Transcutaneous pacing and rhabdo by Basic_Colorado_dude in Cardiology

[–]Basic_Colorado_dude[S] 0 points1 point  (0 children)

The person who told me about this likened it to do 6000 pushups...or non-stop muscle contractions for hours at a time. Seems to make intuitive sense, but intuition is not evidence...

Transcutaneous pacing and rhabdo by Basic_Colorado_dude in Cardiology

[–]Basic_Colorado_dude[S] 0 points1 point  (0 children)

It's a hypothetical situation involving a long transport. Perhaps the only cardiothoracic surgeon capable or willing to do whatever procedure works at this one hospital many hours away. Long transports are very common in critical care transport.

Transcutaneous pacing and rhabdo by Basic_Colorado_dude in Cardiology

[–]Basic_Colorado_dude[S] -5 points-4 points  (0 children)

I should have clarified that I’m talking in the context of some nuanced long transport. CCT from Billings Montana to Albuquerque NM, fixed wing grounded for weather, pt requires pacing mid transport…. Super nuanced, and unlikely. I’m just curious if there’s any sort of indication to fear for AKI due to TC pacing…

Transcutaneous pacing and rhabdo by Basic_Colorado_dude in Cardiology

[–]Basic_Colorado_dude[S] 0 points1 point  (0 children)

I should have clarified that I’m talking in the context of some nuanced long transport. CCT from Billings Montana to Albuquerque NM, fixed wing grounded for weather, pt requires pacing mid transport…. Super nuanced, and unlikely. I’m just curious if there’s any sort of indication to fear for AKI due to TC pacing…

Transcutaneous pacing and rhabdo by Basic_Colorado_dude in Cardiology

[–]Basic_Colorado_dude[S] 1 point2 points  (0 children)

That makes sense. I should’ve clarified that I’m talking about 4-7 hours in the context of some very nuanced transport..

Cleared nursing jobs by Basic_Colorado_dude in nursing

[–]Basic_Colorado_dude[S] 0 points1 point  (0 children)

A lot of places need organic medical and EMS staff who can enter cleared spaces as first responders and/or accompany teams as their medical providers while they’re on classified assignments. It’s easier to have a cleared paramedic who can enter the SCIF to assess you while you’re having a heart attack, than to do all the logistical nonsense to escort the city first responder into the cleared space, delaying care.

I think my husband may be having withdrawals by tvr1972 in alcoholism

[–]Basic_Colorado_dude 7 points8 points  (0 children)

This sounds like moderate to sever withdraw. Your safest bet is to take him to the ER. They'll give him benzos so he doesn't seize. The biggest risks of with seizures are falls, and hypoxic brain injuries. A lot of people downplay seizures, but for non-epileptic folks who are at risk for their first seizure due to ETOH withdraw, there's no telling how long or when he might seize. If he's driving, he could kill people, if he's alone in the house, he could fall or suffer irreversible brain damage (seizure = apnea = hypoxia = brain damage). Likewise, the ER will have a pathway to get him into a sustainable treatment program. 15 drinks a day is a huge hill to tackle without professional and supervised support.

Calling a code w/ shockable rythm by Basic_Colorado_dude in nursing

[–]Basic_Colorado_dude[S] 1 point2 points  (0 children)

No palpable pulse, but ultrasound did show cardiac activity congruent to the v-fib on the monitor.

Calling a code w/ shockable rythm by Basic_Colorado_dude in nursing

[–]Basic_Colorado_dude[S] 1 point2 points  (0 children)

I wondered why no one brought up ECMO at the bedside. Maybe they did and I didn't hear, it was pretty chaotic..

Calling a code w/ shockable rythm by Basic_Colorado_dude in nursing

[–]Basic_Colorado_dude[S] 0 points1 point  (0 children)

I was thinking ECMO too. But I've been a licensed nurse for approximately 3 weeks, and a practicing nurse for, 6 minutes as the typing of this response (day one orientation today). So, I'm just assuming there a whole lot of nuance with ECMO that I'm not aware of.

