Ask a Critical Care Nurse Anything. I'm all ears and drunk on rum. HIPAA rules apply

Ask a Critical Care Nurse Anything. I'm all ears and drunk on rum. HIPAA rules apply

Other urls found in this thread:

youtube.com/watch?v=StIcRH_e6zQ
twitter.com/AnonBabble

my dick hurts can i get the succ

I like zootopia if that will get your attention. (not a furry)

unless they invented machines to magically let me create a girl/guy to suck your dick then no.

How does it feel to watch people die?

Do you do transports or are you hospital only?

How about this. Ever fluid that that body has to offer has landed on me... all of them...

Was a paramedic then worked to be a nurse in the hospital. Field work sucks and pay is not as good as the work... depending on where you work.

How many people have you seen naked? Is it true that males sometimes get less modesty than females when it comes to bodily privacy?

Are your currently hiring MA's?

even jhizz?

To thank you for your help. I was in critical care for years ago. I got into a car accident.

It sucks, though a lot of the time when people die it is generally a good thing. 9 times out of 10 people who are dying in the hospital need to die but, because their families want them to live so much they keep them alive through any means necessary.

I have seen people kept alive by ventilators and iv pumps for months even though their brains have been dead for the entire time. I have seen family put confused patients through horrific ordeals(sp?) just to get them to live a little longer. I have seen wards of the state live for god damn forever because the state is not allowed to make them a DNR even though the patient says they want to die...

When I went into nursing I was all for working towards saving people. Now... after years in critical care, I preach quality over quantity of life.

That applies to the dying and the living...

Do you get to bang the other nurses? Also, do you deal with a lot of alcohol related incidents?

Actually. Most older people don't give one tenth of one shit what people see. It is a rarity when an older person is modest. I think they (like all of us) realize that we all have the same parts (more or less). and that when we are sick, it doesn't matter who sees what.

It's not surprising that alot of older people are nudists later on in life

yes even "jizz" and yes it sucks. btw. Withdrawl patients tend to cause this phenomenon

thanks for that :)

Explain the relation between withdrawal and jizz, pls.

Oh yean definitely i know that a little too well. Well hey congrats on the jump over to RN. I'm on my way there myself. Whats the dumbest shit you've seen administration, doctors, and other nurses do in the hospital?

>Story time

Well, I didn't get to because I was focused on nursing school and working at the same time. However, I found out later that two of my class mates banged their way through the first semester. They cheated off their gfs work through the courses.

As far as banging nurses after graduating. No. I know of only 2 couples between three hospitals that I worked at that got together (even as one night stands or flings/etc). Most nurses that are trying to sleep with their coworkers focus on doctors. I know of one nurse that did so until she married one.

IMO young people tend to be more shy about their bodies nowadays. I'm not a physician or clinician but I've just noticed a general trend of it.

Will a ruptured achilles tendon really heal properly without surgery? How would it reattach?

Withdrawl people don't know what the hell is going on and are hallucinating. They decide to jerk off because they are confused and horney. You do the math.

You work ICU or ER?

ER doc checking in

Post a pic of your scrubs and a timestamp too.

Was there ever a patient that came in for treatment that you knew wouldn't be able to be treated?

Anything like severe drug addiction, obesity, or other habits that you knew no amount of doctor's recommendations would fix?

Story time
>be me
>RN at random hospital
>working one day with a student nurse on the floor
>Instructor tells student to administer medications to my patient (easy shit all oral).
>lessworkcool.jpg
>5 minutes later: patient is crashing!
>RRT called and all staff to room. Patient can't breath and BP is crashing. WTF
>ask the student what happened?!
>"I don't know I just gave this mucyomyst IV and the patient just crashed."
>OMG.jpg
>"YOU DON'T GIVE mucymyst IV!!!!"
>muycomyst is bottled in the same vials as IV meds are.
>student didn't look at the route the med was supposed to be given (rookie mistake)
>patient goes to ICU (lives)

After that RT gives muycomyst and nursing students have to have RNs in the room any time they are giving meds.

favorite part about job?

worst part about job?

how bad do the patients smell?

worst injury that a patient had?

how many times do you or the doctor fuck up?

most notable thing that you did on the job?

