nurseabc123

sounds like a night in my icu. one exception the attending will usually never be at the bedside, let alone return your phone call/page! and a CV fellow that's great, we usually just have an ICU intern! also reopro prior to surgery really sucks! good job

I can think of one recent case. Esophogectomy that stopped taking his plavix/asa one week prior to surgery had an anterior infarct immediately post-op. IABP was emergently placed and started on CRRT within 24 hours. Struggled to keep pressures > 50. A few mini codes here and there and severely acidotic, the family finally withdrew less than 48 hours post-op. Other than that, no other cases really come to mind.

I don't think it can be that cut and dry. A policy like that will do a disservice to your patients and nurses. Nurses should be able to determine whether or not patient's change in status is significant enough to warrent notifying a physician. Maybe more education is necessary, not a policy change.

Agreed - I work in a busy CVSICU -- and this is our practice as well. If the patient has a IABP, unstable, multiple lines, gtts, crrt, open chest, crash cart in the room -- well then they are definitely 1:1. But just because they have the IABP they are not. Pre-op balloons are more stable than 75% of the rest of our patients on our unit. And not all post-op's are unstable for more than an hour or two. An IABP is just a piece of technology - look at the patient, not the machine.

I would file an incident report. I don't care who they are what they are doing can and will result in the harm of a patient.

We lose about 15-20/year as well to CRNA school, in addition to those that leave for NP positions, management, PACU/EP Lab/Cath Lab. We lose about a 1/3 of our staff.

Thanks for the response. Where can I find more info?

So a patient codes (let's say PEA) - they either open the chest or it's open already - they have an IABP - and they decide to to do ICM, what do you do with the balloon? Pressure trigger?

yesterday, my patient was on propofol, levo, epi, vaso, primacor, dobut, amio, lido, and insulin. that's a good start.

The cheaper one. Learn the material, and know it. You don't need a course for that. Plus, the real ACLS training happens on the unit!

I'm coming up on 12 months and I'm just now starting to feel pretty comfortable with everyday things. For example, traveling with vented, sick patients to CT, etc., running to codes on the floor, and just the everyday little stuff. Of course, I'm still nervous with really sick, crashing patients, but you just do what you gotta do.

yep, we have this too, can't clock in more than 12 minutes before, or 10 minutes after..

I would suggest contacting your advisor at your school. You need to take the classes that our prerequisites for your school's or the school you wish to attend's nursing program. Good luck.

Do I like working in the ICU? Yes and no. Do I like cleaning up patients, dealing with some obnoxious/threatening family members, babysitting and getting grabbed/kicked by confused patients? No. Do I enjoy working short-staffed? (Taking care of 3 vented patients?) Do I enjoy have very few senior staff to look to for support? No. Do I like working every other weekend? No! But do I like taking care of a fresh heart/AAA - very sick, titrating drips, giving multiple blood products, etc. Be able to critically think. Helping a patient/family die with dignity. Supporting my co-workers. Yes. Those things I like. Unfortunately, you can't pick and choose what you do. The negatives outweigh the positives.

Wayne State U. in Detroit has a run-in PhD program with the Physio and Pharm depts. Just fyi.

all the time, meds and pleurals.

http://www.datascope.com/ca/elearning_programs.html

I haven't read much of this thread, but I have taken care of several patients of which we have withdrawn support on my shift. I did this just yesterday. I find it extremely rewarding to help someone 'die with dignity' and support a family in a time of terrible grief. It's especially refreshing when a family member actually acts upon their family member's (the patient's) wishes and does withdraw. I find it more difficult to take care of a patient that did not want to be re-intubated/full-code, etc. and the family goes ahead against his/her wishes. I have worked with both of these types of situations.. I would rather help someone die, than keep them alive against their wishes. Upon extubation, I give as much ativian/morphine as I can and as frequently as I can, as ordered.

They are the wave of the future, supposedly. The first one opened in 1999 at Clarian Health System's Methodist Hospital in Indiana (where the babies in the NICU were given adult-dosed heparin- same hospital). They promote continuity of care and save costs. I think I would hate working in one. Search for acuity-adaptable unit.

Interns/residents insert A-lines. Only RTs/MDs/Midlevels can draw ABGS on our unit (w/out an A-line in place). We d/c Swans, we don't advance them - although I would say all of us have at one time or another. We start CVVH (pain in the butt!), and maintain it.. PA's place our PICC's, and interns/residents/midlevels place other central lines. We d/c mediastinal and pleural chest tubes and blakes. Interns/residents/midlevels read the CXRs. Our NP's d/c epicardial pacing wires. It's interesting to see the differences between all of our units.

It's just a peripheral IV, our techs can do them on our unit.

Our CABG's average around 150 minutes... although

We use the vigileo on all our TVR patients and other patients where a swan is contraindicated. So we have it maybe once every couple months. All off our cabgs, valves, sick AAA's have swan's. The Vigileo is based on radial artery waveform - enough said; we know how soon those can crap out on you. You calculate SV/SVI ©CO/CI, SVR/SVRI, every 20 seconds. Not Scvo2/Svo2 - we don't have the additional equipment for it, but you can with a some sort of light oximetry probe.

you're probably right, just physician preference.

Our CV surgeons.. all 10 of them. Sorry no lit references.