Thedevinestman

I work on a cardiac unit and the other day I had a patient who had come in in the middle of the night with chest pain and positive troponins. During my morning assessment she was doing ok, vital signs at baseline, alert/oriented, fatigued, cardiology posted to see that morning. I gave her am dose of atenolol which she took every morning at home. About an hour and a half later she brady's down to the thirties, upon assessment she's drifting in and out of consciousness, nauseous, pulses faint, and bp had dropped thirty systolic from baseline. I called a rapid response; luckily the cardiologist was reading her h and p at the nurses station and was about to see her. He got there before the rrt and I gave him the story. In my hospital the ICU charge nurse comes to all the rapid responses along with a hospitalist, respiratory, IV team etc. They gave her one round of epi and her pulses came back to the forties and she regained a groggy consciousness. Cardiologist decided on an emergent cath and as they were getting her packed up to leave one of ICU nurses in the room started dopamine at the physician request. I didn't have time to ask him how fast he started it or why they chose that med specifically. I figured the ICU board would be appropriate theater to ask this question; given we don't use it a lot on my unit. What rate do they usually start? Any clue as to why they picked dopamine over other pressors? Thanks

Thank you everyone for your comments. It's nice to know more about other hospitals and how they run their units. Warm Regards

The head CT was a good call given all the agitation, but I think the intensivist killed that patient by extubating early. You clearly did all that you could and I wouldn't loose sleep over it. Imagine if that same patient was in a third world country with the same problem, they never would have even been treated, certainly not with the excellent care you gave. Some people just aren't meant to live through cv surgery. Stay strongí ½í²ªí ¼í¿»

I recently started my first nursing job on a cardiac unit. Many of the experienced nursing staff have voiced their opinions regarding the patient populations we are serving and that the acuity of these patients is too high. My hospital has two general icu's with one of them taking only cabg/valve patients, one cath lab, and one cardiac unit. We can take any cardiac patient that isn't vented including patients on vasoactive drips, patients on heparin, patients in active chest pain etc. As well as post EP patients, post angio/stent patients, and patients with femoral art lines. We can take 4 patients on my floor (though it is more often 5). I have heard many of my preceptors say that our staffing ratio's are unfair because our floor is "basically a stepdown." I've never heard this term before and because this is my first job I don't really have any global perspective. Could anyone that works on a stepdown, or knows what they are, shine some light on the subject?

There are two former EMT's that work in my ICU and they are both excellent nurses, especially during codes. It could be that these are just two great nurses that would have been great anyway, but not likely. In your case I would avoid paramedic and go straight to RN, you'd be better off in 5 years.

Excellent topic. I've heard the phrase used by old jaded nurses many times, and I'm of the opinion that it isn't entirely useless. But really, as someone said earlier, it's just a reminder that not every patient follows the rules clinically speaking. The patient IS the monitor. We TREAT monitors all the time; we also treat the patient. I choose not to use the phrase because I'm afraid it will make me look jaded and dogmatic (in my opinion).

Unfortunately, if you enjoy talking to patients than a CRNA career probably isn't right for you. Unless of course you're doing it for the money, in which case keep on trucking. I was a surg tech before going to nursing school and the OR is really a different environment compared to ICU. There are more ego's and more alpha's. But if you enjoy talking to patients and having a consistently relaxed environment than get your nurse practitioner and head to the clinic. There's considerably less money, but who cares if your happy! :)

Thanks guys. I just started in the ICU which is why I asked; I know its a pretty basic question. What I've seen the most of is nurses just adding slack to the vent tubing when turning the patient away from the vent. But I can tell the general consensus is that it should move minimally.

I'm fourth semester nursing student and an ICU nursing assistant. I'd like to know a little bit more about ET tubes, in particular, how much the can be safely manipulated during pt. positioning etc. Thanks guys. Warmest Regards