What's the best foreign object that has been in someone's butt, and/or best explanation by pt of how it got there?

What's the survival rate of a deep knife wound to the stomach?

depends on how bad it is. Your body would reattach it though it would be with significantly more scar tissue if it was a bad rupture and it would limit your ability to work it appropriately. Go so a doctor and follow his advice.

ICU and progessive care

and thanks to the ER doc checking in!

Lawlz. That's terrible, haha. Should have gotten a doctor's order to read and follow directions.

Anytime, do you need me to put any orders in?

Thanks. Dr. says they don't do surgery on achilles anymore, just boot with the foot down. Seems dubious to me. Also wy do so many nurses have disproportionally large asses ?( not a bad thing).

All the time. There are sooooooooooooooooooooo many problems that can't be treated and can just be managed. Even then there are times when we can't do a damn thing.

Biggest thing is smoking. People who have smoked for 15-30 years even after quitting still are screwed because their lungs are damaged. We can give them all the oxygen we can and they still will suffocate eventually.

One of the worst deaths IMO.

Nothing like a death rattle from a smoker

I'm gonna need an order of at least 3 stories of dumb shit that's happened in your ER that you think are funny.

Nursing student here, likelihpod of me getting into ccu with just an rn? I really wanna be an anestitist but hear ccu experience is needed

survival rate is good. The recovery sucks balls. Think of all your gastric fluids (acid, food, stool) leaking into your abdomen. It hurts like hell. After that... if you're REALLLLLLLY lucky. You will not develop any complications...

However, I have seen people with severe complications including what are called FISTULAS.

Your bowel is very good at regrowing. However, it can grow into the wrong places including trying to grow outside your abdomen causing "fistulas" Basically your bowel is trying to grow outside your body.

People with this problem spend more time in the hospital than any other kind of patient.

What's the most inappropriate thing a patient or fellow RN has done to you/tried to do to you?

Rape in the ER room

ICU RN checking in, well, 12 years ICU, most recently interventional radiology

easy.

However, My suggestion from a LEARNING stand point is to start in a stepdown/progressive care unit and then transition to an ICU. Starting in an stepdown/progressive care unit gives your the TIME MANAGEMENT chops that you will need down the road. I have known many nurses that have wanted to be nurse anesthetists that have failed because they went straight to ICU first. Learn Time Management and then go to ICU.

>I have a masters in health adminstration

It takes a brave man to face Emphysema...

Go on...

Well I'll give you the good story first. Didn't happen to me though.

>be me
>Night RN
>boring night because people are stable
>guy who is a huge prankster working
>gives a patient lasix overnight
>has some left over
>whatdo.jpg
>decides to spike co-workers drink with rest of lasix
>co worker going to the bathroom ever 15-30 min for 4 hours
>he has a good laugh and tells coworker
>nurse is fired one hour after end of shift.

The most inappropriate thing I've experienced is older patients hitting on me hardcore... Like they would get on me if they could get out of bed readily...

OP here. Agreed. Especcially when patients are dependent on Bipap to live.

For those of you who aren't familiar that means wearing a mask with constant pressure pushing air into your lungs in order to keep you alive and if you come off it you die.

op here, what stories do you have my vented happy friend

How fast is a deep cut in the palm suppose to heal? I had sliced mine open before and it was sealed up after like 1 to 3 minutes

One thing I have learned is that families need to accept death and dying a lot more readily than they do... I think it's a cultural thing. They feel that if they give up on their family memeber or let them die that they are failing them. They don't realize that the compassionate thing to do is to let them die because everyone dies at some point and sometimes quality of life is better over quantity

Hi wolverine.

Ok seriously, a cut can clot in 1-3 minutes but it will take about a month or more to heal depending on age and health factors (and if its your masturbating hand) :P

atul gawande? is that you?

Didn't just clot, i couldn't pull the cut open to clean it thoroughly

wow... good reference but no I am not he. I don't get paid that much nor do I have a wikipedia page.

The only thing I have published is poetry when I was in high school.

