Yuma Regional Medical Center on LinkedIn: YRMC has earned the 2024 Get With The Guidelines Stroke Gold Plus Award… (2024)

I read an article today on the American Heart Association website about an escape room designed to train nurses in stroke protocol and I think it's a brilliant idea!"The researchers developed the escape room in response to two key needs. Nurses at Tufts Medical Center Comprehensive Stroke Center gave feedback in recent years that they were looking for more interactive ways to meet their continuing education requirements through in-person formats. And those educational opportunities must be provided without requiring that nurses spend too much time away from their patients."I'm sharing a link to the article below and also thinking about how the idea of play as a way to learn could be applied to a sterile processing department.What if the game of Clue was crossed with the chain of infection? I could make a couple characters like Tanya Tuberculosis or Carlton C-Diff and assign teams of techs that character/microorganism. I could then "spread" that character through the department in some obvious and less obvious places along the 1 way work flow. Then give each team 10 minutes to trace that pyrogen's path through the department and at the end score each team based on if they found where the chain of infection broke down. It was Carlton, in the endo suite with a damaged channel brush! Based on how competitive our SPD Jeopardy game got, I think this would be so fun.What games do you think could be used to teach and build community in your sterile processing department?https://lnkd.in/gCzSsF3J#breakthechain #handhygiene #1wayflow #yeghealthcare

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Thank you Greater Ohio Vascular Access Network GOVAN for shifting the paradigm! It was nice to present on the adult patient perspective of living with long-term vascular access devices alongside, Tara, who is a PICU nurse and a parent to her son with TPN, and Mickey Hawes, nurse, researcher, consultant, previous Home Infusion Company exec., and PICC patient. The presentation was titled, “The Story Behind the Line: The Journey You Don’t See.”Todd Heslep BSN, RN, Paramedic, VA-BC, President, and the Executive Team at GOVAN made sure a patient and family perspective was shared in a meaningful way at their network meeting by:1. Having us as the first speakers for the day. Doing so respects our time as the rest of the content is catered to clinicians and allows us to speak to audience members after having shared the bulk of our story so we do not have to repeat or experience any repeated trauma in resharing. Starting with the patient and family perspective can help set the desired tone and provides a good reminder of our why.2. Valuing our time and energy as individuals and as a group. 3. Giving us autonomy in our slides and our call to action to the audience. I also thought putting questions from the audience in the middle of the presentation changed up the style and pace nicely and allowed the audience to feel included and have their questions answered. Great questions were asked pushing us to a good panel discussion.It was a joy to present and be a voice alongside Tara and Mickey’s thoughtful and direct insights. We shared the education we received to care for our lines in the home that has been most useful and the hardest to implement, and tips on how to communicate with us as adults, children, and caregivers, in the hospital at different points of access and the resources we may or may not have in the home. We truly asked everyone to understand this is our life not our job and we want you to take ownership of care delivery WITH us. We must work as partners. Being in a more intimate audience I got to see more closely for the first time clinician reactions of shaking heads, jaw drops and big eyes, when they learn I have had 31 central lines, 26 CLABSIs, 15 yrs no infection, same line for >5 yrs, and too many sticks w/o ultrasound. This is my why. This is why I continue to educate and travel to present. I get similar reactions in the hospital as an adult, especially at non-subspecialty hospitals stating I am the problem instead of asking why I had infections and line placements, what has been and is currently working well, and how can we continue that for you in this hospitalization and moving forward beyond these 4 walls. No one else should go through what I have gone through. We all have to learn from mine and the larger patient and family community experience for the next generation, for my gutsy peers, and for my friends who I have not met yet. #vascularaccess #vascularhealth #centralvenouscatheter #rarediseases #isavemyline

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Nurses change the body position of critically ill patients as frequently as every two hours toprevent bed sores and other complications associated with immobility (pulmonary complications such as ARDS, VAP and bronchopnemonia). Turning from side to side may also help loosen and drain secretions accumulated within the lungs. A lateral rotation mattress with position holding function can help nurses achieve above daily care activities. What an ICU bed can't do, our mattress can.https://lnkd.in/gawPC7MR.

❕ Secure the airway asap ❕ In a cardiac arrest, intubate ASAP. The ACLS algorithm lists airway management as a critical step - right alongside of CPR and defibrillation.⏳ Time is critical. A brain 🧠 without oxygen is a dead one.❔ What can an LNC look for to determine standard of care was met❔ When reviewing a cardiac arrest case, look to see when an airway was secured. Was it within minutes of identifying an arrest or was it much longer? For those taking a while to intubate, ask yourself a few questions:🗺 Location: pre-hospital vs in-hospital? EMS can take time to show up - especially if it's a rural area. The response in the hospital should be within minutes.🚑 Resouces: What were the resources available? If an arrest occurred at home or an outpatient center, intubation supplies will not be available until EMS arrives. Did this occur in the ER, on a med-surg unit, or in the ICU? Each may or may not have certain supplies or the anesthesia team immediately handy. Ask ALOT of questions about where things are at.💡 Knowledge: Who was there and what were their credentials? ALL healthcare workers are responsible for knowing BLS or ACLS - even if they do not work in a hospital setting. Look closely at who responded in order to determine if a knowledge-deficit was present.The 🅰 in ABCs is there for a reason. Secure the airway!Any tips for determining appropriate airway management as an LNC?🔽 🔽 -------------------------------------------------------------------------------------If your questioning intubation timing on a post-arrest case, reach out!Hannah Welk, BSN, RN, CCRN, LNC🌹 Red Rose Legal Nurse Consulting🌹 welkhannah@redroselnc.com🌹 (717) 940-3717

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It is imperative that we determine if you are positive first. CAM is the gold standard however there are other validated tools too. Let the end user drive the tool selected or give them options.

