Reddit critical care

All critical patients go to the 2 icu-trained nurses but they're both part-timers. Speaking as a critical care NP. org. It's a good course for being new in the ICU. All of which has been in the ICU. vent and sedation management, knowledge of surgical pathology, etc. Even my superiors told me that they feel like idiots sometimes. Trauma fellowships are 1 year also and top programs are houston, emory, det receiving, shock, harborview, usc, cook, etc. I appreciate the feedback and will look into purchasing a book! 2. If you want to stay on your side of the pond, European Respiratory Society (never been, but I hear it's good). 03. Pulm crit still has some component of primary service in it. It just organizes trials by topic. I've heard Burn has a nice lifestyle, and the compensation is better for the amount of work. Agreed on outcome not being the factor, but there does need to be some care provided that shows deterioration may have occurred without it. However ICU is also much harder than just doing anesthesia, and the hours are considerably longer. Everything else will be getting more specialized and more in depth. 35 votes, 16 comments. Yes it gives you an edge. This demand is met by mid levels. c) Give 12 mg Bulbasaur IV and 2 mg/hr IV Mew. I am a 25f with a masters in nursing, and have been a nurse for about two years. Either they do whole day or it rotates every 4 hrs during the day. You won’t be consulting any other specialist as a Cardiologist. Many times the ICU nurses know what im going to order based on patient. They basically function as PGY3ish. Life in the Fast Lane is also a nice website with the quick and dirty on a lot of different critical care topics. More students come out with increased debt are more likely to take crappy pay jobs. Alright guys two things. Mostly, to be honest, exposure is your best friend. More egos in cards. 5%. In pulm crit sometimes you deal with futile care. Acute Care Surgery: in theory, it's a term that covers Trauma, CC, and emergency general surgery. Our ICU nurses get to take smaller groups of more acute patients when they float to stepdown. Award. This deck is about a 3-months of hard work taken from various sources of critical care literature. The patients who would, in an open ICU, be handled by a Hospitalist. Less than 10% of the patients I see in the ED require critical care, so I’m not sure the CC to EM route is as easy for a PA but will still help you land the job you want. 01. If you don't get an ICU spot for preceptorship try to reach out to the manager and ask if you could shadow for a few hours one day. And separate csicu. Critical care, you’re taking care of the sickest of the sick, and most of the time it’s futile to be honest. I love medicine, I love being a doctor, I love impacting peoples Edit: Here's the breakdown of their offer, the face value for my health insurance for Major CI is at 5M, Minor CI at 25% of Face Value (1M), Recovery Benefit at 50% of Face Value (2. I feel like it is expanding as physicians and hospitals are recognizing it is not be cost effective. The "Internet Book of Critical Care" had spectacular articles on lots of basic things. EM surg crit is not a popular option because of the surgery year. Please note: this sub is not an appropriate venue to request medical advice. UF's Critical Care Paramedic course was top notch. 4 weeks paid vacation, 1 extra week at Christmas or New years. (Annual payment 155k or Monthly payment 14k) If it is same with AIA Critical Protect The full daylight shift rounds on 2 of the four ICUs with an attending and they split up who wtites which notes, does procedures, etc. And if you’re going to do it, you NEED to find a good training program. The more popular route is to do a three-year pulmonary and critical care fellowship (aka pulmonary and ICU) where you get boarded in both pulmonary medicine (aka respirology or pneumonology) as well as critical care medicine (aka ICU medicine, intensive care medicine, ITU medicine Anecdote: When my MIL wanted to seek treatment from one of the Mayo Clinic cancer care centres, they actually turned her away, saying "we cannot provide any better or faster care than you are already getting. 