Then it wasn't deep? or you're weapon x

It was deep enough to mess up the lines in my Palm and see it flap open quite a bit

OP here.

PSA: Make a living will and get a DNR order if you do not want to be resuscitated. So many people say they want to be DNRs but do not sign documents making them such before they are unable to. Then their families keep them alive forever.

Also decide if you want to donate your organs if you die. People need them dammit.

youre not a fucking super hero user, probably wasnt as deep as you thought or it clotted up and wouldnt pull apart, you did not heal up a deep wound in a few minutes
fuck off

What's the best size catheter for chest decompression? Any reason not to go for a 10 gauge?

Got nothing weapon x. Just heal up and go make some movie with ryan renolds in it.

I use 14, but I work pedi ER

.22 always works for me.

If I was a super hero I wouldn't have a 2.5 inch long scar from the cut

Depends on if you are going for a straight decompression or if you are planning on placing a chest tube. Circumstances also dictate what goes on.

Realistically, the only time you'll see a chest decompression in the field is if someone is a) OBVIOUSLY having air in their chest. b) have a really aggressive and experiences paramedic team and c) the patient will die if they don't do it or its a DAMN long way to the hospital.

Most times. They will transport to the hospital and place a rather large chest tube in to decompress the chest.

nah man if you're a veteran medic in a muncipal fire-based EMS in a real city... is RN pay at 8-10 years.

you CEN or CCRN?

shut up and enter your billing audit sheets

attending county ftw

Where I am at Veteran Paramedic pay in a city run fire department MAXES at 50kish if you don't do administrative work (though they do get a pension).

As an RN I make well over that without having to do any administrative work (though I do since it increases my pay significantly).

Oh and I am PCCN

LOL. I am actually doing some work from home right now. Day off tomorrow! Want to enjoy it. M&M on Monday, I do a lot of QA work so I'm looking at some incident reports and stats for last month :)

OP here. This is why you guys make money 24/7. Hats off to you! Also, don't get admit happy. it makes us floor nurses sad. :(

Straight decomp, in a pre-hospital setting. Mostly interested because I go out shooting and hunting, sometimes far from care, and I have a jump bag in my trunk.

I used to do CC EMS as an EMT with a rad RN who let me get hands on for a couple of years, so I have a lot of the skills pretty well down, but I don't know if it's ever contraindicated to just go for just go for the biggest fuck off cath you have if there's pneumothorax.

Also, another thought:
Any reason to prefer NS over LR or vice versa for hypovolemia? Or any better alternatives for a heavy bleeder in an "Oh shit we're 2 hours away from a hospital" situation?

look at top 5 municipal fire departments and what they pay. a few years in, average minimum $60,000 per year for 9-10 shifts per month and can rise to over $100,000 per year if you're a senior officer with incentive paramedic pay that bumps that another $7,500. EMS (Every Minute Sucks) varies so much from transfer posers earning minimum wage to struggling shit systems in mid-sized cities working 56 hours per week to scratch out $40,000 per year. One really has to plan out their life better if they want to make a career in EMS.

Also, CEN

ER MD. Whats the SADDEST thing you've ever seen?

Ah thank you! That's kind of you to say. I def try to keep admits to a (responsible) minimum!

Cseh

i can tell you that a 14g is the standard for adult needle decompression and which isotonic fluids to run for various conditions but if you lack any accurate current training along with monitoring equipment and clinical judgment, you're going to make the fuck-up that you're in, epic. so just call da ambulance and provider pinpoint location information. let's not turn this PTX into a HTX

another one here and that is very simple: FICA on my paystub.

Saddest thing I've ever seen was a pediatric case in a city outside of Boston that was notorious for rampant drug use.

A 16 month old girl was being watched after by her step-father, who nodded off on opiates and she managed to strangle herself on a string hanging from a curtain.

The step father comes to, does not call 911 and drives the little girl to the ER- We run an unsuccessful code - she was DOA but anything's possible. The stepfather did not really care, and actually had the audacity to ask for opiates to "calm down"

The saddest part was when the mother arrived and was hysterical.

Then the grandmother 10 minutes later, heartbroken over the lifeless body, sobbing and holding the mother of the child.

