As The Hospital Pervs-- It's Overtime Time

[sweepthefloor]

I jumped to atrial flutter eyelash batting, but we are not there yet.
It's automatic.

 

[sweepthefloor]

Conduction Pathway

Where are the electricians in the house, in the heart?

 

[sweepthefloor]

This is more fun: The Heart please Ride The Lightning

Real Questions and rationales.

 

[sweepthefloor]

I love being pulled from ICU to ED.

Help me!

 

[gotsnowgotslush]

Awww! Videos, in time for Valentine's Day. I can only wink with my left eye. My eyes are not ambidextrous. That limits what I can demonstrate. *sigh*
Some people are gifted with the ability to wink each eye, alternately. Add that ability, to being able to smack their lips, and that could add up to a three ringed circus.
(Three chambered circus ?) Some people have the ability to wiggle their ears. I used to copy my cousin, and wiggle my ears. I have no idea how to do that, now.

Knowing how to control all of those movements, would take so much practice! Useful, if someone was an actor or an actress, I suppose....
(We had time when were were children. Now children hurry up to catch a ride to the airport, and wait, and wait and wait. "Simon says, wiggle your ears!"

 

[sweepthefloor]

Dear Snow Slush--
I didn't even think about Valentine's Day, but now that you have reminded me I think it's Cardiology awareness month-- Go Red and all that. It makes sense that I am studying Cardiology, and I didn't even know it. My life works out like that a lot.

I can't wiggle my ears. I can wink alternating eyes but I have to use accessory muscles to do it. We are all actors and actresses. The children and time, it goes by so slow but so fast at the same time. I was never at the airport then, but I remember playing with jacks and marbles. Childhood has been given an extension in these times for better or for worse. In my childhood setting, I was out young and it was expected. The child days were packed with experiences that were useful for adulthood.

I will carry on with cardiology and videos. It will probably take me the rest of the month to finish. I still haven't gone through abnormal heart rhythms, invasive hemodynamics, cardiogenic shock, or all of the cardiomyopathies. They give us the breakdown by percent of what is on the exam. Cardiology is a big one. It's a shame that these videos are a secret, I think my work friends would get a great laugh.

I will be using my eyelashes again for rhythms.

 

[sweepthefloor]

On a Sunday

I wasn't late to work, I was getting there on time by my usual method-- speeding.
The trouble with Sunday's is that there are less cars on the road at 6:30am.

I am racing down the highway and guess what? I got pulled over by the State Trooper.
He comes on over to my window and I hand him my documents and tell him: my registration is expired.

Trooper: Do you know why I pulled you over?
Me: Speeding.
Trooper: When you passed me you were clocked at 85mph, after that you raced up to 95mph, and I could barely catch up to you.
Me: I didn't realize I was driving that fast.
Trooper: Can you turn the radio down so I can hear you?
Trooper: Where are you going?
Me: I am getting to work.
Trooper: Where do you work?
Me: I work at the Trauma Center.
Trooper: What do you do there?
Me: I am a Trauma ICU RN.
Trooper: Do you have your work badge?
Me: Yes, it is right here.
Trooper: I will be right back.

Trooper: Why haven't you renewed your registration, and why were you speeding? I could have your car towed for the expired registration.

Me: I am a poor excuse for a trauma nurse speeding, and I am a poor manager of my personal time.

Trooper: Here is a warning. I won't ticket or tow your car.
Me: Thank you so much, I don't want the night nurse to be pissed at me for being very late. Are you working 24 hours?
Trooper: No, I am done at 6pm.
Me: Alright, you won't catch me on the way back. You will be home by the time I get out and I will obey the speed limit.
---
I am a poor manager of my personal time, I said that once before in front of a judge for some other document offense and missed court dates for minor vehicle related problems.

It's the truth, some people love the truth.

 

[sweepthefloor]

On a Sunday

I got out of the speeding ticket, but I didn't get out of my turn to be pulled to the Emergency Department to take care of the ICU holdings, waiting for a bed. I didn't have time to assess the unit to find out if I had a chance of bringing my patients up at some point in the shift. I just left to relieve the night nurse trapped in an ED nightmare.

