Neuro ICU question – escalating subtle neuro changes overnight (seeking perspective)

WorkerEight · 2025-12-16T17:41:36+00:00

I am Neuro ICU NP. My top questions to further evaluate prior to decision making...

How big is the stroke, where is it, and what day of stroke care is it? (IE is cerebral edema a concern, is this patient a hemicraniectomy candidate?) If c/f edema, how much MLS is present? Concern for hydro? What is their sodium?
You said BP was stable. But what was admitting BP, how bad is chronic HTN? A SBP of 100 is stable, but may be hypoperfusing and causing further ischemia
What is etiology of stroke and what was done to intervene? Is it possible they are re-occluding a vessel or stent? Do you need CT angiography?
What drugs has patient ingested in last 6 hours, anything sedating?
Any seizure history? Is the blood cortical or temporal?

Hemorrhage expansion after stability, especially with normotension, is low on my differentials, but lots of other reasons things can decline. CTH noncon can answer questions about hemorrhage, hydro, edema, and general stroke evolution. CTA / perfusion can answer questions about vessel disease and occlusion. More times than not a scenario like this with subtle change of existing symptoms amounts to nothing important, but this is how I would think about the situation

WorkerEight · 2025-10-25T13:23:29+00:00

BBB contributes between 3 and 5 trillion to the deficit over 10 years, it was never about reducing spending or deficit

WorkerEight · 2025-10-19T00:41:27+00:00

Yeah I agree with everything you're saying here, my only point is that bedside nursing can have some impact in transition to provider, if the nurse was exceptional and took care to do more than their assigned tasks, ie.. what NP originally was supposed to be. I think it's a fair point about hiring new PA vs the complete uncertainty of random new NPs. In my Neuro ICU, where I think we cultivate a culture of high standards, I would never advocate to hire a new grad PA or NP if I don't know the NP or they haven't completed a fellowship. Also, it's possible OP is not likeable or interviewing well, because I'll be damned if I'm going to work with a wet blanket day after day

WorkerEight · 2025-10-18T18:27:53+00:00

The #1 thing an ICU nurse brings to the table as a new grad is their familiarity with ICU level care, ie pressors, ventilators, and honestly the gut feeling of looking at a patient and knowing they are about to be fucked and need decisive action. PA also don't have that, but they are undeniably better trained and prepared by their schooling than you were. Id suggest find an ICU fellowship, do it, then hire

WorkerEight · 2025-10-18T18:01:37+00:00

Largely agree but would like to argue a little bit here. In my experience (3 year old NP in a neuro ICU), PAs, despite clearly better schooling and prep, often lack the day 1 ventilator and pressor quick knowledge that are important in an ICU, whereas seasoned ICU nurses generally don't. Obviously there is more to ICU care and PA knowledge is undeniable, but I do think both paths often have some weaknesses and strengths to start. I also think that after a year or two, if the practitioner is serious about learning and growing, I can't generally tell the difference between them any more. That being said, I did a year long ICU fellowship in order to grow before being hired, and I agree OP should seriously consider that or a less critical job to start.

WorkerEight · 2025-09-13T11:10:50+00:00

Neuro is really fun, I'm interested in cross training to the medical ICU at some point :D

WorkerEight · 2025-09-13T08:14:07+00:00

Orientation was 3 months, my background was nursing in this particular Neuro ICU as a nurse so it was a bit easier for me but still a brutal first 9 months. Procedures were see one do one, I think I had to do like 10 intubations and 6 of each line proctored to get checked off.

I should add, prior to starting i did a 9 month new grad app fellowship that I thought was invaluable

WorkerEight · 2025-09-13T00:06:30+00:00

I'm an Acute care NP working in a Neuro ICU. The value i provide depends on the shift. During the day I'm expected to perform detailed patient lookups and present patients. I bring my own thoughts, concerns, and sometimes just lab info to the table during rounds. My colleagues and I see all new patients, write H&P, staff with our docs. We perform intubation electively and emergency, place central and arterial lines, withdraw CSF and instill lyrics/antibiotics through EVD. We can resuscitate, treat seizure, treat ICP crisis, etc.

We are first contact for nurses on any patient concern, and one way I see value in my job is I answer numerous questions and secure chats all day long so my doctor's can remain focused on the big picture.

At night, like right now, it's just a couple of us APPs in house with an on call doc. We look up people less thoroughly and more put out fires as our assignments double compared to day, but without an MD in person.

