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MYSTICOOKIEBEAR

MYSTICOOKIEBEAR

Cardiac/Transplant ICU, Critical Care
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MYSTICOOKIEBEAR has 5 years experience and specializes in Cardiac/Transplant ICU, Critical Care.

MYSTICOOKIEBEAR's Latest Activity

  1. MYSTICOOKIEBEAR

    Switching from Neuro ICU to Cardiac ICU

    Cardiac/Transplant ICU RN checking in! Become familiar with your Adrenergic Agonists, vasopressors, and vasopressor like meds. You already have ICU experience so you know how to walk the walk, now it's just fine tuning your skills to a different specialty. I made a video to help as a refresher to this realm! [video=youtube;hiI-8GV-kBk] Good luck and let us know how it goes!
  2. MYSTICOOKIEBEAR

    Emergency Titration Protocol ?

    I don't want to sound rude or unprofessional but you can tell them to stick to their check lists and office work. This is the big leagues not some Doctor's office or school nursing office. Bring it to their attention that we could have either A) Do what we needed to do to keep the patient alive B) Followed "protocol" and have had our selves a fresh corpse You could have gently reminded them why we work in a Critical Care setting by saying "I realize that there was no written order for me to save the patients life, but I did it with the patient's best interest in mind. Please speak to my Resident/Fellow/Attending to see if my actions were prudent for a patient in such critical condition. I could have left the patient to search for an MD but then I would have been cited for abandoning my patient in a time of need which would have led to their death and would have also gotten my Nursing License taken away. At least I still have a Nursing License and we still have a living patient to talk about right?" Some people (JCAHO) are so far removed from the things we do, so out of touch with the reality of true Critical Care nursing, and have to deal with concepts that go completely over their heads that they stick to what they know.
  3. MYSTICOOKIEBEAR

    Emergency Titration Protocol ?

    I don't want to sound rude or unprofessional but you can tell them to stick to their check lists and office work. This is the big leagues not some Doctor's office or school nursing office. Bring it to their attention that we could have either A) Do what we needed to keep the patient alive B) Followed "protocol" and have had our selves a fresh corpse You could have gently reminded them why we work in a Critical Care setting by saying "I realize that there was no written order for me to save the patients life, but I did it with the patient's best interest in mind. Please speak to my Resident/Fellow/Attending to see if my actions were prudent for a patient in such critical condition. I could have left the patient to search for an MD but then I would have been cited for abandoning my patient in a time of need which would have led to their death and would have also gotten my Nursing License taken away. At least I still have a Nursing License and we still have a living patient to talk about right?" Some people (JCAHO) are so far removed from the things we do, so out of touch with the reality of true Critical Care nursing, and have to deal with concepts that go completely over their heads that they stick to what they know.
  4. MYSTICOOKIEBEAR

    Neuro ICU vs. Transplant ICU for CRNA School

    I am a Cardiac/Transplant ICU and having worked dozens of shifts in other ICUs (SICU, MICU, CCU, NICU). My advice is go with the Transplant ICU. It will give you more experiences with SWANs, vasoactive drips, fluid resuscitation, aggressive extubation protocols, titrating sedation, and hemodynamics.
  5. MYSTICOOKIEBEAR

    Being friends with residents on Facebook

    Sorry OP, I thought you were talking about Medical Residents NOT nursing home residents as in the patients . That being said, I completely agree that it is inappropriate to have a nonprofessional relationship with a patient that you took care of or continue to take care of, whether it be in the real world or electronically through social media.
  6. MYSTICOOKIEBEAR

    New Graduate RN Cardiac/Thoracic Surgery Unit

    It is a great unit and you WILL learn a lot. I started out on a CVT stepdown and I am very happy that I did that. Being on a CT surg floor will make you a very strong floor nurse as long as you are open to learning, can move very fast, know how to prioritize, and can think quickly on your feet. Starting on this unit also prepares you for the Critical Care realm if you choose to continue on in your nursing career. Good luck!!!
  7. MYSTICOOKIEBEAR

    Worried about turning in my two weeks

    Before you give your two weeks, make sure you have another job lined up. That being said go and meet with your manager, tell him/her that you are putting in your two weeks, and also hand him/her a written resignation. Be polite, be stern, and be professional. Good luck!
  8. MYSTICOOKIEBEAR

    Being friends with residents on Facebook

    Is there a specific reason as to why you have a problem with this? I don't want this to come off as rude, but maybe you should mind your own business? You seem unnecessarily and overly invested in who your friends are "friends" with on Facebook.
  9. MYSTICOOKIEBEAR

    New Grad RN going into ICU - prepare?

