offlabel

offlabel

Member

  • Content

    1,709

  • Visitors

    19,060

  • Followers

    1

  • Likes

    780

All Content by offlabel

  1. Charges at Level 1's

    offlabel replied to MassED's topic in Emergency

    Not now, but was a day charge at the busiest level 1 trauma center in the Bay Area. It's like steering a super tanker used to be before auto pilot...Make small infrequent corrections but know exactly...

  2. Phenergan dilution

    offlabel replied to EDnatasha's topic in Emergency

    Perfectly safe to do that, but would only make practical sense if you were running in the liter as a bolus, as with a hyperemetic mom or some heat exhaustion dehydration type patient, etc. The drug...

  3. ECMO Training in ICU

    offlabel replied to IGOTMYBSN28's topic in CCU, Coronary, Cardiac

    The perfusionists usually manage the ecmo at our place. They may have a role where you are..... or

  4. Question about fent OD?

    offlabel replied to benmca13's topic in CCU, Coronary, Cardiac

    MunoRN kind of called

  5. Question about fent OD?

    offlabel replied to benmca13's topic in CCU, Coronary, Cardiac

    The liver is pretty resilient to insult, even cirrhotic ones...my thought is that if this patient were suffering from hepatic encephalopathy 2/2 an ischemic liver there'd be a lot of other stuff that...

  6. NP in the OR

    offlabel replied to birdie22's topic in Nurse Practitioners, NP

    Lots of NPs work in the OR...they see patients in pre and post op clinics, admit patients, discharge them...Get a job with a surgeon and that's what you'll do. But you'll work surgeon's hours too in...

  7. CCRN Study: So confused on dead space vs. shunt

    offlabel replied to sunnybabe's topic in Critical Care

    Here's one way to think about this.... A rise in dead space will result in a rise in PaCO2 A rise in shunt flow will result in a fall in PaO2 and therefore SaO2. So, in the over simplified patient in...

  8. Question about fent OD?

    offlabel replied to benmca13's topic in CCU, Coronary, Cardiac

    Taking everything you've said at face value (although, odds are there is more to the story that you're not aware of, behind the scenes with the physicians on the case)...If you really mean that the...

  9. PICU Nursing: How long would you....

    offlabel replied to Nurse3242's topic in PICU, Pediatric

    I did it as a new grad BSN with several other people and everyone did extremely well. Exceptional unit with excellent

  10. What is it like?

    offlabel replied to paolahevia's topic in Student Registered Nurse Anesthetist

    You have at the very least seven years to go before you should even apply to nurse anesthesia training... my own advice, since you're asking, move in that direction then ask that same question

  11. RN Anesthesia job, where else have you seen it?

    offlabel replied to MIRN923's topic in Critical Care

    Sounds like an anesthesia tech job with nurse pay. Can't imagine why they'd hire an RN for that, but it would be a pretty cushy job for a nurse. Small wonder it's not easy to

  12. Was this a blood transfusion reaction?

    offlabel replied to blahblahblah172's topic in Critical Care

    The blood bank will be able to tell you if this was a transfusion reaction or not with the battery of tests that they do on the banked unit and the patient's serum and urine. Beyond that, there is no...

  13. Checklist after a cardiac cath done femorally to check for retroperitoneal bleeding

    offlabel replied to deweydecimal13501's topic in CCU, Coronary, Cardiac

    Would it be better if she communicates directly with the group she hopes to gain a resource from? Clinician to clinician communication can address specific issues with what she's doing now vs. what...

  14. Checklist after a cardiac cath done femorally to check for retroperitoneal bleeding

    offlabel replied to deweydecimal13501's topic in CCU, Coronary, Cardiac

    That is a really tall order...Check lists go only so far and what really matters in these patients is the experience of the providers and caretakers and the index of suspicion specific to more...

  15. Calibrate at Phlebostatic axis?

    offlabel replied to JayJ10's topic in Critical Care

    So, the above is the answer. You can zero anywhere relative to the patient, whether the transducer is on the ceiling or the floor because the Patm is the same either place. If you dissected a blood...

  16. PEEP and blood pressure/other hemodynamics

    offlabel replied to sunnybabe's topic in Critical Care

    PEEP actually causes a rise in RAP which is the reason for the fall in venous return which means a fall in cardiac output and urine. But you're right about the fall in ANP with

  17. CMC- Cardiac Medical Certifcation subspecialty

    offlabel replied to Jujubear2606's topic in CCU, Coronary, Cardiac

    What does Cardiac Medical Certification even mean? All of these extra certifications (TNCC, CCRN, CEN etc) don't even guarantee a basic level of skill or knowledge. They're evidence of a passed test....

  18. Treat the patient, not the monitor

    offlabel posted a topic in Critical Care

    Can we think of something else to say? This phrase is older than most nurses and is usually a glib crack made by someone who is seizing the clinical expertise high ground in a condescending way....

  19. Carriers for drips

    offlabel replied to MGMR's topic in PICU, Pediatric

    Goes without saying... if there is a line or lumen that is redundant in that crystalloid replacement is being accomplished elsewhere and there are no medications infusing thru it, it can just be...

  20. Carriers for drips

    offlabel replied to MGMR's topic in PICU, Pediatric

    Been a whole since I did Peds ICU.... still putting heparin in those lines? Thought they figured out it wasn't

  21. Carriers for drips

    offlabel replied to MGMR's topic in PICU, Pediatric

    The thinking goes that if you're titrating drip rates frequently, a carrier helps with even delivery of drugs. So if you cut a rate by half of one thing, you won't affect another's delivery that much....

  22. TNCC what is it good for?

    offlabel replied to Broc's topic in Emergency

    Been a while for me...Does TNCC still teach slamming in 2 liters of NS for hypotension from blood

  23. Use of backup saline infusions for medication infusions in ICU

    offlabel replied to taif1's topic in Critical Care

    Yes...a normal saline "carrier" just facilitates a more even delivery of medications. An insulin infusion of 2 ml's an hour will deliver more evenly when titriating vasoactive drips with swings of 20...

  24. New Rule: No work bags allowed in ER

    offlabel replied to DarknTwistyERRN's topic in Emergency

    That's dumber than the bag

  25. New Rule: No work bags allowed in ER

    offlabel replied to DarknTwistyERRN's topic in Emergency

    Tons of apps for that kind of thing and a bag isn't