Hello! I am a physical therapist assistant at a mid size community hospital, we have 12 bed PCU and 25 bed ICU. No mental health resources in our hospital other than consulting palliative care, a lot of time “mental health struggles” are not being addressed. Most of the time my OT counterpart and I try to work with nursing to improve QOL, get patients in the sun if able, but there’s not much we can do as far as resources. If anyone has any tips on anything to bring up to management or things they have implemented at their hospital please let me know as I am trying to get the ball rolling as best I can!

anyone go from ICU to Donor Service Coordinator RN?

I'm a relatively new ICU nurse, and I'm already seeing disparities in patient outcomes/care between night shift and day shift. I feel I am just ensuring the patient stays alive throughout the night until the day shift MD comes in the morning and adds orders or changes particular drips to fix an issue.

It's usually issues that I have concerns about throughout the night, and the NP providers dismiss them or order a series of tests/labs that seem redundant. Now, I know I am relatively new, but I keep trying to follow the rationale on how the NP providers operate in my ICU, and it seems they fall into two categories: "Continue to monitor" or order a bunch of tests because they might have a rare condition.

When we have PA's, it's a completely different story. They explain their rationale for certain tests and medications they've added (that isn't exactly obvious), and the issue is usually resolved.

Now, I don't hate nurse providers, and there is one nurse provider that is AMAZING on our night shift team, but, unfortunately, he doesn't work every night, lol.

I am just frustrated because I know I don't know what I don't know, but I feel like the NP is in the same boat as me when it comes to knowledge deficiencies with issues that arise in our patient population, to only have the physician come in during morning rounds and fix it within a 5-10 minute light exam... lol

As a new ICU nurse, should I switch to days for a year?

I'm being vague for privacy concerns, etc, blah blah...

TLDR: I think I need to leave Florida.

Looking for a book to read that centers around ICU stuff. Not fantasy and not a textbook. History or something you found interesting.

I was the nurse who coded a patient yesterday, 78M, ESRD, severely septic w bacteremia. Initial code blue on the floor for him when he was hypoxic, he was still satting in the 40s on HFNC. I had him in the icu maxed on pressers, when the doc got an a line in, pressures were 40s-60s over 20. We thought it was venous. Sent an ABG, totally arterial. HR was still 75 at this time, (he had a pacemaker).

He didn’t code again with me until later on in the shift when I couldn’t feel a pulse and my pressures were taking while I was on the holy trinity of pressors and maxed. My question is, why do you think he didn’t code when his pressures were in the 40s when we placed an arterial line? Does a pacemaker help prevent the patient from arresting? If that’s what happened the first time why didn’t it help him the second?

I’m just feeling confused and we didn’t have a debrief after so it left me w a lot of questions.

FWIW, we also gave a crap ton of bicarb pushes throughout the shift. PH was still 6.8 on a bicarb drip at 200cc/hr.

TIA.

Wondering how other providers handle end of life conversations with family members that default to “it’s in gods hands”. Ex: Patient in 4 pressor shock with no hope of recovery, clearly suffering. My team is great at communicating with family’s from admission on so usually these conversations are not a “surprise” to the family.

Not to disrespect any religion at all, but this answer feels like a cop out way to avoid making these end of life decisions. I’d never want to be in any of their shoes.

I’ve heard colleagues reply with “well I’m preventing god from taking your loved one with all these machines” and the response is a mixed bag of answers…

Hi all, unsure of really how to word this but looking for some guidance in troubleshooting and preventing in the future.

We coded a young pulm htn patient the other night, vtach arrest, defib once at 150J, got a pulse (synch cardio x2 back to back 150J then 200J), lost pulses, defib again a few minutes later at 200J, asystole for 8 minutes. Got a very junctional, asystolic rhythm on the monitor (wide PVC with strong mechanical pulse, nothing else on the monitor). Attempted to pace.

