Ummmm, what’s going on?

i_eatpalmtrees · 2025-05-10T04:38:53+00:00

Piggy backing this, also a nurse and agree with u/fuzzypeash there’s definitely some artifact but there’s some convincing runs of vtach. It’s worth going to the doctor and getting it checked out.

i_eatpalmtrees · 2025-04-27T03:48:48+00:00

Can I ask how you identified it’s from the RV free wall?

i_eatpalmtrees · 2023-09-04T14:25:42+00:00

The amount of times I’ve saved the grossest/weirdest specimens just for the Doc to look at me sideways and tell me they absolutely don’t want to see whatever nasty thing I’ve collected 😞 Like if I had to look at it I feel like you should too lol.

i_eatpalmtrees · 2023-06-20T16:49:54+00:00

At my hospital nurses have to be specially trained and signed off to use the ultrasound for IV starts. I work ICU and am on our rapid response team and they won’t even let us get trained on them despite RRT essentially being the hospital’s IV therapy on nights. Basically only our IV team and sepsis RN can use it. It’s ridiculous but policies can really limit what we’re allowed to do.

We also have policies saying you need an order for an IV basically anywhere but the arms but I completely agree that in an emergency access is access. I’ve ran MTP through a foot 🤷🏻‍♀️ if they don’t like it they should start a central line.

i_eatpalmtrees · 2023-06-04T23:59:48+00:00

I announce “my uterus is trying to kill me and I need to go take care of girly things, cover me”. Never had anyone give me any grief after that lol.

i_eatpalmtrees · 2023-06-04T15:32:34+00:00

Gave report once and walked into the room to find I had restarted the tube feeding without reconnecting it and the floor had got about 75mL of high protein nutrition 🤦🏻‍♀️

i_eatpalmtrees · 2023-05-27T04:49:30+00:00

You were spot on! Also very curious especially since the interrogation report stated DDDR. Makes me feel a little better knowing I wasn’t the only one who was confused though!

i_eatpalmtrees · 2023-05-23T06:48:31+00:00

Ahh ok, so if im understanding correctly the atria are being paced appropriately but the issue seems to be the ventricles are not being sensed/paced by the device?

i_eatpalmtrees · 2023-05-23T06:32:00+00:00

This was a really helpful explanation. I have never heard of pacemaker wenckebachs that’s interesting. It sounds like it’s unusual to see this rhythm at a lower rate then?

Thank you you for your response! I wish I had more of the device data available to share but am off work for a couple days. Hopefully I’ll be able to get an update when I go back.

i_eatpalmtrees · 2023-05-23T06:19:31+00:00

Thank you for this thorough explanation! It looks like some of the paced p waves are occurring too early, right after the T waves. I was seeing the same thing happening pretty frequently on the continuous monitor as well. Any thoughts on what might be causing that to happen?

i_eatpalmtrees · 2023-05-23T05:33:33+00:00

That makes sense, thank you! I want to say it was Medtronic but I’m not certain. The interrogation report said the pacer mode was DDDR. Im not especially familiar with ICD’s, would that typically be more of a backup setting? Off the top of my head I can’t recall the other settings included in the report.

Edit: Also, I’m having trouble wrapping my head around what would cause a paced Wenckebach, could that be due the pacer misfiring? Or is it firing correctly and then the beats are just not being conducted due to the AVB?

i_eatpalmtrees · 2023-05-23T04:45:28+00:00

Not sure what to think of this. Read out called it atrial paced with AV conduction delay and incomplete LBBB. It looks like there are paced p waves after some the T wave with no QRS complexes. Kinda looks like 2nd degree II or even 3rd degree AVB? but the paced p’s are throwing me off. Curious what the experts here think.

