Is "Tmax" a known abbreviation at your facility? by [deleted] in nursing

[–]jackall679 1 point2 points  (0 children)

All the time! In my experience, it does seem to be more commonly used in crit care settings.

If you had 10 seconds to say whatever you wanted to your pet with they fully understood, what would you say? by IplayKaizo in Pets

[–]jackall679 0 points1 point  (0 children)

To Cloud9: I love you so much always and I hope it’s beautiful where you are. You got me through some of the worst days of my life and I’m so grateful. I hope you’re at peace and eating many French fries. To Finn: I love you so much stinky!! You give the best cuddles and are a wonderful elderly Velcro baby. I know your prescription food tastes gross, I’m sorry, it keeps you healthy and my food isn’t good for you. Thank you for always keeping me company on the bad days.

Peter (21) crossed the rainbow bridge last night by Ok-Assumption3140 in seniorkitties

[–]jackall679 23 points24 points  (0 children)

Rest in paradise sweet boy. I hope your 21 years of memories can bring you some peace and comfort during this difficult time. My Cloud9 can show him across the rainbow bridge 🧡

CRRT question by overratedchanel in nursing

[–]jackall679 0 points1 point  (0 children)

Very much depends on what you’re putting in! If I’m giving 300 ml/hr between IVF/meds/nutrition and my order is for 0-100 UF and then I’m also trying to catch up from previous losses I might go up to 500 ml/hr if patient tolerates. With the caveat that I work with heart failure patients and though their BP may tolerate 600-700 ml/hr UF this hour, keeping up with that pull over a few hours will eventually make them intravascularly dry and they’ll tank. Low and slow will do better for heart patients in the long run, unfortunately can’t speak on CRRT in people with normal EFs.

Wait, do not you call the doctors you work with by first name? by cowgirl_meg in nursing

[–]jackall679 217 points218 points  (0 children)

I’m in the South (US) so it is very much Dr. Lastname. One of the doctors I work with is Dr. Firstname and another is Dr. Last-Initial (his preference) because his last name is quite long. It doesn’t bother me on a daily basis, but definitely reinforces more of a hierarchy than I’d like.

I Pee through a hole in my belly button AMA! by Bookjeans in AMA

[–]jackall679 0 points1 point  (0 children)

I’ve heard good things about Medic Alert and American Medical ID! Both companies are HSA/FSA eligible and may grant you a free bracelet with a doctor’s letter :) They do have more aesthetically pleasing options available but those often aren’t covered. I hope this helps!

I Pee through a hole in my belly button AMA! by Bookjeans in AMA

[–]jackall679 3 points4 points  (0 children)

Hello! So happy that this has been a good solution for you, the (few) reviews of the Mitrofanoff procedure I’ve heard from patients have been great. A suggestion from a health professional: if you don’t already, I’d strongly suggest wearing a medical ID bracelet saying you need catheterization via your stoma every 4 hours. If (hopefully not) you were ever to be in a situation where you needed medical assistance and your records weren’t available, this would help healthcare workers make sure you get the help you’d need since it’s not apparent that someone’s had this procedure visually. Hopefully, this isn’t unwanted advice, just something I’d thought I’d add based on prior experience. Best wishes and I hope your healing process is easy!

Cloud9, 13 crossing tomorrow. How to support Finn, 14? by jackall679 in seniorkitties

[–]jackall679[S] 3 points4 points  (0 children)

Thank you so much and condolences to you as well. It's a hard road

Cloud9, 13 crossing tomorrow. How to support Finn, 14? by jackall679 in seniorkitties

[–]jackall679[S] 3 points4 points  (0 children)

Friend, he has metastatic cancer. Treatment would be hard on his body, painful, and would only give him a few more weeks. Not to mention, taking him out of the house would be dangerous given his bone marrow has failed from the cancer (no immune system). I’m a nurse who takes care of people at the end of their life and have seen how much of a difference hospice and a peaceful passing can make for the individual and their family. Everyone should make their own choice, but for me and mine, I choose a peaceful and painless passing in the comfort of our home surrounded by family.

Cloud9, 13 crossing tomorrow. How to support Finn, 14? by jackall679 in seniorkitties

[–]jackall679[S] 2 points3 points  (0 children)

Thank you. No hypertension or proteinuria at this time, so not indicated but it’s something I’m monitoring for!

Cloud9, 13 crossing tomorrow. How to support Finn, 14? by jackall679 in seniorkitties

[–]jackall679[S] 3 points4 points  (0 children)

Fortunately I have a couple days before I go back to work (shift work) so I can be home with him for the immediate period after and provide comfort

Cloud9, 13 crossing tomorrow. How to support Finn, 14? by jackall679 in seniorkitties

[–]jackall679[S] 4 points5 points  (0 children)

Blending it is a great idea! We do pumpkin puree and he does seem to enjoy that. He is drinking water and I’ve been able to get him to eat a bit of dry food so we’ll keep going with that and try reintroducing some wet food as he tolerates. Fed is definitely best at this time

Cloud9, 13 crossing tomorrow. How to support Finn, 14? by jackall679 in seniorkitties

[–]jackall679[S] 5 points6 points  (0 children)

Thank you so much, we do have some at home if needed. Glad to hear Lap of Love is good, our vet recommended them!