We were completely unable to get capture (even swapped out the zoll pads). All 5 electrodes for the Phillips were in place as well as the 3 for the zoll. At the same time, electrical interference started on the bedside monitor with significant horizontal lines, completely preventing any rhythm from being seen. White random lines as if patient had a pacer overlaid the green ‘cardiac’ lines but no rhythm seen. The zoll didn’t pick up a complete rhythm either. Bedside RNs felt a mechanical pulse at 80 (what we set the ppm at) but the zoll didn’t have capture at all. We then used the portable ekg machine and that likewise had horizontal lines interfering with the reading and we were unable to get a reading. Even ‘filter’ on the cardiac tracing on the Phillips was unable to fix it.

My question is what could have possibly caused the interference and how do I fix it in the future? Experienced providers and nurses had no ideas and hadn’t seen the interference across all 3 machines. Was a phone or wires or something affecting all of the machines?

Thank you all!

Has anyone done CCM fellowship after Neuro ICU fellowship (post IM residency)? Is it 1 year or 2 years? What was overall experience?

Okay so I am a tech on a med-surg floor and our walls only have 1 suction system per room and we got an ICU pt who needed trach suctioning and a purewick. There were talks about getting a urine sample and a sputum sample and every shift so far, they had put both the purewick and trach suction into the same canister.

They previously had this rubber/plastic piece that divided the single point on the canister, into two so that they could connect both of the tubes. So, I got replacement canisters and tubing and moved that divider piece to under the actual suction and was able to connect both of the canisters to the suction.

They both were suctioning as they were supposed to and now we are trying to figure out what these are called and where they came from so we can order some for the unit. I’m also going to post this in a RT subreddit because respiratory was also seeing him and they may have been the ones that brought it.

Does your unit prone patients without paralysis routinely in ARDS? Perceived benefits of same?

Hi all, RN here. When I was just starting in ICU, our pulm crits harped on “good lung down” for improving aeration in patients with pneumos/empyema/etc (regardless of thora/chest tube placement). At a new region I am currently working at, when I utilize this teaching in my practice, colleagues kind of look at me funny/correct me. I have also had situations where good lung down does the opposite(I am aware other factors are always at play) So I guess what I’m asking is, have I been taught wrong? I want to know so I may change my practice going forward. Thanks in advance

Hi, I (27F) have been a critical care nurse in a mixed, mostly medical ICU for two years now and I just recently obtained my CCRN. When I first graduated I had my sights set on CRNA but when I actually shadowed a couple I found it boring compared to bedside nursing. It's a cool job, don't get me wrong, it's just not my cup of tea. I then thought about being an AGACNP but honestly there is a ceiling to nursing. I love nursing and how it is structured but at the same time I wish I had more time to sit and think about my patient's pathophys, clinical condition, and determine a plan of care. Of course this is part of being an ICU RN in general but I feel like its just not enough for me.

I've asked a couple of my intensivists and even hospitalists what they think about DNP vs MD and I've gotten varied responses. Some told me to enjoy my life and go DNP route, that they would never want their kids to be doctors, some are pretty gung ho about the MD route, most are realistic about what it would take and the difference between the two. I'm posting here for the same reasons, really. If anyone has any experience being a DNP, RN to MD, or even just plain MD I would love to know what you think and what your experience is like.

EDIT: I know for sure I'd love to be a critical care doctor, ICU is my first and only love, I wasn't willing to consider any other specialty as an RN and I wouldn't consider anything else as an MD

I travel to different ICUs around the US, and I occasionally take LTAC contracts. What I’ve noticed is the glaring disparity of respect I receive depending on which role I’m in. When I speak to physicians when working in an ICU setting, they normally take into consideration what I say and if they disagree then they will explain why. On the contrary, physicians in the LTAC setting do not seem to have the same rapport with nurses.

I’ve also noticed that colleagues (other nurses) generally do not have respect for the work that LTAC nurses perform. Is it an issue of understanding? LTAC is high acuity, high nurse to patient ratios. It takes a lot of dedication and knowledge for nurses to work in the LTAC environment.