Then, the father, who compounded the sadness by letting out the must guttural scream of grief i've ever heard

Really sucked having to break the news 3x

If you are doing a straight decompression then the biggest one you have will work... However, you have make sure you are poking into the area where the air is. If you poke the wrong part, you will produce another hole that will cause the lung to fail even faster. This is why, in the field. It is a last resort. Size of that cath should be 16+ if you are doing that. You can make a makeshift valve as well to prevent refractive decompression (see youtube).

As far as NS over LR. LR has a few more elctrolytes than NS but as far as IV fluids (IVF) to use in an emergent situation it doesn't make that much of a difference. LR is preferred if you are loading someone with fluid but if you are giving someone meds post stabilization NS is preferred because it reacts with less stuff.

I know this from experience. I one pushed a med into LR and it turned into a solid in the line.

HUGS

unless they shit is burnt, old, or septic/dead, use saline. everything else is a crap shoot and noone got the damn time to read the compatibility sheeeet

how fun was YOUR testimony?

This is all in a hypothetical hours-away-from-care innawoods situation where lack of treatment will lead to death. I'm not dumb enough to go poking caths into anyone with my cert long expired - especially considering that my cert technically never even included poking caths into people. Strictly desperate emergency hours from care information only.

This about sums it up

Worst thing I saw was not someone dying but someone living. I took in a patient who didn't want a vent, who didn't want to suffer, who had lots of health problems. But she didn't tell her family.

The patient goes down hill and cannot make decisions for her self.

The family decides that they should do everything for her.

One trach and abdominal surgery later she is moaning Constantly no matter what pain meds we give her. She is mumbling gibberish most of the time but the one thing she says that we can understand is "kill me"... over and over again. This lasts for 3 months. The patient is fighting infections and her own chronic medical problems and trying to recover from the surgery and all the while she is saying "kill me."

The family says we need to do everything for her even though she wants to die.

I wasn't the when her heart finally stopped. I just know I cried many times before that and was grateful when she finally died because she finally had her wish.

LR is better from an electrolyte standpoint... check your shit.

>The family decides that they should do everything for her.

because that social security check ain't gonna cash itself.

These cases are absolutely heart wrenching. As a culture we need seriously evaluate quality v quantity in end of life care and dignity of the dying.

Really hard case. Nice work

OP here. because I can...

OP here unfortunately you are right more often then I would like to believe :(

ER doc 1 here. Last month my girlfriend and I broke up and she is keeping the dog :(

you smell like a basic emt.

you don't dump lactate into a renal or CHF pt you ignorant slut.

stop eating your shit.

Waters JH, Gottlieb A, Schoenwald P, Popovich MJ, Sprung J, Nelson DR. Normal saline versus lactated Ringer’s solution for intraoperative fluid management in patients undergoing abdominal aortic aneurysm repair: an outcome study. Anesth Analg. 2001;21(4):817–822. doi: 10.1097/00000539-200110000-00004.

Khajavi MR, Etezadi F, Moharari RS, Imani F, Meysamie AP, Khashayar P, Najafi A. Effects of normal saline vs. lactated ringer’s during renal transplantation. Ren Fail. 2008;21(5):535–539. doi: 10.1080/08860220802064770.

zootpia hugs

Ironically this has driven me to become a palliative nurse.

is that her under the plastic?

I think that's fantastic! How long have you been working palliative care? Were your expectations aligned with the realities of the job?

I imagine hypothetically if it ever came to it, whichever care I got to first would probably want to run their own line instead of trusting what some crazy bloody guy who just dragged his buddy in from deep innawoods did. Better to use LR, then? Or just KISS with NS? Any issues with LR already in the body for meds down the road, or is it just a concern while it's in the line?

Identifying where to decomp seems simple enough - Go for the side with diminished breathing sounds that the trachea id deviating away from, and steer clear of the heart and all those juicy arteries - second intercostal space at the mid-clavicle.

>you don't dump lactate into a renal or CHF pt you ignorant slut.
Not planning to go innawoods with anybody who needs dialysis, but good to know. Any other important contras?

youtube.com/watch?v=StIcRH_e6zQ

Not yet :P