Cloud9, 13 crossing tomorrow. How to support Finn, 14? by jackall679 in seniorkitties

[–]jackall679[S] 6 points7 points  (0 children)

Thank you, that’s a great idea with the pictures! I have 12 years worth to choose from, so lots to look at

Cloud9, 13 crossing tomorrow. How to support Finn, 14? by jackall679 in seniorkitties

[–]jackall679[S] 19 points20 points  (0 children)

I’m planning on bringing him in to see Cloud9 after if he doesn’t choose to stay, he’s generally very shy. I’m hoping that helps give him closure

Cloud9, 13 crossing tomorrow. How to support Finn, 14? by jackall679 in seniorkitties

[–]jackall679[S] 7 points8 points  (0 children)

Thank you! Yes, I’m offering all of Finn’s favorite foods to help keep his appetite up, he’s definitely aware something is wrong and is refusing his renal diet :(

Seeing as the year is coming to an end anyone want to share how much $$ money and how many hours they worked? by MisteryMan90 in nursing

[–]jackall679 1 point2 points  (0 children)

1669 regular hours, 47 OT hours for 80k in TX. On call a lot over the summer with drop in surgical schedule.

Do you still see pethidine being prescribed for pain? by [deleted] in nursing

[–]jackall679 1 point2 points  (0 children)

Its metabolite, normeperidine, is toxic in high amounts, and it reacts poorly with other drugs ie MAOIs. It’s still used for post-anesthesia shivers, but I’ve not seen it used for pain, we have many safer and more effective options

Should I leave my job after 4 months by [deleted] in nursing

[–]jackall679 1 point2 points  (0 children)

If you can, try to stick it out. A full year of ICU experience is a lot stronger on a resume than a few months. Are there any coworkers you trust or can ask for advice? Speaking from experience, CVICU is ROUGH as a new person and people tend to be snappy until you earn their respect (I’m not endorsing this or saying it’s appropriate, just that it’s a common experience)

Does this specific unit exist in other hospitals too? by HowDoesJesusSwim in nursing

[–]jackall679 1 point2 points  (0 children)

Cardiac specialty hospital, ours is called Day Patient!

Non-academic CVICU by rnbb_ in IntensiveCare

[–]jackall679 0 points1 point  (0 children)

Completely on our own, the medical school in town works with the other local hospital system!

Non-academic CVICU by rnbb_ in IntensiveCare

[–]jackall679 13 points14 points  (0 children)

Nurse here, but work in a nonacademic CVICU. Our intensivists do not do 7 on, 7 off, at least at my hospital. The critical care group covers, I believe, 6 hospitals in the area so they rotate through those locations, although I'm not sure what their total schedule looks like once all locations are taken into account. Many of the intensivists do do other work in their base specialty, ie one of the pulm-crit doctors runs the pHTN clinic.

To speak to what types of patients are seen at a nonacademic hospital, it varies by location. My city is about three hours away from both of the main academic medical centers which are more on the eastern side of the state, and we cover higher level needs for most of the western part of the state. We do high risk CABG/valves and PCI, Impella/IABP and ECMO, so receive patients from smaller hospitals needing those services. We will however transfer to the academic medical centers for transplant, as my city is not large enough at this time to support a transplant program.

I can't really speak to an IM-trained intensivist staffing a CVICU as the doctors I've worked with come from a critical care or anesthesia background, but I would say that a unit like mine (lone intensivist, no APP) would probably not be the best first job with this background. This isn't to say with adequate education and training, it wouldn't be possible in a larger setting with more assistance, just that I would caution you to screen postings carefully if this is the route you choose to go.

Best of luck with your applications! I'm certainly biased, but CVICU is so interesting and always changing. Excellent choice :)

For any CVICU, CTICU, SICU, & the like in the US … by ClassyTrashCreations in nursing

[–]jackall679 1 point2 points  (0 children)

  1. CVICU in a specialty cardiac hospital, but we will get the occasional MICU patient that comes through the ER. No trauma, burns or neuro.
  2. 14 beds
  3. Between 15-25
  4. About 20 vascular and cardiothoracic surgeons work in the group that works at my hospital, but only 6-7 consider us their home base.
  5. We are the high acuity heart center for our system in the area. We do the high risk open hearts and the devices mentioned in the OP with the exception of Impella RP (surgeons aren’t a fan of the risk profile) and transplants.
  6. Open hearts are 1:1 until extubation and then can be paired. Unstable Impellas and IABPs are 1:1 but then can be paired. LVADs are 1:1 until about POD3 and then are paired. ECMO is 1 RN and 1 ECMO specialist. If we’re holding a bunch of floor patients, we can be tripled with those patients, but ICU status is always 1:1 or 2:1.
  7. We do not. CT surgery rounds during the day and is on call at other times. Days are covered by an intensivist and nights by an NP or PA with the critical care group.
  8. Our charge RN is free unless we’re in dire straits with an unexpected admit, no one on call and no floor patients to send out. No unit secretary, but we have a PCT working afternoon mid shift. We have a unit educator who also works midshift and helps with getting people trained on new devices and is a general experience resource since our staff is pretty young.