t981

Exactly what I was looking for, thanks.

It is supposed to go something like this: Get report on five patients, make sure everyone is stable. Review labs and vitals for trends. Assessments. Charting. Determine who has 0700 or 0800 meds that need to be given right away. Review any results from imaging studies CXR, Echo, CT etc. Charting. But it really goes like this: Get report on five patients, make sure everyone is stable. 502 is on bipap and needs to go to the bathroom. Transport is on the way to take 503 to the cath lab, but where are the consents? Where's the preprocedure checklist?! Their heparin is to be stopped on call to cath lab AND they need their aspirin before leaving the floor. ED is on hold to give report on Afib RVR going into 504. 505 has discharge orders and is on the call bell. Charge nurse reminds you to discharge ASAP because we need to step-down a patient from CVICU into that room. Family member on hold for 506. Still getting report…..Wait, 506 is on a dopamine drip….drop everything get over there and verify that drip NOW. etc. etc. Review labs and vitals for trends There are no lab results for 502. Oh, 502 has a PICC and apparently nobody drew the 0500 labs…..grab supplies and get to 502 ASAP. There was a 0700 PTT for 506 who is on heparin, phlebotomy is running behind, draw PTT…..confirm with phlebotomy that they will be on time for the 1300 draw. See if anyone on my team can help with the draw because 504 just rolled up from the ED. Determine who has 0700 or 0800 meds that need to be given right away 0800 Vanco needed for 502, but where is it? Call pharmacy. (Also, make sure Vanco trough is on order) I need metformin for 506, pyxis is out……call pharmacy. Three patients are on sliding scale and breakfast is on the way. 506 dopamine drip is running out, no replacement bag from pharmacy….call pharmacy! Assessments Afib RVR arrives into 504, orders for heparin and amiodarone, hang drips, order follow up PTT, talk to family. I hear the bipap beeping in 502, get over there and troubleshoot. RT is busy. Lab is on hold with a critical value for 506. Try and recruit someone to help with the 505 discharge. Apologize. Overhead page It is now time for your hourly rounding with your buddy!” Transport delayed for 503…..an extra minute to give the aspirin, heparin stopped, consents signed, woohoo! Review any results from imaging studies CXR, Echo, CT etc. 504 is about to puke because the Amio is making her nauseous, grab the Zofran, see how they tolerate…maybe need to call MD and see if we need to switch to Cardizem. Still trying to discharge 505, but where are the prescriptions? They're not in the chart! We haven't met the core measure for an ACE or ARB on this patient either….see if it is documented in a progress note anywhere….NOPE! 506 had an echo ordered yesterday afternoon, but it hasn't been done yet. Call echo. Hey echo, this patient is pretty disoriented, this needs to be done bedside. (Oh, you want that bedside? Wait in line buddy!) Family member waiting in the hall wanting to know why the echo hasn't been done, it was ordered yesterday! Charting Adjust 506 heparin, get another RN to confirm rate change, order follow up PTT. Overhead page It is now time for your hourly rounding with your buddy!” Hey, wasn't I on the 0900 turn-team? Docs are rounding, new orders coming in….place foley for this patient….loading dose of Cardizem P.O. for that patient…..potassium high on this patient, no electrolyte protocol in place, get orders….give Kayexalate (oh boy). Morning meds need to be given for everyone. Bipap beeping again in 502. 504's pressure isn't tolerating the amio.... Ad infinitum!

Thank you for the info on Levo and Epi. It is my understanding that the pressors and inotropes must be mixed when needed in the cath lab, and I am trying to get a general idea of the concentrations.

Please give me a rundown of drips you mix in the CCL esp. when the patient is decompensating. What are your typical concentrations and rate or does? Levo, Neo, Dopa etc. Thank you for your insight.