u/1ntrepidsalamander

I’m a critical care transport nurse and write a detailed narrative for every patient. Every narrative ends with a description of handoff at destination.

If the patient is obviously stable at time of handoff, I write that, but I’m always trying to improve my documentation. Is deciding “good” “fair” “poor” a vibes based description, or does it describe something objective?

Also, sometimes patients are “stable” on ECMO and pressors —as in clinical picture not actively getting worse and they are stabilized — but they are obviously very critically ill.

I’m curious how others use these words in their notes, particularly others in transport, doctors and NP/PAs.

I’m a critical care transport nurse (all ground/ambulance) and transported a high acuity adult pHTN pt on HFNC and nitric last night. We had a specialized RT come out to manage the nitric for transport.

I’ve only worked with nitric a few times in ICU, pre-Covid and had only seen it with intubated pts. I couldn’t find a lot to brush up on while driving to the call and am now going on a deep dive to try to fill my knowledge gaps.

Any good resources for using nitric for adults, especially not intubated?

The RT kept the HFNC flow low (15-20L) but the fiO2 % high to “not dilute the nitric”. Pts sats 89-91%.

I saw the sending hospital had sent a few methemoglobin levels but had refused to do an ABG 🤦🏻‍♀️ despite having an a-line. Maybe they aggressively didn’t want to know?

RVSP was in the 80s 😳. They hadn’t placed a PA catheter.

Anyways, we don’t transport a lot of pHTN pts that are this sick, but I want to be more knowledgeable next time I transport one.

Any good papers or resources you can recommend for this niche?