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PixieRN1

PixieRN1

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  1. PixieRN1

    Propofol Infusion syndrome?

    First, don't say that I said status epilepticus was benign...because I certainly said nothing of the sort. Period. Here. Early stages of propofol infusion syndrome in paediatric cardiac surgery: two cases in adolescent girls | BJA: British Journal of Anaesthesia | Oxford Academic Propofol-Related Infusion Syndrome in Critically Ill Pediatric Patients: Coincidence, Association, or Causation? http://pediatrics.aappublications.org/content/112/4/1002?download=true Both articles mention up to 48 hours as a max guideline but state it can and does happen much sooner. The second journal notes that propofol is NOT FDA approved for use in sedation in PICU populations. I'm done arguing.
  2. PixieRN1

    Propofol Infusion syndrome?

    The problem in this case wasn't that nothing was effective, it's just that propofol was MORE effective. Peds is a different beast. Brains are much more elastic and can tolerate much more hypoxia and insults than the adult brain. Having mostly reduced and significantly less intense” seizures on another protocol is proven safer in peds than strictly relying on propofol. Tolerating a few seizures a day is preferred over having no seizures on propofol. However, length and duration of course is highly pertinent. This example was a clear-cut case of mismanagement. Last I heard, the family was litigating the outside hospital.
  3. PixieRN1

    Messed up bad.....

    Anytime!
  4. PixieRN1

    Messed up bad.....

    OP, look at this link. It's a document of the actual statute and will help you I'm sure. It's looks like the program does exist but does have a lengthy list of criteria one must meet to qualify. The timing looks quite important. I would start here...it's at least worth a shot to looking into what you can do proactively. This isn't legal advice...it just looks like it gives good info on the program. Lawriter - OAC Best wishes!!!!
  5. PixieRN1

    CHOP Nurse Externship (Summer 10-week’s)

    I've personally never heard of a paid externship or reimbursement for housing. None of mine were paid on any level at least when I was a student. I did one in NICU, PACU, and ICU. Mine weren't paid. I can't imagine that anything would be paid, housing or hourly. What you get is the privilege of the unique experience an externship offers you. Why? Well, if my hospital won't pay the $40 discounted rate for their established nurses to stay in a nearby hotel during a blizzard or a flood when they need those very nurses for critical staffing, I doubt that they would pay for a student to have an educational offering or pay for housing when that student isn't contributing to improving staffing levels. Nurses co-bunk in any spare room on air mattresses. I doubt they will pay for a student hotel. Maybe I'm wrong...I'm probably somewhere between a realist or a pessimist here. But that sounds like it would be a pretty significant benefit give out and usually students don't get any kinds of benefits from hospitals, period. Usually the benefit is that the student gets the ability to practice nursing with a skilled preceptor in a unit of their preference for an extended time, which they can then list on their new grad resume. Externships definitely can help you land your preferred job as a new grad!!! That is a massive benefit!! My NICU externship was a big reason I got hired as a new grad in the same unit I externed in. That was my benefit. The externship indirectly takes away from the hospital's resources anyway because it is an investment of the preceptor's time...and that preceptor may or may not make an addition $0.25-$1.00 an hour for that role...so the hospital is paying to host you in a way. So if the preceptor is to make next to nothing for their time, I doubt the student would be making anything at all. I could be wrong. But I've never seen an externship have any financial incentive. YMMV. I agree a quick call to the program will let you know.
  6. PixieRN1

    Messed up bad.....

    Egads! That is truly a shame.
  7. PixieRN1

    Messed up bad.....

    Be very careful about going inactive! In VA, you have to have an ACTIVE nursing license to be eligible for the recovery program!! Please, please check the requirements of your state's program before you do that! You could be easily shooting yourself in the foot with that move. In VA, the only way to keep our licenses in situations as severe as yours and mine is to do these programs. If you are willing to do a recovery program, I would start the ball now and not wait for the BON to catch-up to you. You will have to do the time required by the program regardless, so there isn't a lot of point holding out if that is the option you would take if offered. I knew I was being reported. As soon as I got the contact info for my state's recovery program, I called. Things moved quickly for me and I had a signed monitoring contract in place just as the Board was starting their investigation. It was almost a year by the time I got the verdict regarding my discipline from the BON. Because I was in the program already and because of other mitigating factors, I was issued a stay of discipline; as long as I successfully complete my five year monitoring contract, there will never be discipline on my license for this event. Another reason to call is that these programs typically have lists of people that they approve to do your assessments, and another list of rehab/IOP facilities that they accept. It would suck to enter treatment and find out it's not approved. Yet another reason to start quickly is that you are more likely to get more out of your rehab now then you will maybe nine months later after the Board gets back with you and the cogs start churning. It's easier to swallow rehab when you have an active problem than it is when you have been clean for almost a year. At least I would think so. As for some of my personal experience, I made the choice not to lawyer up. I felt that my case was pretty darn cookie cutter for a very significant addiction and didn't see the point of trying to fight the accusations. Other people with lesser problems probably would benefit from a lawyer, but I knew I was in a massive pickle with no good way out; I was fairly pinned by the neck. All things considered, I received the best possible outcome someone in my situation could have had, with or without a lawyer. I got the elusive Golden Goose that is the stay of discipline. But again, I was dying in the hospital from sepsis and endocarditis thanks to my habit so pretty much anything else was a step up. I didn't think a stay was going to be possible...I was expecting a suspension or revocation. Best wishes and keep us posted!
  8. PixieRN1

