When you begin taking care of patients who are on cardiac monitoring (AKA “tele monitoring”) you’ll need to chart a few key ECG measurements once per shift and any time there is a change in the rhythm. These are the PR interval, the QRS, the QT and the QTc. You probably are already very familiar with the PR interval and QRS measurements…but what is a QT and why do you need to measure it?
In this episode we talk about the basics of ARDS – Acute Respiratory Distress Syndrome. It is the most severe form of acute lung injury and is something we see pretty regularly in the MICU. Learn about the different stages that occur as ARDS develops, what you’re going to assess and how the patient is going to be treated in this episode of the Straight A Nursing Podcast.
ECMO (otherwise known as extracorporeal membraneous oxygenation) is essentially a life support measure used when the lungs or both heart and lungs cannot function adequately with traditional mechanical ventilation support. In ECMO, blood is drained from the body, diverted to an oxygenator where gas exchange takes place, then returned to the patient. There! Now you know everything you need to know about ECMO. Just kidding! Let’s start at the very beginning.
Before I start an “us” vs. “them” war, let me start off by saying that I cannot imagine the pressure that physicians are under these days. They go for long stretches with no days off, work very long hours, have tremendous responsibility and, basically, have a job that I would never ever ever want. So, with that said, it is understandable that you will, at times, deal with a difficult or demanding physician. These tips about SBAR and effective communication should help!
Taking care of patients with neurological injury means managing their intracranial pressure, or as it’s commonly called, ICP. And when we say neurological injury, keep in mind that we’re not just talking about people getting bonked on the head with a 2 x 4. We’re talking about space-occupying lesions, hydrocephalus, intracranial hemorrhage, subdural/epidural hematoma, even severe hyponatremia…basically anything that’s a key player in (drum roll please….) the Monro-Kellie doctrine.
I first encountered Heliox when working in ICU and assuming care of a patient with severe asthma. As the team brought her up from the emergency room, I saw the respiratory therapists pushing a huge cart with what looked like gigantic oxygen tanks. The patient was wearing an oxygen mask hooked up to these tanks via long tubing and working hard to breathe. As I would learn later, she was on Heliox and it made the difference between ending up on ventilator or improving enough to downgrade to telemetry the next day. Which she did. Go us!
Knowing when you need to intubate a patient in respiratory distress is a key skill you will use regularly as a nurse. This skill applies across the board…not just ED or ICU. Nurses in all settings come into contact with patients who decompensate, and knowing when you need to intubate can mean the difference between life and death.
Capnography and ETCO2 monitoring is one of those super cool things that seem so simple at first blush, but that can really provide you with a lot of very useful data. But first, what the heck is it?
Capnography is a way to monitor carbon dioxide levels using waveform technology. See? I told you it was super cool! Why is this important? Think back to your gas exchange physiology…what is it that drives your need to breathe? Is it low oxygen? Nope. Is it high carbon dioxide? Yep! So, it stands to reason that monitoring the MAIN thing that spurs the respiratory drive would tell us loads about how our patient is doing in the ol’ gas exchange department.
When you do your critical care clinical rotation, you will most likely be monitoring your patient’s CVP (central venous pressure). We’ll get into the what’s and why’s of CVPs in another post…for this post we’re going to talk about the basics of setting up the CVP line. With any luck you’ll get an opportunity to practice, so this should give you a wee bit of a head start. Note that I always say there is more than one way to skin a cat….if your preceptor sets up the lines differently, that is great…you’ll learn multiple ways and ultimately figure out the one that works best for you. Ok, let’s get going!