patients to be extremely unpredictable at times which I find very stimulating and satisfying. There is no such thing as a "simple" open heart surgery. As a recovery nurse of these surgeries you have an amazing amount of autonomy and are responsible for initiating standing orders completely on your own discression. Ex: Keep the MAP between 65-80 and you can use a variety of different meds to acheive this. (NTG, Nipride ,beta blockers,etc) Remember that just as I have stated my case for CVICU there are tons of RN's who can tell you of the virtues of Neuro. But I think all us will agree that we are happy in critical care--that is where the challenges are.