4. That’s a bit more expensive. Hemodynamics and shock are my favorite things. McFeeny. Providers always ask about resuming home meds and want to know about weird new outpatient meds so gotta be up on those too. org pretty helpful! I don't have any helpful books, just Critical Care. Critical care is way to nuanced for midlevels to take over and you’ll be hard pressed to find any intensivist who is scared for his career opportunities or those of the generation that will follow them. Critical care courses/resources. the training is 2 years, usually 1 ICU year and 1 operative year. 3. He cited the fact that adult ICUs have about a 40% mortality rate while PICUs are closer to 6. Hang in there, critical care is hard for a lot of people in the beginning. I would second emcrit. Our pulm service has one NP who does 5x 8hr days. CCEMT-P is still in its infancy, and so it is handled differently in different states. AACN is the best source for everything critical care, join and do the CE credits to gain perspective on things you will eventually see, order their bundle of 5 cards that cover meds and pressors etc (I still carry them 5 years in) and get the quick reference to critical care book off Amazon (is For storage: Per the manufacturer, unopened bags of Critical Care can be stored in a cool, dry location for up to 2 years after the manufacturing date (see Best By Date on the bag). 10 patients per attending, 30 beds mixed icu. It’s challenging and gives me more motivation to grow and adapt. The higher up is based on roles like charge nurse, preceptor, critical care areas (ED, ICU, and peri-op are all considered critical care), certifications, etc. I’m wondering if there are any courses/conferences that anyone here could recommend? Ideally, I’m looking for a longer course with both didactic and skills sections but any recommendations would be I did my preceptorship in a CTICU and nurses would ask for orders of Mg++ 2g without even checking Mg++ levels whenever there was arrhythmia on the monitor. Some of my geckos’ favorites are dubias, black solider fly larva, mealworms, silkworms, hornworms, and crickets. kryptikjoker. The correct answer was an A-E assessment, and that you'd call Currently I help teach the MS1 pulmonary block, MS4 critical care rotation, IM intern orientation, IM resident noon conference lectures, and sim lab and POCUS teaching for all ages :) The clinic/ICU split will just depend on the contract you get in the end - I don't think there's one specific template given that jobs are so variable. You’ll learn on the job just fine. A critical care “fellowship” in nursing is going to be a lot different than an actual critical care fellowship, which is for residency trained physician and the materials will be a lot different. there is a fellowship however to further specialize in ACS. Be a sponge for knowledge and never ever ever ever turn down help or suggestions from fellow nurses. Mostly it’s due to either sepsis, severe Resp or cardiac failure but I can’t help but feel like ICU is sometimes functioning as geriatric unit where some patients come for the end if their lives. I did a general surgery residency and then a critical care fellowship. I've seen anything from day shift 7a-7p or day 7a-5p and a second day 9a-7p or 9a-9p, then nocturnist from 7p or 9p to 7a. Second, exactly, not everyone event WANTS those kinds of relationships in their lofe. Classification of Respiratory Failure. At my ICU interview the scenario questions were: what would you do if a relative complained that their mother hadn’t been washed that morning; and what would do you do if see that your pt has low BP and raised resps. Look at indeed or job boards. The following instructions are specific to Oxbow's Critical Care recovery food. Metal ones can injure their mouths if they bite it. Yet the myth of lowly med-surg nurse versus elite ICU nurse persists, even among nurses Out of all the physician I know who trained in EM (EM residency) and did a fellowship in critical care (know about 10), only 1 of them does critical care - all the others just do EM. One aspect of trauma surgery is burn surgery, and there are a few dual burn/crit care fellowships. Rheumatology, you’re treating diseases that are barely well delineated with treatments that are barely well delineated to end goals which are barely well delineated. 5. I am also interested in hearing your overall opinion on which My classmate was a CNA in an icu and got hired as an RN right away onto her unit. Scheduled for 4 week days (2 ICU, 1 inpt Pulm, 1 clinic, can vary though), 7a-5p, no nights (midlevels in house), home call 2-3 nights per month, work every 3rd weekend 7a-5p (may be q4 by the time I start). Padis, surviving sepsis guidelines, AMS. The EmCrit podcast is a little hit or miss but the host, Scott Weingart, has several excellent videos about how to do a lot of critical care procedures like central lines, intubation, etc. Generally speaking, you want to reach out to the critical care folks at your institution - depending on your field of interest (anesthesia v IM v surgery) they will be key in getting you research and elective rotations and letters of recommendation needed to build a competitive application. There are also 'acute care surgery' fellowships, typically 2 years, which combine a year of critical care with a year of trauma and acute care surgery experience, to You can do critical care medicine (also known as ICU) as a standalone two-year fellowship from internal medicine. I'm guessing the private guys use that time to go At one point getting a credential to be a CRNA required absolutely no ICU experience. You don't need a fellowship to practice critical care my friend. My residency gave me enough critical care foundation to be comfortable transitioning to the ICU. I am considering starting my critical care paramedic education process. This was my main study source. It’s succinct and to the point. Since I was a kid I have always had interest in the military, and if I didn’t play a sport in More in PGY2 onwards. 