I picked up two ICU patients. One got written to step down so I transferred that one up. I got back and picked up another write down, and kept my true ICU stable the whole time. I picked up another write down without even being asked to then I stayed with my one patient and did my work. I watched the environment around me. I noticed that one ED RN was getting hit hard all day long with high acuity. I couldn't understand why they were slamming her, I guess they were all busy and didn't take into account the acuity.

What is an ICU RN to do? I realized that the teamwork in ICU is far better than ED teamwork on this particular day, I don't know how they usually roll.

And here comes another patient for the slammed ED RN. The patient has a blood pressure of 200/120. The MAP is sky high and the heart rhythm is in the 50s. The pupils are unequal and the patient isn't talking. The ED RN goes to CT scan and I check on her other patients. When she gets back, Neuro-Surgery shows up and it's a big brain bleed. Who would have guessed? Me. They want her back to CT for a CTA-- in the meantime, the ED MD is intubating the patient for the decreased level of consciousness, wants Cardene infusion to control the pressure that is no doubt busting more blood on the brain. The ED MD is talking to me as if I were the RN for this patient.

The ED RN was so busy at the same time she was transferring a child out to a children's hospital. I told her: You chart, I am going to CTA for you with the patient because most likely this patient will go to OR directly from CT department. I will meet you somewhere out there. She couldn't believe it.

We ended up taking the patient to Neuro ICU together with the Respiratory Therapist.

At 7:15 my patient got a bed assigned to my home in the Trauma ICU. Guess what? She gave night shift her report and rolled my patient up, with me and the Respiratory Therapist.

We hugged each other out.

When I finally walked out of the Hospital I realized it had snowed. I was thrown into Dante's levels of hell for twelve hours with no windows.

So, the plow truck man cleaned off my car, and I went home.

 

[GoddessTink]

Have you taken CCRN or still studying?? I took it last summer after 4 years Icu and trauma neuro, so if I can pass it, I'm 100% sure you can. Before I took it, I was very intimated by people studying for CCRN. After taking it, it wasn't that bad really. Nurses like to scare each other. Honestly, not bad.

Your young patient with the pink frothy and ARDs, they do HIV testing? History of chemo? H1N1? Drug history? I read a lot of charts, I have a lot of ideas.

I lost a young one who had had aggressive chemo for his non hodgkins. Killed his lungs, we had him on flolan and did NO with his peep of 20 to try and oxygenate. We got used to his sats being low 80. He got bilateral pneumos on my shift one night, with crepitus to the top of his head (his eye lids were crunchy) down to his knees. I loved his family. I still feel horrible. He was my age and I had a huge dose of mortality with him.

Anyway, any concerns for CCRN Let me know I'll be happy to talk you down. By the way, we have similar voices lol

 

[sweepthefloor]

Have you taken CCRN or still studying?? I took it last summer after 4 years Icu and trauma neuro, so if I can pass it, I'm 100% sure you can. Before I took it, I was very intimated by people studying for CCRN. After taking it, it wasn't that bad really. Nurses like to scare each other. Honestly, not bad.

Your young patient with the pink frothy and ARDs, they do HIV testing? History of chemo? H1N1? Drug history? I read a lot of charts, I have a lot of ideas.

I lost a young one who had had aggressive chemo for his non hodgkins. Killed his lungs, we had him on flolan and did NO with his peep of 20 to try and oxygenate. We got used to his sats being low 80. He got bilateral pneumos on my shift one night, with crepitus to the top of his head (his eye lids were crunchy) down to his knees. I loved his family. I still feel horrible. He was my age and I had a huge dose of mortality with him.

Anyway, any concerns for CCRN Let me know I'll be happy to talk you down. By the way, we have similar voices lol

Thanks! I have heard that it isn't as bad as we say it is! We do like to get all worked up and dramatic. I am still aggressively studying. I should slow down.

The young patient got extubated on my time day two, still coughing bloody sputum, and short of breath but managing. I didn't want him extubated but his weaning parameters were perfect, and so was the ABG. HIV and Influenza were both negative, no drug history but echo did show some vegetations on his heart, or it could have been thrombi. No history of cancer. He did come in with rapid afib and was cardioverted along with the respiratory problems. I presume the afib was secondary to some kind of pulmonary exacerbation. I had a sense of impending doom the whole time with this patient. I started to feel better-- and I was off for a few days so I am not sure if the AFB was positive for TB.

