Another popular thread titled "Oldie but goodie" inspired this post. Being a nurse with only 6yrs experience, I unfortunately don't have any great stories of the way things used to be done. However, I have been a part of some pretty cool, newer innovations and am curious what others have had the opportunity to take part in.
I remember working with the newer Heartware LVADs when they were still pending FDA approval, and thinking how cool it was that they plugged into the wall or a cigarette lighter, the first time I had a pt have a balloon pump inserted, and using an Alsius machine for therapeutic hypothermia and to treat a hypothermic trauma pt.
Not something I have done but rather something I've learnt. Sildenafil, aka Viagra, can be used to treat pulmonary hypertension. I haven't had to give it to a patient for this yet. Boy, will that be something when I tell a patient guess what, the doctor prescribed Viagra. And I can only imagine what can happen when I educate patients (male patients especially) on the side effects.[/quote']
One of the older infants I have taken care of (former 25-weeker now 7 months old) was on viagra q8hr after having a pulmonary hypertensive crisis 2 months prior and they couldn't get her off iNo any other way.
Precedex. The first time it was ordered by a new ICU attending I remember looking around and asking, "why are we not using this drug all the time?"
Precedex is the bane of my existence. Every now and then we get an attending who thinks we can replace propofol running at 80 with precedex...of course only titrating by what, 0.2 q15 minutes? Or something like that... Anyways I have yet to see it work. I find that flooding their system with haldol is a much more effective method of improving delerium and weaning sedation. Of course I really don't think our docs prescribe Precedex appropriately, it isn't really meant for the people flipping out in the bed and swinging at you...
My favorite things are watching TPA work- I hate neuro patients but it is awesome to watch deficits disappear like magic. I would love to learn more about monitoring cardiac output from arterial lines. I know the technology exists but need to find some good resources so that I can understand how it works. So many of my patients would benefit from better hemodynamic monitoring but placing a swan-ganz is almost always contraindicated for my population. I suppose running CVVH is a pretty cool thing that I get to do, but in all honestly it can be pretty irritating!
Precedex is the bane of my existence. Every now and then we get an attending who thinks we can replace propofol running at 80 with precedex...of course only titrating by what, 0.2 q15 minutes? Or something like that... Anyways I have yet to see it work. I find that flooding their system with haldol is a much more effective method of improving delerium and weaning sedation. Of course I really don't think our docs prescribe Precedex appropriately, it isn't really meant for the people flipping out in the bed and swinging
We had an extremely agitated patient on Precedex. It didn't do diddly, and that was in addition to ATC Haldol and Ativan. We could NOT calm him down. He wasn't even sleepy. Despite our attempts at sedation he ended up in 4 points after kicking a nurse in the crotch.
I had never taken care of anyone younger than 12 - until I just went to a rapid response that turned into a code blue for an infant. It was different, but definitely ten million times easier than doing compressions on a 500-pounder. It's almost enough to make me want to work NICU.
HyperSaurus, RN, BSN
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