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oh good...I've been working on being more direct.That's a pretty judgey tone there
oh good...I've been working on being more direct.That's a pretty judgey tone there
I don't really care about varying styles and think it's interesting but 500 on transport??? For what?Cool to see all the different practices.
Personally I run precedex 0.3 mcgs/kg from the start, increasing to 1 when wires go in. Only give midaz to young patients (55 and younger), or whos anxiety is cranking up the catecholamines. 250 of fent on induction, 250 on sternotomy, 500 on transport.
I waste narcotics in the patient.I don't really care about varying styles and think it's interesting but 500 on transport??? For what?
I waste narcotics in the patient.
Joking aside, it’s for the ICU nurses. Provides a good 45-hour of sedation; nurses can get the patient “tucked in” without worrying about them flailing around.
Ooooor, they could just get the patient breathing and extubated that much sooner. Often, if patients are getting a little fidgety, flipping them to PSV gets them to calm back down, so the nurse can finish the initial charting.I waste narcotics in the patient.
Joking aside, it’s for the ICU nurses. Provides a good 45-hour of sedation; nurses can get the patient “tucked in” without worrying about them flailing around.
There’s a predictable and transient bump on the levophed during transport, no doubt. If I were practicing in a vacuum, most would go up on a prop gtt.Usually we get some hypotension on transferring the patient from the OR table to the ICU bed. Do you have issues with hypotension during transport after giving 500mcg of fentanyl for transport? I typically used 250mcg for a routine case and transported with propofol 30mg/kg/min.
I agree, unfortunately the CT ICUs at these shops have poor/no intensivist involvement. As I’m sure many have seen, you need to treat the nurse / surgeon at times.Ooooor, they could just get the patient breathing and extubated that much sooner. Often, if patients are getting a little fidgety, flipping them to PSV gets them to calm back down, so the nurse can finish the initial charting.
As an intensivist, that's quite frustrating. When I came to my current shop, I was quite aggressive, and able to get nursing buy-in (by being very involved in all aspects of care, and charming when doing what I wanted, rather than be an dingus). As a result, our average time to extubation was reduced by about two hours.There’s a predictable and transient bump on the levophed during transport, no doubt. If I were practicing in a vacuum, most would go up on a prop gtt.
I agree, unfortunately the CT ICUs at these shops have poor/no intensivist involvement. As I’m sure many have seen, you need to treat the nurse / surgeon at times.
So the transient need for inopressor from the universally described MAP dump on going from the table to the ICU bed (@ nimbus) or from the narcotic hit? Or both? That universal fall in blood pressure is well anticipated and has been postulated as being 2/2 release of sequestered acidotic blood on the move off of the table. Pure speculation, never seen a paper on it, but it's a thing. Can imagine how a whack of fentanyl would exaggerate it.There’s a predictable and transient bump on the levophed during transport, no doubt. If I were practicing in a vacuum, most would go up on a prop gtt.
Nah. Sometimes I bolus a smidge of prop on the walk to the until. Icu nurse has prop drip waiting on arrivalFor folks that give more than 2-4 versed, are you infusing sedation as well? There is a culture in some places of giving 2-3 anesthetics per case (over doses of fentanyl and versed + volatile agent + propofol +/- precedex, the main objective being amnesia apparently...