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rickard's Latest Activity

  1. rickard

    Question regarding posturing

    This position sounds like decorticate posturing. It is seen commonly in neuro icu's and trauma units. here are some links Abnormal posturing - Wikipedia, the free encyclopedia Decorticate posture: MedlinePlus Medical Encyclopedia
  2. rickard

    SVR too low!!

    The condition you are referring to is Vasoplegic syndrome. Vasoplegic syndrome - Wikipedia, the free encyclopedia Vasoplegic Syndrome after Off-Pump Coronary Artery Bypass Surgery Vasoplegic syndrome--the role of methylene blue Ganesh Shanmugam * Department of Cardiac Surgery, Royal Hospital for Sick Children, Dalnair Street, Glasgow G3 8SJ, UK Received 15 May 2005; received in revised form 27 July 2005; accepted 29 July 2005. Vasoplegic syndrome is a recognized complication following cardiac surgery using cardiopulmonary bypass and is associated with increased morbidity and mortality. In several patients profound post-operative vasodilatation does not respond to conventional vasoconstrictor therapy. Methylene blue has been advocated as an adjunct to conventional vasoconstrictors in such situations. There is limited data pertaining to the use of methylene blue and a number of reports have been anecdotal observations. This article reviews the incidence and problems associated with the vasoplegic syndrome, the mechanism of action of methylene blue, its effects and adverse reactions and the literature supporting its intra-operative and post-operative use. In cases where first-line therapy fails, the use of methylene blue seems to be a potent approach to refractory vasoplegia. The early use of methylene blue may halt the progression of low systemic vascular resistance even in patients responsive to norepinephrine and mitigate the need for prolonged vasoconstrictor use. However, dosing regimens and protocols need to be clearly defined before widespread routine use. Whether methylene blue should be the first line of therapy in patients with vasoplegia is a matter of debate, and there is inadequate evidence to support its use as a first line drug. More scientific evidence is needed to define the role of MB in the treatment of catecholamine refractory vasoplegia.
  3. rickard

    Rural ICU

    Possibly the rising creatinine and LFT's were a result of hypotension which they thought they could correct with fluids and pressors. With both kidney and liver effected it is highly probable that they are right but the first question needing to be asked is what were admitting levels?
  4. rickard

    am i gonna fail ...cause of math nerves?

    if you have a smart phone or an ipod touch download and become very friendly with something called epocrates (its free). its a quick drug reference tool and also has several calculators. ive been using it for years
  5. I work in a CVICU the does approx 200 - 300 open heart procedures a year. Early mobilization means, in my unit, that a pt gets out of bed after PA catheter is removed
  6. rickard

    Post CABG dressings (what do you use?)

    i have seen silk tape with sterile gauze changed before 24hrs and elastoplast tape changed at 48 hrs. i'm wondering what other heart programs do for post op dressings????
  7. rickard

    Any Tips for Cardio/Thoracic ICU Preceptorship?

    probally the best online hemodynamic monitoring site is http://www.pacep.org
  8. rickard

    Book Recommendation?

    this was posted on another thread, i took a quick look and seems like an excellent resource. https://allnurses.com/ccu-nursing-forum/vasoactive-drug-table-370869.html
  9. rickard

    Vital Sign & I/O Assessment frequency

    i work in a CVICU I&O is assessed at least hourly and VS are pt dependent if no vasoactive gtts then hourly is fine if on something and not titrating the q 30 mins maybe even q hour if very stable on the same rate but titrating gtts are recorded q 15 mins
  10. rickard

    Question about dopamine

    Another consideration (side effect ) of increasing the contractility of the myocardium is it also increases the irritability. Dopamine causes this less then some of the more powerful inotropes but at higher doses does cause similar effect . The consequence of the increased irritability, more frequent PAC's possibly leading to afib? or frequent PVC's leading to Vtach? Treatment for these are antiarrhythmic agents which most have negative inotropic effect. So a catch 22 has just happened. :)
  11. rickard

    New Grad Nurse in CVICU ????

    I am wondering if any open heart programs accept new grads? and if what is a reasonable orientation period?
  12. rickard

    Question regarding CCRN eligibility.

    Many ICU's are willing to take new grads into an orientation period. I work in a CVICU and we are taking our first new grad in the next couple of weeks, but understand an orientation period will be longer then a med-surg floor. Our new grad is expected to be in orientation 8 months to a year.
  13. rickard

    CCRN discouragement?

    to quote the AACN " Eligibility Requirements A BSN is NOT required to sit for the CCRN exam. Applicants must hold current, unencumbered registered nurse licensure in the United States. In order to meet the RN licensure requirement for initial CCRN certification and recertification, an individual nurse's RN license must be unencumbered. This means that an RN license, issued by a state board of nursing, must not have provisions or conditions that would limit the nurse's practice in any way. It is the responsibility of the exam applicant or CCRN-certified nurse to notify the AACN Certification Corporation when any restriction is placed on his / her RN license. CLINICAL PRACTICE ELIGIBILITY Critical care practice as a registered nurse is required for 1,750 hours in direct bedside care of (adult, neonatal or pediatric) acutely or critically ill patients during the 2-year period preceding date of application, with 875 of those hours accrued in the most recent year preceding application. All 1,750 hours must be in care of same patient population (for example, for the adult CCRN exam, all 1,750 hours must be caring for acutely/critically ill adult patients). Clinical practice hours accrued in an undergraduate student role are NOT acceptable. Nurses serving as manager, educator (in-service or academic), CNS or preceptor may now apply their hours spent supervising nursing students or nurses at the bedside. Nurses in these roles must be actively involved in caring for patients at the bedside; for example, demonstrating how to measure pulmonary artery pressures or supervising a new employee or student nurse performing a procedure. " to summarize if you are an RN with a clean license and you worked 1750 hours as a bedside nurse in a critical unit you qualify to write the CCRN exam. the process of studying for the exam is more the challenge. the increase of your knowledge will improve your ability to care for really sick pt's. i wrote the CCRN exam after 2 years in crit care, i am a very good test taker, and as i walked out of the exam i was convinced i had failed it because it was the hardest exam i had ever taken. i had passed it. the next challange was to plan out my recert in 3 years because i was never taking that exam again ! and that is where the true knowledge of the CCRN's come out. My advice to you is study hard and take the exam and ignore the nay sayers !!! a quote for you from a pretty smart dude "Great spirits have always encountered violent oppostion from mediocre minds." -Albert Einstein
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  15. rickard

    Anyone going to TRENDS in Pa?

    anyone going to Trends next week ?
  16. rickard

    pa lines/swan ganz

    best site is pacep.org