    Best way into ICU

    Many PACUs require a year of some sort of ICU experience as well.
  9. PixieRN1

    Code Blue

    A 15 year old girl...she had been on our unit as a frequent flyer. First she had infectious cardiomyopathy of unknown origins, in and out of heart failure. She eventually had a CVA that landed her back with us. She stepped down only to come back to us in worsening heart failure. After just two days on the transplant list, she got her heart transplant! We were all overjoyed for her and her family. She was back in her room fresh post op looking great. We were prepping to extubate shortly! Something like 15 or 20 minutes later, she coded (never was extubate). I'll spare the details, but she got crashed onto ECMO. She was losing blood somewhere faster than we could replace it. I've never seen a human that white before or since. Official cause of death was a ruptured aorta that the ME attributed to aggressive chest compressions during CPR...but that still begged the big old question...why did she code in the first place?? We never did find out. She was declared brain dead and the family removed life support/ECMO three days later. She was an AMAZING child and her family was some of the loveliest people you would ever meet. Every staff heart was broken over that situation.
  10. PixieRN1

    Old Dog, New Tricks

    I recently switched specialities and I look forward to the day when it feels like a bit of a rut! In my younger years, I spent several years in a specialty, would get bored, and then bounce to something new. I liked that and it served me well. That being said, at my age, I'm ready to plant some roots for a while, get the perks of some real seniority, and hopefully enjoy becoming an expert at some point in this specialty. I've been around the playground long enough to know that my days of adrenaline seeking and pushing myself to the physical limits are slowly winding down. That was part of the massive specialty shift for me, but not all. Who knows? Maybe I will follow my historical pattern of boredom and move on to more aggressive waters again, but I just don't know. At this point I'm looking forward to the day where I am a senior (seniority wise!!) nurse on the unit and and have the comfort level that comes with being an expert nurse in that unit!
  11. PixieRN1

    Nursing notes & legal stuff

    I don't use that phrase in my notes, although some of my peers do. I'm of the school of thought that my exact job is to monitor the patient on an ongoing basis. Why state the absolute obvious? To be sure, it is a generic filler, unless you caveat what exactly you will be monitoring. The diaper rash? The A/B/D events? Everything under the sun? I too leave nursing notes for the things that I can't tick on boxes. And in your case, in NICU, the job expectation is that you will be watching the Tele monitor for spells, you will be assessing that diaper rash q diaper change, you will be monitoring for any changes, yada, yada, yada. That's in policy as part of your job. I don't think the phrase is going to land you in hot water, per se. It's pretty benign. But it seems superfluous. And I'm always against superfluous charting!
  12. PixieRN1

    Per Diem Agency Interview

    If they drug tested you and had you fill out paperwork, that all sounds very good. For big organizations, a week isn't any time at all. I would let your email do it's work. If you haven't heard back in another week since the email, then calling would probably be appropriate. It sounds like you are in a good place; I think it's fine to hang tight. Keep us posted!
  13. PixieRN1

    Propofol Infusion syndrome?

    The etiology is poorly understood; it's thought to be related to direct mitochondrial respiratory chain inhibition and/or impaired mitochondrial fatty acid metabolism. Acute neurological injury is a predisposing risk factor, so that didn't help my patient either. As for Thiopental, it has precious little research in the pediatric population, aside from some surgical uses as an induction agent to reduce ICP in certain surgeries. So I personally have never seen it used in the PICU. Kids on propofol are supposed to have routine lipid panels done, as well as CMPs, lactics, CKs, and ABGs. I don't know what the policy was at the outlying hospital. The problem is, in my experience, once you figure out what is wrong, it's awfully hard to swing the pendulum back in the right direction in these kids. Especially if the hospital doesn't have the equipment to handle the complications. When they crash, they crash hard, fast, and often don't like to cue you in. I do know that propofol infusions are much safer in adults, although the risk is there. In peds, we are just very clever in creating cocktails that can avoid a prolonged propofol infusion. Once you've seen someone die from propofol infusion syndrome, you never want to see it again.
  14. PixieRN1

    Propofol Infusion syndrome?

    I don't know how it works in adults, but the risk of this is sky-high in pediatrics. We NEVER EVER EVER EVER use it for more than 24 hours. Ever. Adults I believe is no high dose therapy (4 mg/kg/hr) longer than 48 hours. We will move earth, wind, and fire to find any other combo that will work remotely well enough to substitute. Even if we know propofol would keep things copacetic and in the comfort zone and switching would be less than ideal, darn tooting we switch. My philosophy: Don't **** with propofol outside of evidence-based practice. At least in pediatrics!!!
  15. PixieRN1

    How do I survive this schedule?

    I would drop the second job before abandoning nursing all together. Abandoning your profession is drastic; it seems like losing one job first would be the less drastic option. Even if you need the money, working one job with OT would seem less stressful? I don't know. YMMV.
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