    Congratulations, that is quite a feat! One thing that is not really explained to well is what to do/where to be during a code. I made a video to help explain different roles and key positions during a code. I hope this helps! Let us know how you are doing so far in your new role
  10. MYSTICOOKIEBEAR

    Going out with your co-workers (Mixing Business with pleasure)

    This is a very interesting subject because it has a lot to do with culture. In Japan, if you go out with your company for the monthly hangout, you are EXPECTED to get plastered with your coworkers, managers, directors, VPs, and senior leadership. The idea is that everyone works together towards a common goal, you make money together, you work hard together, you play hard together. It helps bring everybody together and helps develop a rather robust espirit de corps. But here in the USA that can be seen as a No No, that going out with your coworkers makes you too familiar, kind of on the same lines as not getting to know your neighbors is now the norm Spend time with the people that you want to spend time with. As long as it doesn't affect you professional working relationship, there shouldn't be any issues.
  11. MYSTICOOKIEBEAR

    Case Review: BP and Urine Output

    Did you have a SWAN in? If so, how was the CI and SVO2? How was your CVP? How was your Base excess/deficit on the gas? Did you choose those drips? There are a lot of questions that would help paint a better picture. If it were me I would say "These are the drips that were ordered, your orders were to keep maps in the 70s-80s, I followed those orders, please change them as you see fit". It sounds like she did just that, but don't be worried that she was pissed off at her own mistake. In a pt with a EF nearing VAD implantion territory I would have recommended a pressor that has B1 properties (Epi, Dob) and then Norepi for BP because it would also stimulate A1, A2, and B1 receptors. Next time just ask for clarification, ask them the theory and physiology behind it, and thank them for teaching you. Attendings can lash out over weird things, don't let it get to you
  12. MYSTICOOKIEBEAR

    CCRN tips

    Pass CCRN was a fantastic guide and is a pretty good indicator of the types of questions that will be on the actual exam.
  13. MYSTICOOKIEBEAR

    CPR

    Hopefully no patients get cooked? The reason that we start the Arctic Sun protocol aka therapeutic hypothermia is if we are worried about Anoxic Brain Injury. By cooling the patient, decreasing their metabolism, decreasing their O2 needs, we optomize O2 delivery to the brain and hopefully optomize their recovery. There are times when a patient codes, where after a round or two we achieve ROSC, and they are completely neurologically intact. Im talking about not needing restraints, writing stuff down, watching TV whilst still intubated (Not gonna lie that kinda weirds me out when they continue on their day like nothing happened ). These people are not appropriate candidates for Arctic Sun since their is no evidence of anoxic brain injury. But there are other times when a patient codes and they are completely unresponsive, no sedation, not moving, sluggish pupils, barely to no reflexes. That is when the Arctic Sun protocol is appropriate but it is usually Neurology who decides what is appropriate.
  14. MYSTICOOKIEBEAR

    New Grad in the IICU Advice?

    First of all, CONGRATULATIONS!!!!! You should be really proud of yourself for all of your hard work and landing a pretty sweet gig after graduation! Going into the Critical Care arena you find out very quickly that there are a ton of drips to learn about and understand. One of the first things that I did was master my understanding of adrenergic agonists and vasopressors. I am really happy that I did this because it gave me a very strong base and helped me understand why we made the moves that we did. For fun I actually made a video going over the finer aspects of different adronergic agonists and vasopressor like medications. [video=youtube;hiI-8GV-kBk] Good luck, have fun, and don't stop asking questions!
  15. MYSTICOOKIEBEAR

    CVICU or NTICU?

    I am a Cardiac/Transplant ICU RN in a Top 10 hospital so I bet you can guess where I will tell you to go! In my CTICU the MDs (residents, fellows, attendings) heavily rely on our input and our insight for the very critically ill patients. The patient populations, overall, have much more complex conditions than the Neuro/Surgical/Trauma ICU. In a CTICU/CVICU we primarily deal with a sick heart but might also have to deal with multiple sick organs as well. In a Neuro/Surgical/Trauma ICU more often than not there is one very big problem, but the rest of the organs are working pretty well. I am very biased, but in my years on The Units, CTICU/CVICU training and experience will prepare you very well for entering other ICU specialties.
  16. MYSTICOOKIEBEAR

    Struggling with what goes on around me.

    I don't mean to sound insensitive or disrespectful, but we are NURSES, not MDs. Our job is to advocate for our patients, give them the best care possible, and to notify the MDs if we see a change in condition or throw up a red flag for an alarming trend. If you are more experienced ,then you can add guiding the MD's decision with your input and insight to the list as well. If you don't like what the resident says then page the fellow, if you don't like what the fellow says then page the attending, if you don't like what the attending says, page another attending. If you still do not like the answers you are getting then you are out of luck and all that you can do is chart that you notified everybody. If the patient ends up passing because of the actions of the MDs or the lack thereof, you did everything that you were supposed to and you shouldn't feel bad or guilty. My philosophy is that I will follow any order, no matter how weird or even if it is a 4th quarter 3 seconds left on the clock long shot hail mary, as long as it IS NOT criminally negligent. It sucks to have so many losses in such short succession but you also have to remember that you have a lot of wins as well. But like you said, many of those things happened outside of your control and you are unfortunately left to clean and salvage the mess. This happens to all of us at one point or another when the losses start to bother you. Through some pretty emotionally taxing work related events early on in my career, I made the decision to forge myself into the best nurse that I can be. I did this because I want to be the best, I want to give my patients the best possible care, and if there is a weak link in a team that is caring for a patient, it is NOT going to come from the nursing aspect of it. Through hard work and determination I have made sure that is the case for every single patient that I am tasked to manage. As long as you did everything in your power to advocate for the patient, you made all of the right moves, there were no better interventions, then you can still leave your shift with your head held high. This is something that we all go through as Critical Care Nurses and you will get through it in one way or another. Whether you stay on The Units and make yourself into a Beast Mode member of it, continue to be an All-Star, or if you decide to do something else, you will make it out alive on the other side. But only you can decide what is right for you. Good luck and stay strong!