CoolDork

If it is new for the patient, I would def. consider calling the provider; however, I would investigate a little more esp. if the pt is non-symptomatic but a run of ten is quite significant. Therefore, I would make sure electrolytes were insignificant, k+, mag...etc, and other check Dx tests completed prior to this event. Then call the MD. It's better to be proactive then reactive.

The ICU has more bells and whistles. Of course with the whistles comes more knowledge base; however, trauma docs and residents that I worked with loved to micromanage. *shrugs.* However, I would say the on ICU I had more autonomy but then again I had good rapport with the docs.

That ratio does seem absurd; however, what are your resources? Does NY use med techs, medics and CNA 2's. If so, it can be stressful but manageable with how many resources you have at your finger tips. Currently at my facility, I have 4 pt's with CNA IIs as my only resource. Not to mention there are only 3 of them to staff a 57 bed ED. I don't know how I would manage in your shoes right now but God bless your situation.

The physiology of SaO2 and SpO2 is totally different. SaO2 is directly related Hgb and how saturated the blood is with O2 molecules. SpO2 is the measurement of dissolved O2 molecules in the blood/plasma and solely dependent on lung functioning. Therefore, a patient can have an adequate SaO2 (saturation of O2 on Hgb) but in general the lung functions can be dec. causing a low PaO2. The patient needs oxygen. In conclusion, PaO2 is dependent on lung functioning and SaO2 is dependent on SpO2(dissolved O2 in the blood that eventually binds to Hgb).

Everyone discussed great points for lactic acid indicators and the pathology of it. For US, it is important for a trauma because it provides information on where there is internal organ trauma especially and where it is. Also, CO=SVxHR ; SV=preload, contactility and afterload. During hypotension, first thing I see is fluid resuscitation which improves preload. CVP is a diagnostic tool to evaluate preload. Secondly, with lactic acid. CHF,Renal failure and/or cerebral edema MDs use fluid resuscitation cautiously. If preload does not improve, afterload or contractility is what they target...pressors are used. Depending on what type of shock, indicates what pressor is used. MDs USUALLY never Rx pressors without filling the intavascular system d/t greater harm you can do with them. I hope this helps.

I've worked SICU and now ED and although CVP monitoring was standard in practice, a lot of our EDPs are getting away from it. CVP can give provide some unclear indicators of intravascular volume. Pressure does not equal volume. Therefore 3L was pretty much standard. If MAP and/or urine output remained inadequate after fluid resuscitation, shock was suspected.