GE90

administering urokinase into chest drain or putting catheters in

Recently moved to a new facility to look after kiddos with tracheostomy on long-term ventilation. I'm quite amazed to see that most of the nurses here would suction the child every 2hours even when there's absolutely no increased WOB, nil decreased AE, nil changes in TV/vital signs or Sats. They'd also do chest percussion literally at least 2-3 times a shift even when there's absolutely no indications for it and said frequent chest physio helps reduced VAP? (But to be fair I did witness this one time where the child had extremely minimal secretions overnight and at the end of the shift the nurse did one chest percussion and got large amount of thick secretions). Coming from PICU I always thought that chest percussion should not be something you do simply because you could as there are risks associated with it. I'm just wondering whether there's any evidence behind frequent suctioning and chest percussion when there's no or minimal indications for it? Or if this is common practice for patients needing prolonged mechanical ventilation?

Been browsing on reddit and was quite surprised to find out that apparently in the US, nurses need a doctor to put in an "order" for literally everything they do, from taking vital signs to checking BSL, from requesting diets to measuring UO, from changing a wound dressing to giving medications, from weaning ventilation to titrating inotropes, from adjusting sedation to turning a patient. I'm hoping if someone can tell me whether this is true and if so, does this system actually help improve patient safety?

Thx so much! :) Think I'll definitely try to get some experience in long-term ventilation then :)

I see, well that's encouraging! I feel more comfortable taking up this new advantage then! :)

Such as looking after someone with severe infection, difficult to ventilate, electrolyte imbalance, managing an EVD, chest drains, neuroprotection, icp monitor, invasive hemo monitor, inotropes, major post-op...

thats awesome! I'm actually planning on doing a MPH as well! (plus tropical medicine), may i ask how much peds icu experience has she had?

thx for the insight, need to rethink whether the unit's worth joining..

Doctors without Borders. They require applicants with a minimum of 3 years experience working a any of the following specialities (eg. peds/icu/er/or/surigcal/infectious disease/tropical/neonatal and so on..) The unit is actually in another country which makes shadowing a bit tricky...from what the recruitment agency told me the unit is like a picu with a particularly focus on ventilation What i'm worried about is that I'll be only looking after children with a trache and end up losing all the skills acquired from working in PICU..

Medicines sans Frontiers, or Doctors without Borders

Recently received an offer to work at the long-term ventilation unit, the pay is amazing with lots of benefits but I'm a bit worried that work experience on such unit isn't really gonna help with my application for MSF (hopefully in 2 years)... Does anyone have any insights or suggestions? A little background : peds nurse with 3 years under my belf, half in general peds and half in PICU (where I'm working for at the moment)

I've been working in Peds for 2 years and 7months ago I moved to work in the PICU. Last night the patient of another nurse, a 11yr kid who came in with MVA and severe TBI 2weeks ago who was I+V and on filter and had his bp dropped continuously to the point where we could no longer feel a pulse so we started APLS for 40mins and eventually lost him. I felt bad the moment the doc called it and when the mum started crying and moaning so loud that the whole unit could hear it. I was also sad that this child passed away but moment later after the debrief I returned to my patient and there was like nothing had happened, I tried to feel really sad but just couldnt.....now I'm scared there's something wrong with me... I remember I cried when I was 7months into nursing when one of the nurse managers told me that the kid I had looked after prior to going to ICU passed away, but ever since then I just don't feel much anymore...

get the doc to talk to them

paediatric, definitely paediatric.... can't stand all the whining adults who think the world owes them everything and we are responsible for cleaning up all their messes from their doggy lifestyle...(not saying you don't have parents like that in paeds though)

here comes a third wave feminist