02. Here's the deal. On the subject of #3: Critical care training will make you a better doctor for sure. Reply More replies. ”. Matches: 157. One that hires a ton of new grads every year, not just experienced nurses who are new to ICU. Spent a few years as a hospitalist before doing pulm-critical care. This is a subreddit specifically for interns and residents to get together and discuss issues concerning their training and medicine/surgery. Taking care of just 3 patients stresses them out and half of them will say "I don't know how you guys do this shit every day . This differs from advanced life support by the scope of practice and knowledge of the providers. Also, you don’t have to constantly be a charge nurse or preceptor; you just have to have done these things in a calendar year. Watch ins and outs more carefully, as well as more frequent 2 Critical care is where medicine, anesthesia, and surgery meet because at some point failing organs are failing organs regardless of the cause and managing them systematically is the same. a) Give 10 mg Bulbasaur IV followed by a 2 mg/hr IV dragonite infusion. -EM 3-4yrs residency + 2yrs fellowship = 5-6yrs total. Reply. . Currently in a NeuroICU. One book that I was recommend and is really good for ICU is the Washington Manual of Critical Care. From things such as variations in medical knowledge (e. If someone is rude to you don't be rude back. Not sure on the specifics I'm also a new grad finishing up my orientation in the ICU. I have learned that life is short and no one ever wishes they spent more time at work. We have EM-specific pathways for fellowship training and board certification in so many fields: critical care, emergency medical services (ambulance systems, tactical medicine, healthcare policy), toxicology (poison centers, environmental tox, medical expert witness), sports medicine, palliative/geriatric care, global health and probably others I wanted some input into the pros/cons of choosing to pursue critical care through anesthesia vs. New grad NP's can have an advantage if they are acute care-trained, with ICU experience as an NP student or even as a working RN. icufaqs. Alcohol withdrawal. More burnout on pulm crit side. ) to differences in the residency/job opportunities. Partner salary were all >500k, higher by 100-200k for sleep folks. It’s the easiest crit care experience to get, and showing up and working hard shows good team work, work ethic, clinical judgement etc which are all things that anaesthetists need to have. Fuma_102. Indications For Intubation. I am an MS-III and really interested in Critical care medicine. Monitor for Metwoo. Prehospital critical care is the stabilization and transport of the critically ill or injured, neonates, or high-risk obstetrics patients. This horrified my wife and some of my friends. Yes, I did encounter jobs at rural hospitals which would have required ICU coverage, typically with e-consult to a critical care doctor at a central hospital system. I actually prefer the online university since it is good for 1 year and you can watch the topics you struggle to get a grasp on several times. Sherwood makes a recovery food as well. This isn't a ACGME accredited fellowship, although The crit care only attendings at my hospital do week on week off 12 hr shifts. I’ve had Aflac for years for Critical Event and another for Cancer. Since the gecko is blind, tong feeding is probably the best option. Academic NCC attendings use the off-time to teach and do administrative stuff. Some fields, like ID, are trying to tie fellowships to CCM because CCM is more popular. There are many programs on the YouTubes for ACFT training. Anyone with experience can lend some thoughts? Thanks. Third, women in mentorship/leadership roles who "eat their young" are the worst, and definitely are to be kept at a distance. I liked my hospitalist job a lot (we did a few weeks on and then a week off), and when I first looked for jobs post fellowship I was surprised at how bad the schedules were - for many private groups the night and weekend call is insane. Most do not need this and will start eating within an hour