Pghfoxfan1

I believe that we do require ICU experience but, I feel that almost all of EP is learned on the job. I'm also an EP nurse and I can tell you that after 17 years of working in an open heart ICU, I was lost in EP.

You should always care about VT even when someone is paced. Granted there are some VTs which do not affect the blood pressure as much as others (RVOT VT), most will cause some bit of hypotension, causing dizziness, syncope and possible callapse. You should always consider the cause, electrolye imbalance, hypoxemia, MI just to name a few.

I have worked in the EP lab since 2002. I had worked 17 years in an open heart ICU before that. The reason I mention that is because, I felt so dumb when I started working in EP! For the first 20 years of my nursing career, I prevented people from passing out. Now we try to make people faint by doing tilt tables. I prevented people from going into VT or VF, now I induce it. I was very competent in reading chest X-rays, now I had to learn fluoro. It's a totally different world. But I love it!

ALmost always trained on the job. PCU is a great start.

You may be able to rent a room in someone's house till you can get on your feet

Listen, we are all nurses here. And we KNOW that MANY of the patients in the hospital don't need to be there. For starter, all patients that CAN be discharged SHOULD be, and be sent home early enough that they can also protect themselves. Heck, it's a hurricane, we know it's coming for at least a week. Patients that remain in the hospital should only be the sickest of the sick. I have stayed for a blizzard. But I don't feel I should give an opinion in a hurricane situation. Family should come first but we know down deep we also need to make sure that patients are cared for. I feel your pain. I am not sure you would be fired.

Remember a few things. You are there to do your best to help the patient...but, don't blame yourself, sometimes people die. Sometimes families can be a pain in the butt but, think of what they are feeling and going through with their loved one in an ICU. They are not at their best during this stressful time. Offer help to others and they will offer help to you. Even though you have your patients, it doesn't mean a group of you can't function a bit like a team. Tag teaming helps with bathing and turning for example SAVE YOUR BACK NOW so you are not a cripple later. If you have time, make rounds with the doctors, including looking at X-rays. You can learn so much, even when it's not your patient. I love to listen in when doctors were teaching residents and fellows.

Placing a magnet over a pacer will make it pace asynchronously. (While placing a magnet over an ICD will ONLY turn off tachy therapies and do NOTHING to pacing) If prior to the code blue, the patient's pacer had "failure to sense", placing a magnet over it would probably not help. Just remember, "you can't pace a dead heart". If the patient's intrinsic rate is above the pacing setting it shouldn't pace. Some pacers will pacer at the rate response setting if the device is giggled (if CPR was being done). This is because the device thinks the patient is running, walking up steps etc, requiring a faster heart rate. Always remember to Do CPR when a pulse is not felt. Shock when appropriate. It is easier for the pacer to work when the patent is in SR or even AFib. If the patient is in VF, pacing spike will not capture. If the patient is in VT, you could try to anti tachy pacer.

Bi V pacing can help increase EF but not always instantly. The IABP is a great tool. Not all hospitals have the Impella . I agree with Dobutrex for it's inotropic properties. Epi will vaso constrict increasing after load. Primacor Ntg and Nipride can vasodilate.

Any "seasoned" nurses remember doing Endocardio viability ratios "EVR's" back in the "olden days" to wean IABPs? Oh, the good old days...

I worked with an LPN in an open heart ICU. We had to do her IV meds, but she did everything else. BTW, some of the best nurses I ever worked with were LPNs. And the best nurses I ever worked with were LPNs before becoming RNs.

Been a nurse 35 years. I have always thought that touch was very very important. That is the reason I learned Reiki. I am now a Reiki Master. I also believe that essential oils have their place in medicine. I am only beginning to learn and understand their properties and healing abilities.

Great post! Thank you! I also want to say that 0 silk is used when you want to hold something in place forever, for example a pacemaker/ICD tied to the chest muscle, and it's leads. You wouldn't want these sutures to absorb/disappear in time because the device could fall into the armpit/breast area.

When I saw what the OR documents (hardly anything), I questioned that we are documenting way too much.

I do too! Why do nurses do this? Are we covering our asses?