Clinical Pearls: Shock
Diagnosing the type of shock your patient is exhibiting is clutch when it comes to appropriately treating. Yes, Levophed is our quarterback when it comes to pressor selection, for good reason. But you need to have a darn good understanding of what it can and cannot do, when it is not the ideal choice and when there are better or adjunctive measures that must be undertaken quickly to save your patient. It all starts with coming to an accurate diagnosis. Often in real world practice this is hard to do as multiple states can co-exist, iatrogenic factors obfuscate, and no one piece of data is the be all end all. As with most things in medicine, you have to piece together the data to form the picture. This article reviews the pathophysiology, shares a hemodynamic chart, and overviews how to differentiate shock states.
Clinical Pearls: Procedures Performed In An ICU
What exactly can I do as an AGACNP working in an ICU? Commonly encountered question with the answer being fairly straight forward, with a little variation. Several factors exist which effect routine practice and this includes your training, your credentials (with the hospital), the comfort level of your attending, and the culture of scope allowance at your specific workplace. I’ve worked places where I do it all, and places where I do less. I find this varies most by work team structure and culture. The more staff available, including medical trainees the fewer procedures you will likely perform. Most students are aware of the common procedures we perform (central lines, dialysis catheters, and arterial lines) but there are a whole host of procedures we could perform. In this article I’ll discuss the myriad technical skills we as nurse practitioners can learn and perform to contribute to patient care.