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

Hi all I'm a relatively new PICU nurse(only 6months in the unit), so recently I've started to look after patients who are intubated but I still find ventilator/ventilations very confusing. Here are some of the questions I've been having. 1. what's the difference between CPAP/PS and BiPAP? My understanding is that with CPAP/PS gives you a EPAP (PEEP), and a IPAP (aka the PS) once the patient has initiated a breath. So CPAP/PS is technically BiPAP as they are exactly the same? however if you have a PS of 5 and PEEP of 5, doesn't that mean there is no difference between the IPAP and EPAP therefore it is simply CPAP? 2. SIMV PC/PS If i have a pressure control of 10 and a pressure support of 10, does that mean if a breath from the patient is synchronized with the ventilator, the patient is going to receive a total pressure of 20 for that particular breath? if my patient is not initiating any breaths, then the ventilator is going to generate only a pressure of 10 for each breath since i have a pressure control of 10? 3. Suctioning an ETT with saline. This one is actually quite stupid (I'll admit). I've seen many nurses do this but I always wonder, won't you put the patient at risk of aspiration? At the end of the day saline is still liquid?

dont know what u mean by your question/topic, but in my hospital (and the previous one that i worked for), RR's nurse is a senior nurse from ICU who responds to all the code blues within the hospital precinct and doesn't have a patient, when everything's calm and quiet they'd just hang around in icu helping out

if you don't mind me asking, is this a normal policy for american hospitals to do full assessment on every patient regardless of their conditions and acuities?

i've got a cardiology iii works really well, and told by others this one can last a long long time

so the only detail we have is that a 4month old having a cough and his mom wanted him to have a cxr? such good parenting and i wonder if she indeed has worked in the "nursing field".

i normally just call them if i have concerns or need something maybe a change in vs which i could not figure out why, that doesnt necessarily mean something bad is gonna happen, but i like to notify them just in case. or if i need them to do some charting. and for orders, that depends on which doc is on today, if it's the one that i know well i'll just put put in the order myself using their names in my country we don't need to notify them with lab results

gen peds floor 1:4 day, 1-4/5 pm, 1-6 night depends on the acuity, sometimes we have 1:1

and you go in, ask them what they want, once they are done talking about their crap, you tell them how many minutes they've wasted you and ask them to get the **** out of the hospital, go see a private specialist if they are expecting 5-star hotel kinda service but cleverly point out that they are nothing but a bunch of broke, whining suckers and you wonder if they have the finical resource to pay for private service.

hi thx for the reply. I've read the requirements extensively. work exp, from one of the most needed specialties, language, availability.... The minimum exp required is 2 years, not 3, maybe it's a bit different it in australia... They also did not specifically mentioned what the min management exp would be but i'm wondering, does mentoring nursing students and other new grads counted as part of it?

seconded!