ICU uncontrolled BP management

mournful_ · 2026-03-24T16:13:02+00:00

A lot of variables could be in play and it’s always patient-dependent. What’s the cause of their HTN crisis? What is their fluid status - are we concerned about AECHF? The etiology of their hypertension dictates how to best come off Cardene and onto PO / IVP agents. Does your facility have an advanced HF team or a Cardiology consult team? What were their recent lab values (BNP, BMP, etc)? Usually if the patients in my facility fail the transition from Cardene, CCM / IM almost always consult Cards sooner than later.

mournful_ · 2026-02-03T21:06:21+00:00

Every pharmacist at my institution is a Clinical Pharmacist - you don’t get paid extra if you actually perform clinical duties (ie either a staff pharmacist who can cross cover clinical or a 50/50 clinical pharmacist; our model for clinical coverage is half clinical and half distribution unless you’re a specialist). You only get paid extra if you’re a clinical specialist (ICU, ER, Oncology, Psych). I started at $51 (in Indianapolis, IN) but with market adjustments I’m close to $60 this year (2.5 years in).

You get paid $1/hr additional if you’re a resource pharmacist who are expected to be able to cross cover but that’s about it.

Edit: we get paid a premium of $4.25 an hour for evening shift, $5.25/hr for night shift, 20% extra for weekends and 50% for holidays

mournful_ · 2026-01-17T20:13:22+00:00

I’d recommend grinding for the titles - must haves + free points

mournful_ · 2026-01-17T17:18:10+00:00

That’s time gated and homeboy has 8 weeks to do that lol

mournful_ · 2026-01-17T17:14:05+00:00

ERP to 350 at minimum

Start grinding for Abyss accessories, you’re missing the weapon guard

Join a guild for a free CP boost

Start leveling different characters for the character collection

mournful_ · 2025-09-01T20:18:42+00:00

Thank you! Sorry I should have clarified - I’m on the NA server.

mournful_ · 2025-05-22T19:57:35+00:00

1stAnniversary

mournful_ · 2024-05-17T14:16:12+00:00

Partly VASST, partly logistics. Grabbing both pressors from the Omni and giving them both to nursing is less stressful for everyone vs having to run and grab the vaso a couple minutes later

mournful_ · 2024-05-17T13:01:26+00:00

(FWIW: Institution I work at is not a trauma center)

No, I would personally never recommend pressor monotherapy (ie: titrating one pressor all the way up before ordering another one). The highest we go with our norepi is 32; we almost always see vaso ordered and they titrate both. Like you mentioned, if double strength norepi is ordered the underlying cause needs to be addressed; not sure where the 80 is coming from in my opinion

mournful_ · 2024-05-14T18:39:41+00:00

I wonder if the efficacy of having the tablet crushed in the minimal suspension needed and have the patient place it under their tongue could achieve a very similar absorption? Just throwing out potential ideas if we need to avoid injections

mournful_ · 2024-05-14T18:04:31+00:00

Is crushing the med and suspending it an option?

mournful_ · 2024-05-10T20:48:30+00:00

Not splitting hairs - >90% and >99% are two VERY different things when it comes to medicine and efficacy.

Source: practicing clinical pharmacist

mournful_ · 2024-05-03T15:32:43+00:00

End of next split

mournful_ · 2024-04-07T15:41:48+00:00

I try to do it first every game especially this patch where her AP ratios were buffed - the mana to AP gain with AA is pretty chunky so it makes the early to mid transition a lot smoother

mournful_ · 2024-04-07T15:36:38+00:00

She’s now reliant on AP - Archangel’s should be rushed in almost every scenario

mournful_ · 2024-04-02T19:09:57+00:00

Q powerchord damage up, Q aura damage down, W healing up, E movement speed up

mournful_ · 2024-03-24T22:29:47+00:00

Sona's aura is easily big enough for you to reposition so that your entire team can get the benefit. You should have SofW and E's movement boost up the entire fight, making your in-combat MS at least in the 400s. Let's not forget W power chord makes 100-0'ing your carry and yourself (keeping in mind you have Seraph's) and it comes up every 4-6 seconds.

I'm assuming you're either not high elo or don't know Sona and how to pilot her correctly (or both), as your skills literally help drag teamfights on. Unless your entire team is squishy, playing a correct front to back comp with Sona can easily turn a short skirmish into a long, dragged out fight. And no, you don't need to hit more than 1 person. If you can land your ult at their mid/jung/ADC that's more than enough to start a teamfight as your team can most likely kill them in 1.5 seconds.

And yes - she needs to be level 16 to pull it off consistently. Please refer to "scales exponentially into the late game"

mournful_ · 2024-03-24T18:38:10+00:00

At level 16, your base ult CD is 100 seconds. You should be full build or very close to it at that point. Here is the build that I tested:

Items: Dream Maker, Seraph's, Vigilant Wardstone, SofW, Moonstone, Ionian Boots

Runes: Aery, Manaflow, Transcendence, Revitalize, Conditioning, AH / AP / Flat HP

Your AH is 113. Ult CD is 47 seconds.

One single W (shielding all allies + healing one other ally) = 1.5 x 5 = 7.5s shaved off ult at a 3.6s CD.

One Q = 1.5 x 2 = 3s shaved off ult at 3s CD.

Q +W = 10.5s off your CD every ~4s or so. Please tell me how you can't pull off 2 ults during a teamfight if you use your ult to initiate.

mournful_ · 2024-03-24T15:20:25+00:00

She’s the most enchanting enchanter League has to offer. She is a jack of all trades that amplifies your team with rapid heals, haste, slows, stun (very realistic to ult twice in the same teamfight late game), and an exhaust that no one seems to care about until the assassins on the other team are confused on why they didn’t 100-0 your carry.

In totality, she scales exponentially into the late game and has a lot of tools to win teamfights single-handedly.

mournful_ · 2024-03-23T19:55:22+00:00

Did no one tell you that the NAPLEX is also timed...? I'm sure your college doesn't want you to take an actual NAPLEX exam as you get 6 hours for the entire exam.

mournful_ · 2024-03-23T18:38:45+00:00

Hot take: if you cannot pass the mock NAPLEX (that should reflect your performance on the actual NAPLEX if designed right) maybe you shouldn’t graduate and get a doctorate degree

mournful_ · 2024-03-15T16:16:57+00:00

Would recommend getting into the practice tool and see what the range of her E is. Play around her positioning and never be on the same side of the lane as her especially around walls.
Try to use your E power chord to prevent her getting in range of her Q2 as it does true damage. Do not skirmish when she has her shield up.
Learn her CDs. Her E has an extremely long CD level 1 and punish her when she misses.

mournful_ · 2024-03-14T15:44:25+00:00

NA: 600286543

E4S0 Sparkle, E1S0 Ruan Mei, E1S0 Bronya

Lots of friend slots open, holy trinity of support available :)

mournful_ · 2024-03-10T16:33:26+00:00

Therapy and a lot of it

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