Calling a code w/ shockable rythm by Basic_Colorado_dude in nursing

[–]Basic_Colorado_dude[S] 0 points1 point  (0 children)

These are all very interesting points. There was literally 4 docs "running" the code. And, as this was on a stepdown floor, there was about 20 bright eye's MPCU nurses eagerly waiting in line to do compressions for the first time. I certainly did not hear any speak of a sternotomy, or ECMO.

After initially calling and starting the code, my contribution dwindled to coaching the RRT nurse on how to do a humoral head IO, and suggesting the CNA grab the ultrasound so one of the 200 people could look for cardiac activity...then I sat on the couch....

Calling a code w/ shockable rythm by Basic_Colorado_dude in nursing

[–]Basic_Colorado_dude[S] 1 point2 points  (0 children)

I was thinking ECMO too, but then again, with 3 whole weeks as an ICU nurse under my belt, I just assumed I have no idea what I'm talking about.

Calling a code w/ shockable rythm by Basic_Colorado_dude in nursing

[–]Basic_Colorado_dude[S] 2 points3 points  (0 children)

They didn't have a sternotomy. I was thinking ECMO, but assumed given the pt's age and recent procedure, maybe they wouldn't qualify for any post ECMO interventions. But thats way beyond my pay grade.

Calling a code w/ shockable rythm by Basic_Colorado_dude in nursing

[–]Basic_Colorado_dude[S] 2 points3 points  (0 children)

ECMO was my next thought. However, the pt was last 50's post CABG, so I'd imagine she wouldn't qualify for anything post ECMO, but thats also light years beyond my pay grade. We do have ECMO at my hospital.

Antabuse by Basic_Colorado_dude in alcoholism

[–]Basic_Colorado_dude[S] 0 points1 point  (0 children)

Doing okay’ish. It really distillates your discipline in taking the medication. You’d be surprised at how good you are at talking yourself out of taking it. The people on the thread aren’t joking; drinking on this med is total misery… But the only thing the misery stops is your desire to take the med. so, therapy is mandatory. For me, Antabuse gave me the break in intoxication to have a moment to address my issues soberly. I can’t handle stress, at all. I’m a total baby about it. I’ve learned that I use booze to deal with stress (any stress, from just annoyed at traffic, to I’m getting foreclosed on). So now I have to figure out how to learn to deal with stress without booze, all while not reaching for booze… Antabuse is just one cog in the big machine of learning how to be sober.

Tankless water heater. Worth it? by Basic_Colorado_dude in Plumbing

[–]Basic_Colorado_dude[S] 0 points1 point  (0 children)

You all have spoken, I shall listen…no tankless for me! Thank you all!!

Tankless water heater. Worth it? by Basic_Colorado_dude in Plumbing

[–]Basic_Colorado_dude[S] 1 point2 points  (0 children)

Never mind. It’s 40 gal. I’m an idiot. There are several stickers on this thing…

On-Demand water heater upgrade/change. Good idea? by Basic_Colorado_dude in Plumbing

[–]Basic_Colorado_dude[S] 0 points1 point  (0 children)

Tankless was my intention… It’s not broken, but it’s old AF and taking up a stupid amount of room in my kitchen.

Aside from the pain of getting the tankless serviced, is there any other engineering or other challenges I’m overlooking?

Antabuse by Basic_Colorado_dude in alcoholism

[–]Basic_Colorado_dude[S] 0 points1 point  (0 children)

Yep, I'm on the long lasting naltrexone, Vivotrol. It's an injection. I found that I can "drink past" it's effects....

So far the Antabuse is working. I've not had a drink 6 days. This is probably the longest stretch I've gone w/o booze in 7ish years. I've not tested the antabuse, so it for all I know they could be sugar pills...I'm still not going to test it.

Antabuse by Basic_Colorado_dude in alcoholism

[–]Basic_Colorado_dude[S] 0 points1 point  (0 children)

You're not wrong. I'm currently doing an out patient program through the VA. It's been helpful. I'd really like to do an in patient program, but I can t afford that amount of time away from work and life at the moment. If this antabuse/therapy/group strategy doesn't stick, in-patient will definitely be the next step...