The dose of mortality is real. I empathize with your experience. Sometimes it is just the craziest and unexplainable.

Reading charts: A patient came in with angioedema from a peanut allergy. The patient went to CT scan and was intubated for airway. I read the CT scan indication and it was typed, or dictated--

Indication: Allergy to penis.

I thought that was funny.

 

[sweepthefloor]

Chest Trauma

 

[sweepthefloor]

Anyway, any concerns for CCRN Let me know I'll be happy to talk you down. By the way, we have similar voices lol

Concerns: So, what's on the exam that I wouldn't already know from experience?

 

[sweepthefloor]

Tamponade and Cupcakes.

I am taking a break now. I might take a nap or fix my chipped nails.

 

[GoddessTink]

Mmm I was concerned there would be EKGs I need to read, nope. They did ask a question about it. Only a few questions about hematology and oncology stuff. Neuro, cardiac, and pulmonary are your bread and butter on there. If you're not googling things at work, then you're probably going to be fine. I had a book with practice questions and rationales for answers. That's all I used to review. And life experience. As long as you're a decent test taker you'll be fine. It's like every nursing test "what's the least wrong answer" is what you pick.


I wrote an admission note and wrote "pt is currently hemodynamically swimming" my NP that was reading it started cracking up. Oops. Don't sing nemo songs next to me.

I love reading the notes that have been dictated by the ER docs, they usually have non sensical things in there.

 

[sweepthefloor]

I passed the PCCN exam when I worked on telemetry. I studied well and did lots of practice questions. The exam wasn't that easy. It had more than a few: "If ST elevation is in this lead on ECG, what vessel is most likely occluded?" and then there was a question about the side effect of lidocaine infusion and the liver.

I was surprised.

I know the least wrong answer, when all the answers could be right. I am a good test taker.

I am going to start next with invasive hemodynamic parameters and what they indicate. I have a good hemodynamic swimming baseline. We don't use Pulmonary Artery Catheters (Swan) so I hope there aren't lots of questions about that.

 

[Byron In Exile]

I passed the PCCN exam when I worked on telemetry. I studied well and did lots of practice questions. The exam wasn't that easy. It had more than a few: "If ST elevation is in this lead on ECG, what vessel is most likely occluded?" and then there was a question about the side effect of lidocaine infusion and the liver.

I was surprised.

I know the least wrong answer, when all the answers could be right. I am a good test taker.

I am going to start next with invasive hemodynamic parameters and what they indicate. I have a good hemodynamic swimming baseline. We don't use Pulmonary Artery Catheters (Swan) so I hope there aren't lots of questions about that.

Is it possible to derive hemodynamic parameters without being invasive?

That seems a bit much for a first date.

 

[sweepthefloor]

Is it possible to derive hemodynamic parameters without being invasive?

That seems a bit much for a first date.

Yes, minimally invasive, and non-invasive predictions. It just depends on how sick you want to get with me.

 

[Byron In Exile]

Yes, minimally invasive, and non-invasive predictions. It just depends on how sick you want to get with me.

I want to get sick with you in a non-invasive way.

I want to be able to die in your arms and have you tell me it'll be alright even though you have no idea and don't know shit about what it's like to actually die. I don't believe it. What I want is for my last thought to be that YOU believe it. That someone is still there who believes it. That's all anyone could ask for, really.

And if Dante was right, then that's yet another adventure.

 

[sweepthefloor]

I want to get sick with you in a non-invasive way.

I want to be able to die in your arms and have you tell me it'll be alright even though you have no idea and don't know shit about what it's like to actually die. I don't believe it. What I want is for my last thought to be that YOU believe it. That someone is still there who believes it. That's all anyone could ask for, really.

And if Dante was right, then that's yet another adventure.

I won't tell you it'll be alright. I will hold you in my arms, and push morphine till you tell me it feels alright. I will believe that, and whisper to you all the things I want to say. Things we will believe.

 

[sweepthefloor]

I was the girl with a boyfriend that drove me to work in the snow with his truck.
And that was always a dream!

Remember the night I drove home during a hurricane? It was scary and dark.
I only pack the sleep-over bag if I am scheduled back the next day. I am back tomorrow. I have a bag, but I don't plan on staying.

