Cite this post as:
Scott Weingart, MD FCCM. EMCrit 214 – When they Stay & The Medical Tertiary Survey. EMCrit Blog. Published on December 11, 2017. Accessed on March 21st 2023. Available at [https://emcrit.org/emcrit/medical-tertiary-survey/ ].
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
Original Release: December 11, 2017
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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Re: End of infusion alarms
Many pumps have a “nearing end of infusion” alarm, giving the nursing staff a good 10 minutes to set up a new bag without needing to resort to the methods described in the podcast.
Have a look through your pump’s settings, and discuss with your pump supplier rep.
Tom–? is: is this alarm loud and blary or quiet and polite.
That was my first thought too!
That is how we think of you bro
A few other points that need attention when they’re staying longer (as in > 1 day): – Meds to prevent VTE/stress ulcer needed? – Patients who won’t be extubated right away probably need an NG tube. For antibiotics, the safest thing in my mind is to write them continuously from the get-go, and incorporate antibiotic dose adjustment into per-shift rounds. For most antibiotics, even a few days of overdosing will be far safer than missing the second dose. Similarly, if a home med needs to be stopped temporarily (eg bleed due to indicated anticoag) I write it continuously at a… Read more »
huge omission-VTE proph. Thanks so much Maarten!
In my ED we have separate intensive care zone – 4 beds, two nurses who are really great at their job. Now I know how lucky am I 🙂 in Poland
What about gastric ulcer prophylaxis
Controversial in some places
But would love to hear your take on it
has kind of faded from my priority list over the years. to the point that i am not starting it in the EDICU anymore unless the pt has a gi bleed/high risk ulcer
My IV pump trick of the trade is to hang 2 bags of the important medications, one on the primary line the other as a secondary. Program the pump just shy of the total volume hanging. When you see the secondary bag is out, replace it then. Make sure you add the new volume to the pump.. You’ll always stay one bag ahead of the game.
sure! problem is when folks are breaking other nurses and don’t have clear ideas when the infusions will run out.
Came here to say VTE ppx (the thing I forgot on my last 12+ hr ICU hold that I couldn’t get transferred anywhere…) but I see that’s already been caught! From a systems perspective, it was helpful to call a hospitalist and learn how they input ordersets like a VAP bundle, VTE prophylaxis and such. In our system, simple bed holds are taken over by the hospitalists and/or intensivists within 2 hours of “attempted admission” even if they physically stay in the ED. As such, we only really need to respond to emergencies with these patients. They do a good… Read more »
Setting VTBI on pumps ~50-75 ml less than bag volume is pretty standard practice at least amongst larger health networks I’ve worked. Having had the luxury of an ED pharmacist most pressors were mixed at a concentration that ran less than that 50 ml/hour. Regardless of the ratio for nursing, patients critical are getting hourly vital signs thereby allowing someone to hear an infusion ending before it dries. Also, we were able to reprogram our pump alarms to scream louder (go through your hospital’s sales rep for help). As always partnering with clinical leadership, clinical educators, etc. has proved most… Read more »
yep. i think programming the infusion complete alarms much louder is the way we are going at the Janus
My practice as far as IV bags is to look at the tubing packaging, it will tell you approximate priming volume. Ours is 20 mls, so I carefully and deliberately prime the tubing, set the pump VTBI 30-40 mls less than the total, note the time the infusion is set to take and set my phone alarm to 10 mins prior to that completion time. This way I know my line won’t run dry, and I have an alert to go change the bag. Also, for any infusion that I know will complete in less than an hour, I immediately… Read more »
Hello, Increase the Levophed concentration from 4mg in 250 to 8mg, 16mg or 32mg. The lower infusion rate makes the IV bag last longer. Plus, cuts down on the volume of IV fluids administered.
What about starting NGT/NGT feeding. We start as early as we can after admission and slowly build up according to patients acceptance. Just running at 20 ml/hr has benifits.
the current crop of literature did not strike me as showing much benefit to ultra early feeding. we don’t keep patients for >24 hrs and usually we get them up at the 12 hr mark, so we have not gone that road.
this guy throws down a bunch of equations and stipulates that per the laws of physics, you cannot determine cuff pressure by palpating the pilot balloon.
his argument seems specious. if i understand it correctly, it is that the pilot pressure is proportional not equal to the cuff pressure. This seems self-evident.