r/IntensiveCare

Hi, I just wanted to know what you guys do with your facility if you are having a hard time getting a pulse ox reading on a patient in a critical care setting. I have a patient on Neo and also vaso the vaso has been on and off, but most consistently on neo and I was unable to get pulse ox throughout the shift. I tried placing it in various places and tried different forms. Fingers were cool so were the lower extremities. The forehead probe did not work sometimes I would get some sort of a plethora and sometimes it’s just a flat line. We did any pao2 was 93% on 4 L other facility we do not have a pulse ox that is placed in the air to see if that would work. What do you do

In retrospect my old job was a LOT. I left it with my self esteem a wreck. When I got in the car after my last day I just sobbed. I'm travel nursing now, I'm in a MICU. I needed to clear my head. It's crazy different. I am beginning to feel like a competent nurse again. And I'm meeting nurses from all over and learning that my unit was different than many others.

For example: I've learned a lot of places double VA ECMO. As in, two nurses to one patient. We never did that. We would have a patient with VA ECMO + CRRT + Impella and only one nurse. Another story is I had to take a triple pressed patient, POD#1 from a MVR+AVR, with pulmonary hypertension, cvc swan art line ventilator, to MRI with only a RT. No other RN to help.

We didn't have resource nurses, we never got to eat a real lunch, we never debriefed codes. We never singled CRRT, LVADs, or IABPs. The APPs could be so bitchy and condescending to nurses. The nurses could be so cruel to each other. Management would call me on my personal cell phone to ask inconsequential questions about my previous shift. The culture punished mistakes so harshly and even punished you for asking questions.

I miss CVICU and I'd like to do it again someday. But I'm scared it will be like this at a future job. How can I suss it out? What should I look for? I'm not sure how much of this was my specific unit, and how much is just the intensity of CVICU. I know CVICU is tough in general.

Maybe I just want to go back because I want to prove to myself that I can be a good CVICU nurse....

What can I gift a dear friend that has been in ICU for a month now?

I thought about lip balm, hand moisturizer, dry shampoo, body cream (unscented) but read that some products might be flammable when on oxygen therapy?

All suggestions welcome

I’m a postbacc working toward med school and considering different specialties. I know residency is a long way off, but I like critcare.

I’m wondering what people’s experiences with malpractice suits have been, though, since mistakes in the ICU seem more likely to yield severe consequences (not that mistakes in other specialties can’t).

I‘m also thinking about how many COVID deniers insisted that vents and ECMO were killing people.

Gross negligence aside, how are suits looked at in the field for hiring and credentialing? Are they common?

I made a stupid mistake that might have resulted in a critical outcome. I'm not sure yet as I have a meeting with my manager this evening. I am currently just stressing out right now.

I had a patient that came to us after a crani and evd placement.

Read the order wrong and clamped the EVD all night instead of having it open to drain. ICP stayed stable under 5 all night however. When mistake was finally realized by AM shift, drain was unclamped and very minimal output was noted, even after dropping the drain per MD order.

Pts condition was very concerning immediately after surgery and into the following day (highly confused and agitated when weaning off sedation to do neuro checks). Could my mistake have caused his condition.

UPDATE: patient is fine. went to the meeting with my manager and another higher up. They ran through what happened, asked questions, got my account of the story. Questions, asked what I could've have done what I should have done.. the works. I answered as honestly as I could, made no excuses, owned up to my mistake. At the end, they said they will talk it over as a group and will Let me know in a day or two what will happen. Since it was such a critical error that COULD HAVE devastating/fatal results they were taking it very seriously. I completely understand that. So corrective action pending. That could. Mean a mark on my record to as far as getting fired. I'm spiraling right now. Guess all I can do now is reflect and wait the 2 days. Thanks everyone for all your help!!

Hey all,

Current PCCM fellow. My plan is to do full CCM after fellowship and I’ve been thinking a lot about the long-term sustainability of a pure CCM career.

I’m considering trying to find a way to pivot to only 18 weeks of ICU time per year rather than the more typical 24-26 weeks.

For those of you working around 18 weeks/year, what does your setup look like? Are you academic, with the remaining time split between research, admin, or teaching? Are you community-based and working something like 0.7 FTE? What does your compensation look like, and how has the schedule affected your lifestyle and overall job satisfaction?

Would appreciate hearing from anyone!

Has anyone gone from PICU to an adult MICU? Lots of adult to peds but having a hard time finding the other way around.

Just started pulm crit fellowship and immediately having cold feet about whether I picked the right specialty. I love the ICU but I saw a recent report that pulm crit will be in surplus in the next 10 years. And I’m not the biggest fan of pulm except for PH but I’m worried I won’t get a job in PH especially since it’s institution dependent about whether it’s cards or pulm.

Feel like maybe I should’ve done cards instead… it just seems like they’re making good money, good lifestyle and job security.

Don’t know what I should do… should I quit?

hi everyone,

I have been a nurse for a year with only neuro med surg experienc and have an interview for the cvicu and I rly want the job. I’ve interviewed for the cardiac surgical icu and did not get it. for that interview I was only asked like four questions like what do you know about the unit, have u ever been in a code, was there a time when you had a pt decompensating, and tell me about yourself. I thought I did good but I guess not. I’d rly like some tips because I’d rly like to work in an icu but no one will hire me.