The weather man is making me mad: Stay home!

Yeah right jerk!

 

[gotsnowgotslush]

You are one of the essential people. You are wanted and needed! Your secret is kept by other essential people.
Now, be careful driving, because I will be worrying about you.

 

[GoddessTink]

I do believe I had several swan/invasive monitoring questions. I'm 100% sure I guessed. I had two swans ever and one the balloon ruptured so it was just a fancy line. Sepsis was big. And I didn't get any "where is the MI occurring".

Like i said, if you can critically think you'll be fine.

Oh! One question that I encountered involved the use of albuterol for hyperkalemia. I'd never heard of that until about a month before the test. Oddly it was on there.

 

[sweepthefloor]

You are one of the essential people. You are wanted and needed! Your secret is kept by other essential people.
Now, be careful driving, because I will be worrying about you.

I made it home and back! I wasn't sleeping over. I will just get up at 4am and do it again tomorrow.

 

[sweepthefloor]

I do believe I had several swan/invasive monitoring questions. I'm 100% sure I guessed. I had two swans ever and one the balloon ruptured so it was just a fancy line. Sepsis was big. And I didn't get any "where is the MI occurring".

Like i said, if you can critically think you'll be fine.

Oh! One question that I encountered involved the use of albuterol for hyperkalemia. I'd never heard of that until about a month before the test. Oddly it was on there.

I have heard about the albuterol, but I have never seen it utilized and I wonder how effective it is. I am going to find out.

They should take the swan/pulmonary artery catheters off the test because unless you are in a specialized open heart surgery unit the benefit doesn't seem to over ride the risk. We have only had a few and they were all transferring out to a higher level of cardiac care. I will be like: You want me to wedge a pulmonary artery? I don't think so! Pushing cold saline to get a cardiac output? What kind of crazy work is that?

Anyway for the trauma surgical patient we have this great Vigeleo Monitor. It's less invasive set up with just an arterial line. It's awesome! It gives: CO/CI, SV/SVI/SVV. It will also give SVR if you plug in the CVP number. I have seen it in action and it works: Suddenly the patient has a high SVV-- and you give some fluids, the SVV goes down and the CO/CI improves. It's great goal directed therapy. I like it. They also have another transducer that can hook up to the CVP to provide SvO2 monitoring.

Anyway, I know the normal parameters for hemodynamic monitoring, and I am a good test taker. It's kind of fun to practice and realize that I know more than I think I know. I am going to review the medications that we use everyday, and I like studying once I get obsessed. I am aware that going in too deep is not a good idea.

Sepsis cascade and multi-organ failure will be a breeze because 1/2 of our patients are septic or turn septic. Always looking out for early sepsis. Most of our severe traumas end up in ARDS, so I am good there. Neuro: I have a strong foundation. Renal: I got that too.

Hahahahaha! I am ready to take the test! Not, really but I won't delay too long.

If you think of anything else that you remember! Let me know please!

As soon as I choose my test date I will let you know. I plan on sometime in early April or late March.

 

[sweepthefloor]

I forgot to mention that I can be the sweet thing in this world but when I get angry it's a whole other animal.

Yesterday I left my house two hours early-- not to just get to work on time, but to relieve the night nurse. We don't need the hospital overhead system blaring in our ears about some kind of emergency response plan that means no nurse can leave till the next shift has arrived. We just show up. Everything was great, I got him out early by five minutes. I took fast easy report.

Last night, he showed up on time but trying to give him report while he barely listened to me because he was checking his phone and listening to voice messages on speaker phone was annoying.

It's true he knew the one patient from the night before, but there were many changes.
It was so rude, and that is not like him at all- but I still flipped out.

Me: You are a RN-- figure out what I did all day. Bye. Oh, and all the urine is yours.

This is on top of the fact that he didn't roll the patient the night before-- the A line transducer, and CVP transducer and every drip infusion tubing was outdated. No nurse wants to roll an unstable patient but if my patient is going to code-- it will be a clean code.

And I made a mess changing the A-line transducer. I turned the stopcock off to the patient, but removed the stopcock to change the whole line!! It's a good thing I had clamps in my pocket to clamp the A-line bleeding. I made a bloody mess and then cleaned it all up.