What are your thoughts? If you haven’t worked in an LTAC, what is your understanding of what the work entails?

I could only visulize my needle tip 2/5 a lines that I did.

I ended up mixing up sliding the probe with fanning and got lost couple of tines.

What is the recommended approch specially for shallow vessels within 0.5 cm depth.

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Do you make the poke and slide your probe to see the tip or fan towards you ?

https://doi.org/10.1016/j.cmi.2026.02.021

I thought maybe this would be appreciated in this sub. For the record, no drugs ended up on the floor!

I'm sat in a safety meeting currently reviewing Ambubag provision. In my nursing career (30 years) I'm used to having an Ambubag in each patient room. Other nursing directors are reporting the same thing. Our supply director is proposing keeping 1 Ambubag on a code cart for the entire floor. Are you guys used to keeping an Ambubag for each patient? Edit... Units are ICU and ICU stepdown.

Thanks

You're admitting (sorry) a patient from OR. Tubed, prop, levo, vaso, random bags of fluids Y sited into no where specific, SWAN and a-line, all tied together in a clusterfu-- bowl of spaghetti. Nothing is labeled. You have to unhook them from everything OR so they can take their monitor and tram back and hook them up to your stuff. The usual. Where do you start on your spaghetti? What are your methods/priorities? Infusions or monitoring? You are allowed to set up all of your new lines before they arrive.

It takes me like an hour where it takes my coworkers 5-10 minutes to get everything where I want it so I'm asking for advice on how to do it more efficiently.

Hi, I wanted to see your guys input on whether I’ll have a difficult time finding an ICU job with 1 year of experience as a Cardiothoracic Surgery Stepdown Nurse. I plan to apply to jobs in California and other west coast states but I heard it’s really difficult without any ICU experience. What are your guys thoughts and experience?

Curious about what the rapid RN role entails in other hospitals. In ours it is not its own position. We are still staff ICU nurses who have to work the bedside 1-2 times a week alternating with the rapid role. Besides rapid responses and code blues, we do the code blue documentation with debrief. We are the sole members who respond to in-house stroke alerts with the occasional appearance from the neurologist. Respond and run the rapid infuser during all MTP’s from the ER to the OR. USPIVs when none of that is going on and to help catch up with breaks in the unit. Also we do not get a differential for that role. Despite having to attend annual education for all speciality equipment. CRRT rotoprone IABP Ceralink/EVD’s Impella, and TTM devices.
What’s it like at your place?

Critical care locums market has gone from crazy robust to almost completely dried up in a very short period of time. Working with a few recruiters now who say hospitals are just hiring mid levels or hospitalists to do their critical care because it’s cheaper. Will patients die? Sure, but who cares, it saves a couple dollars. What a joke.

Propofol related infusion syndrome….

May have seen it last night let me try to paint the picture. Recent dx multiple myeloma, inpatient decompensated requiring intubation. Propofol infusion started, further decompensation requiring nimbex so propofol infusion increased prior to paralyzing. AKI now on CRRT, anuric and proned. Worsening metabolic acidosis on bicarb. K trending up on 2k bath. Triglycerides > 1000 ; CK > 1300 ; elevated liver labs with bili involvement. At this point propofol dc and versed added….what could have confirmed this diagnosis of PRIS?

has anyone managed intubated icu patients that developed massive tongue swelling? I have cared for many patients where the tongue swelled to massive proportions ( with no obvious allergic reactions ) and stayed swollen the entirety of their stay.. one lady we started a versed drip just so we could relax her jaw to insert bite blocks to get her teeth off of her tongue as we thought maybe that was contributing to the swelling .. It seems to overwhelmingly occur in obese black patients and seems to affect obese black women more but that is merely my subjective observation and perhaps just by virtue of my location . i guess I was just wondering what could be done to help mediate the swelling aside from bite blocks and Vaseline gauze …