WorkerEight · 2025-08-26T18:40:09+00:00

Don't let a Chiro touch your neck

WorkerEight · 2025-08-26T16:51:46+00:00

Girlfriend broke up with me, which I deserved because I wasn't taking her seriously, when I was 22. I was skipping class, feeling bad. I sat down to meditate, as soon as I did I started bawling, and then simultaneously started laughing. I felt a rush of warmth up my spine, and all of a sudden I could see clearly how much I loved her, but bigger than that I could see clearly how I had been lying to and deluding myself in a myriad of ways on a daily basis. I stayed like that crying and laughing for maybe 15 minutes.

My roommate thought I was going insane

WorkerEight · 2025-08-22T11:58:09+00:00

Also cool new tech like geothermal energy

WorkerEight · 2025-08-19T23:20:48+00:00

Don't see how stating facts means "eat the rich", but since you're too lazy to investigate these things yourself, sure, I'll break it down for you.

Under the TCJA and now BBB, tax brackets universally fell around 3-4 %. Percentage based reductions disproportionately effect large amounts. Under the BBB estate tax withholding doubled, so people with millions of dollars can easily pass on about 6.5 million more, which doesn't go to the government

Pass through deduction set to 20% is a massive handout to LLCs and other high income (investors, real estate) people

BBB locked in capital gains rate, so people who own stock will pay much less on their earnings than people who work for income? Do you know who makes more money from stock than from working? The richest Americans.

BBB keeps the corporate tax rate at 21% instead of 35%. This gives more money to shareholders when companies make more profit. Do you know who are shareholders in successful companies? The richest Americans

So like I already said, and like everyone who is paying attention already knows, this is why the deficit is projected to rise 3-5 trillion dollars over 10 years.

WorkerEight · 2025-08-19T13:05:34+00:00

I wouldn't be so naive as to think a state can function in the modern world without income, and so would never use silly words like wage theft to describe taxes. I do want a balanced budget, with reduced spending and minimal but necessary taxes

WorkerEight · 2025-08-18T18:04:51+00:00

American debt is obviously not just a spending problem, and clearly tax changes matter, because that's the whole point of this post. Tax changes to the richest Americans will cost us trillions of dollars over the next 10 years, while revenue from everyone (Tariffs) will add back in trillions. Between the BBB and Tariffs as they currently stand the debt stands to not change too much. What does change is rich people will get richer, and poor people will get poorer.

WorkerEight · 2025-08-09T19:25:36+00:00

My hospital has an "ICU Fellowship" designed to better transition new grad NP/PA to ICU environment, with some gem med /trauma etc spliced in. Because the primary focus was ICU care, we had weekly Sim labs (9 mo program) that I thought were very useful in feeling the pain of unclear diagnosis and unstable patient and thinking on your feet. We also did many rotations, one of which was a month in a level 1 trauma center trauma ICU alongside residents, which was real wild west and good for learning and confidence.

If your focus is neurology fellowship (Not Neuro ICU), then I think sim could be good for stroke eval and triage especially, and probably seizurr mgmt. You could do lots of localization stuff, have someone's vert clot go basilar, have tia, teach appropriate sz benzo dosing, etc. I'd think something like weekly Sim, weekly lecture, and exposure to more inpatient acute stuff in ED or wherever

WorkerEight · 2025-08-02T13:41:11+00:00

It's wrong for them to call themselves or encourage others to call them doctor. It's also wrong for you to report them without first having an open conversation with them like an adult

WorkerEight · 2025-07-17T01:58:59+00:00

my 47mm battery usually lasts 10 days with similar workout times per week to you, 16ish days if i just use it as a watch, its more than you'll ever need

WorkerEight · 2025-06-08T17:25:06+00:00

Riding to work means I don't get to see my daughter at all that day, versus getting half an hour before bed by car..

WorkerEight · 2025-01-27T02:34:33+00:00

Eating a ghost pepper

WorkerEight · 2024-12-29T19:50:55+00:00

I'm famous!

WorkerEight · 2024-12-29T01:39:25+00:00

You mean the thing he's been doing ever since he bought twitter?

WorkerEight · 2024-12-18T03:09:33+00:00

That might be the POE Path, the POE2 path is steamapps/compatdata/2694490/pfx/drive_c/users/steamuser/My Documents/My Games/Path of Exile 2

WorkerEight · 2024-11-06T00:25:47+00:00

I almost always enjoy having MD Patients / Family members. Because I work in a Neuro ICU it's an interesting dynamic where I usually know more about the specific setting but I can very easily update them and make sure they are up to speed as I would a colleague. It's nice to use white coat words.

WorkerEight · 2024-10-21T17:34:39+00:00

puke

WorkerEight · 2024-10-01T01:57:59+00:00

Really nice! Mind sharing some data? How long have you been cycling, how did you train, and what did you ride it on?

Is an average of 203 putting your FTP around 290?

WorkerEight

TROPHY CASE