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Propofol is a great drug for quick weaning. It has an extremely short half life. There is absolutely no reason to leave a patient on psv overnight when they are clearly failing. With a respiratory rate in the 40s tachycardia and hypertension you need...

This just came up in my unit recently. Its absurd. I guess next time I start norepi on a crashing patient I will start at 0.5mike and then wait 5 min to increase by another 0.5 ARRRRGGGG stop the madness Is JCAHO run by nursing theorists?

This has happened to me twice recently. I have had some very sick patients on bipap (DNR) who were near death. When the patients desaturated, and I suggested to the respiratory therapist (both times already at the bedside with me) to turn the fio2 up...

My belief system? The cascade of the dying process? Is this about nursing theory? Are any of you icu nurses?

This isn't a nursing book, but I liked it better than all the critical care books I read. It covers lots of physiology that's relevant to icu work. Clinical Anesthesiology by Morgan/Mikhail/Murray Also check out emcrit.org and lifeinthefastlane.com

Wow, I guess I should just start a morphine drip the next time I respond to an Rapid Response call on the floor for a DNR or Limited code patient. Or maybe just refuse to treat them and go back to the unit. And never give anyone 100% fio2 because it...

One patient was DNR but we were trying to keep him going until his family got there. The next was a meds only code. So in both cases I had an intensivist in the room and we were giving pressors and code drugs. I don't like it when really sick DNR pat...

I agree that more volume (dry?) and maybe blood (low hct?) might be good options when you are on multiple pressors. Steroids might help also. Lots of people think bicarb helps, but after reading lots of books I'm not sure its a good idea. I have give...

I think you would need to know a lot about physiology to understand why a low pH kills patients. I don't understand it really, but from what I've read at some point your body cannot carry out the cellular functions necessary to sustain life once your...

Do the Pass CCRN practice questions like crazy and if you can do well on the practice test you're good to go for the real one.

wow i have never heard or read anywhere that levophed dilates the coronary arteries. it might increase coronary perfusion by increasing diastolic arterial pressure. maybe you are thinking of nitroglycerin? levophed has some effect on beta receptors ...

yeah i agree don't bring a bunch of stuff into the room. if the patient is sick the last thing you want is a bunch of cleaning supplies getting in the way. you can get that stuff when you need it.. i don't like to wait until the patient is throwing ...

I think experience is the best teacher but here are some good resources for learning outside of the icu: Pass CCRN (throw the book out but do the practice questions on the cd) Emergency Management of the Coding Patient (its going to happen sooner or ...

I just want to recommend to everybody to check out some of the great resources on the internet, especially if you are relatively new to the icu. Some of the info is over my pay grade (c-spine clearance, PE risk stratification, etc.) but lots of it ha...

I studied for several months before I took ccrn and passed. I read a lot of medical stuff on my own (especially relevant topics in Anesthesia books like physiology and meds). I watched the gasparis videos and they were ok but not that useful in my op...

i think the last couple posts are really useful. also you want to see the o2sat and the pao2. the sat on the abg and the spo2 on the monitor will be pretty close. you want the sat>90%. sat is the % of hgb saturated with 02. Cardiac output, arter...

PASS CCRN - the book comes with a cd of practice questions, if you can pass the practice test you should be fine on the ccrn. that's the best resource. i thought the other stuff mentioned was ok but not nearly as important. the internet has some gre...

when i was brand new in icu i asked some more experienced (20-30+ years) nurses about the ccrn test and they told me i had no business studying for it. the test isn't that hard and studying for it will force you to learn some good stuff. i say start...

I say study and pass the CCRN. The only resource I think you need is the Pass CCRN book (throw the book away and use the cd of computer questions its just like the test). Also check out these podcasts/blogs: emcrit.org, emrap.tv, ercast, icurounds, r...

i guess this isn't the point of your thread, but... there is some research which shows that morphine is not great for MI patients. http://www.dukehealth.org/health_library/news/8243

one thing i think is important that is not usually mentioned: after you get a flashback, you actually need to advance a few more millimeters and then stop the needle and advance the catheter. once i started doing this my % of good starts improved a ...

For what its worth- I worked at my first RN job in 2005 at Vanderbilt on 9North surgical stepdown. I think my base pay was $18/hr, night shift differential was a few dollars then there was also a weekend diff. I worked 12hr shifts with 36 hrs a week....

why not just hook it up to a transducer and see what kind of waveform you get?

I need some help with assisting with line insertion. It seems like half the time i assist with this procedure the md gets ****** off because I screw something up. So I thought I would list the steps and if anybody feels like adding anything I would a...

I feel your pain. seriously, its a difficult job and it causes a lot of anxiety. its a painful learning process sometimes but i think it just takes time. My first couple years in icu were tough but I got more comfortable. besides gaining experience, ...