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It's a hot one this week! 🌶 ☀ Let's cool off......with a little Target Temperature Management (TTM). ❄ If a patient does not follow commands after a cardiac arrest, the AHA recommends cooling the patient to 32-36 degrees Celsius for at least 24 hours. ❔ Why ❔ ➡ Preserve brain function ➡ Reduce MortalityTTM should be initiated ASAP. Once the gel pads are applied, they DO NOT come off for 72 hours. The goal is to cool the patient for 24 hours, gently rewarm for 24 hours, and then maintain normothermia for 24 hours.Any interruption is TTM will undue the therapy and can be detrimental for the patient ⚡ After the 72 hour mark, the pads can be removed as long as the patient DOES NOT have a fever. If they have a fever, keep the pads on to maintain normothermia. A rapid increase 📈 in temperature can cause fluid and electrolyte shifts, leading to arrythmias ❤️ and cerebral edema 🧠 Labs 💉 must be carefully monitored during this time to ensure electrolyte shifts are managed appropriately. If the patient is shivering ☃, place a warming blanket on top of the patient (sounds counter-intuitive, I know) and administer medication to stop the shivering. Shivering warms the body up quickly, which we DO NOT want.Facilities providing TTM should have specific policies in place. This can be immensely helpful if reviewing a TTM case or caring for a post-arrest patient. Next week, I'm going to dive more into the critical electrolytes & new changing research around TTM. It gets a little WILD so stay tuned!What's your experience with TTM?🔽 🔽 ----------------------------------------------------------------------------------Need help reviewing a post-arrest case? Wondering if the patient should've received TTM? Contact me belowHannah Welk, BSN, RN, CCRN, LNC🌹 Red Rose Legal Nurse Consulting🌹 welkhannah@redroselnc.com🌹 (717) 940-3717

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Concise content for busy nurses. In this issue, read how ATTs may limit stroke and bleeding in trauma patients, AFib guidelines for a more aggressive therapy approach, refresher training to boost pediatric code skills, and more.

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ICU Delirium: Part 9The CAM-ICU is the troponin, creatinine, ABG, etc. of the brain. A common gap I see when I train ICUs is that many ICU nurses are not trained and/or confident in doing a full CAM assessment. Some erroneous assumptions I’ve commonly noticed are: - If a patient follows commands, they’re “CAM Negative” - If a patient is intubated, you cannot perform a CAM assessment. - Delirium is detected when a patient is hyperactive and impulsive - If a patient can tell you where they are, they’re not delirious. Is it imperative that we treat delirium as “Acute Brain Failure”. We would never go days to weeks without checking the creatinine on a patient in the ICU. Yet patients can go days to weeks without a proper CAM assessment in the ICU. It is time to assess for and respond to acute brain failure as any other life-threatening organ failure in the ICU. #ICUdelirium #acutebrainfailure #ICU #criticalcare #abcdefbundle #CAMICU #delirium #earlymobility

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In the ICU, it's crucial to carefully check if patients can handle and will benefit from fluid treatments to avoid potential harm from giving too much fluid. One simple and effective way to test this at the bedside is using the 𝙋𝙖𝙨𝙨𝙞𝙫𝙚 𝙇𝙚𝙜 𝙍𝙖𝙞𝙨𝙚 (𝙋𝙇𝙍) method, though it is not used as often as it should be.PLR, also known as the "𝙎𝙝𝙤𝙘𝙠 𝙋𝙤𝙨𝙞𝙩𝙞𝙤𝙣," involves lying the patient down from a semi-upright position and then raising their legs to about 45 degrees. This action increases the amount of blood returning to the heart, similar to giving a 300 ml fluid bolus, but without actually giving any fluid. The effects on the heart can then be assessed to see if the heart's stroke volume (the amount of blood the heart pumps with each beat) increases.When you increase the blood return to the heart (preload), it stretches the heart muscles more, making them contract more forcefully and increasing stroke volume. This effect is most beneficial in the zone of preload dependence. However, if you keep increasing the preload, there comes a point where the stroke volume stops rising and additional fluid can be harmful. This is known as the 𝘻𝘰𝘯𝘦 𝘰𝘧 𝘱𝘳𝘦𝘭𝘰𝘢𝘥 𝘪𝘯𝘥𝘦𝘱𝘦𝘯𝘥𝘦𝘯𝘤𝘦.The goal of PLR is to see an increase in stroke volume, indicating the patient is in the 𝘱𝘳𝘦𝘭𝘰𝘢𝘥-𝘥𝘦𝘱𝘦𝘯𝘥𝘦𝘯𝘵 𝘻𝘰𝘯𝘦 on the 𝙁𝙧𝙖𝙣𝙠-𝙎𝙩𝙖𝙧𝙡𝙞𝙣𝙜 𝙘𝙪𝙧𝙫𝙚. Blood pressure alone might not show this change, especially after a small increase in blood volume. However, using a 𝙥𝙤𝙞𝙣𝙩-𝙤𝙛-𝙘𝙖𝙧𝙚 (𝙋𝙊𝘾) 𝙚𝙘𝙝𝙤 to measure blood flow in the heart before and after PLR can be very reliable. A 12% increase in flow is a strong sign the patient will respond well to fluids. If the patient has an arterial line, measuring stroke volume variation before and after PLR is also reliable.It's important to note that the accuracy of this test can be affected if the patient is awake and moving, as this can stimulate the heart in other ways. Additionally, some patients, like those with certain surgical conditions or assist devices, may not be able to undergo the position changes required for PLR.Follow me Leonard Otieno, RN 🇰🇪 for more insights. SHARE | REPOST | COMMENT

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