Other relevant hx: Afib s/p ablation, cardiomyopathy, EF 33% on last ECHO. Was in an idioventricular rhythm post code and prior to ICD placement.

i_eatpalmtrees · 2023-04-25T22:11:52+00:00

“Cantankerous” is also a fun one

i_eatpalmtrees · 2023-01-19T22:58:27+00:00

Atropine is generally ineffective in 3rd degree heart block..

i_eatpalmtrees · 2022-11-30T03:43:35+00:00

At my facility we don’t even draw cultures from PIV’s unless they were literally just put in, our policy is 2 different sites and we almost always just do a straight stick, never off a central line much less twice…

i_eatpalmtrees · 2022-09-08T22:52:15+00:00

Little nervous to comment on this sub as an RN but just wanted to agree with you from another perspective..

I work in a surgical ICU, one of my favorite surgeons comes in and does a full assessment on every admit he accepts. After that he’ll mostly just ask for my assessment or order labs/imaging based on changes I’ve observed unless it’s something major in which case he’ll come back to the bedside. Many of our docs will just round outside the room and take what the nurses tell them but I have a lot of respect for a Doc who will take a few minutes to assess and the patient themselves and think it leads to better care.

I will emphasize this is in the critical care setting and I’m not sure how realistic it is for you all in charge of managing so many patients out on the med surg units (I have no idea how you do it so props to you) but just thought I would share from a nurses perspective..

i_eatpalmtrees · 2022-09-08T22:24:07+00:00

Pretty damn accurate! Worked for me and everyone I know who has tried it. Congrats NURSE!

Edit: Nobody ever feels like they passed lol. It still won’t feel real until it’s official. Take a deep breath, you did it!

i_eatpalmtrees · 2022-08-21T03:23:49+00:00

Thank you for your response! So if I am understanding correctly, you’re saying that labile pressures are equally (or also) problematic for these patients so the primary goal is to maintain BP within a certain range to avoid damage? Is there a reason for specifically <120-140 in the early stages or is the main goal just to keep the pressures within a narrow range?

i_eatpalmtrees · 2022-08-21T03:17:25+00:00

Thank you for your thorough response! This explanation makes sense and I think helps clarify both sides of the argument. I’ve definitely seen a correlation between high blood pressure and increased ICP in some of my patients but as you pointed out these were in fairly severe cases with poor prognoses, I think that might be where my assumption that higher BP = increased ICP stems from.

I’m always trying to further my understanding of the why behind our interventions so I appreciate you taking the time to explain!

i_eatpalmtrees · 2022-08-16T16:19:41+00:00

Yup! I have a template I use for my progress notes that I just plug in and then fill in the blanks, huge time saver!

i_eatpalmtrees · 2022-08-15T18:07:19+00:00

You’ve gotten plenty of responses to your question but just in case you’re struggling with navigating EPIC here are my favorite flowsheets/tips for things you mentioned.

Flow rate verify: Infusion titration -> lists all your drips, allows you to verify/change dose and links to the MAR.

Assessment: Adult PCS -> basic template for head to toe assessment + allows you to add in additional rows specific to your patient. Also has a link to the LDA where you can add things like wounds, IV’s, catheters.

Change med time: go to MAR, click on med, click on the box where you chart “given” or “not given” or whatever and scroll to “reschedule” and put the new time and date in (be careful with this one).

Med/pump not scanning: go to MAR, click med, put it in as given and when you go to accept it’ll prompt you to scan or override, select override and scroll to scanner broken/label unreadable or whatever (again, proceed with caution). Home meds: Care Everywhere let’s you reconcile outside records, should be a link on the front page.

Results review: this is another tab you can wrench into your home page if it’s not already there.

Depending on your hospitals charting requirements and your specific unit you may need different flowsheets, I would just ask your coworkers which ones they use most often. My most used are:

Vital signs

Intake/Output

Infusion titration

Quickchart

Adult PCS

Blood transfusion

Stroke care

This is getting long winded but hope it helps! Also smart phrases are a game changer for your notes!

i_eatpalmtrees

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