or two after a spay/neuter. You will also never make up the opportunity cost that you put into a year of fellowship - in fact, your salary may even be lower for doing critical care. Split EM and ICU for a year and am moving to ICU full time. AXL434. But if you want more detail then maybe go with Pass CCRN. Got nocturnist offer as a hopsitalist to cover mix 26 bed ICU (trauma/some GSs cover their pts since they r CC trained so not much SICU). Fundamentals of critical care support. I’m looking for critical care in person courses and resources for the non-intensivist. Feeding instructions: The Oxbow feeding recommendations should be on the back of the bag -- they generally recommend 3 tablespoons of dry product or 50cc of mixed product daily per kilogram of body weight. 5M). HappyHiker1. I have never needed to critical my buns after a spay/neuter but that doesn’t mean some bunnies might need it. Do that, read the rationales, and you should be fine. Barron’s has a a pre test, a small amount of questions after each section, and 2 practice tests. I've also seen 24/7 coverage with home call. . There is an abbreviated daylight shift that is the line service which places lines and procedures as well as sees new admits. We notice which students vibe with the unit and a lot of ICU managers will ask the nurses how we felt the student fit in. I think it’s a wonderful blend of critical care and surgical procedures. Airway, pleural and vascular. In big centers each specialty will stay in their lane a bit more, but in smaller hospitals you can work in any type of ICU. My understanding is I can do IM, Anesthesiology or EM residency to get to a Critical care fellowship. • 5 yr. I am torn about which to pursue for fellowship. Exactly. ICU, MICU… About myself; IM grad, pretty comfortable w/lines, chest tube, para, thora, and intubations and Im not into daily social hospitalist dispo issues. Assuming you want only Cards ICU and not medical ICU. IM pgy2 also be at night shifts 6/7 days, and PCCM daytime Critical Care is a popular field that tends to fill (Pulm/CCM is highly competitive and a lot of people go in saying they like critical care). They've offered you an interview without any prior ICU experience so they won't expect you to know anything about ICU really. Call schedule depends on whose on that week. ETA: I'm not surg crit. The course I'm referring to is the AACN's Essentials of Critical Care Orientation (ECCO), an online course which costs the hospital $2000 to access, and another $225 per student. That said, the vast majority of the time these cases do meet critical care, just not by default. Pulm crit has more general medicine than cards. I As far as resources, podcasts I like are: Emcrit, continulus, rebel cast, flight bridge ED, internet book of critical care, medgeeks, and the elective rotation. I was accepted into a new grad critical care program and a requirement was prior exp as an icu cna or a rotation in an icu. Mechanical Ventilation. As they progress through their rotations they are given more responsibilities. And it’s like 25-29$. It does however, give great longer winded answers and provides PEARLS you wont find in I hope things get back to normal soon. All posts requesting personal medical advice will be removed. Most highly ranked programs prefer to see 1 year experience after the completion of residency programs or orientation before you apply to school. Wooden tong and rubber tipped tongs are best. Train up: don’t injure yourself, but build a good running foundation and maybe some weight training. PennyTrait. Representative page from my handwritten notes are attached to this post. An example, the CTICU nurses know in the post open hearts were going to go with epi over norepi or neo. I have taken their in person class and their online university both. % matched: 43%. Your rank will be determined by a few things like how long you’ve been an ICU nurse. Understanding the pathophysiology of shock is critical. 401k Most programs send their EM residents to the ICU in their first (maybe early second) year of training. Hospitalist PA here. No need to go through the hell of a surgery year. I apologize if this isn’t where I should post this, I am just desperate for honest feedback. I'd do it on my own but AACN doesn't allow individuals to take the course. r/IntensiveCare: r/IntensiveCare is a sub for medical professionals to discuss and improve their knowledge of critical care medicine. One of my friends is taking a crit care job in Central Valley California for 485k plus bonus. Several tried to get a contract to do EM/ICU, but it was always difficult to get details worked out (W2 vs 1099, who made the schedule, how does pay and benefits For foods you’ll want to offer a varied diet. The ICU and cardiology have differing goals. Low salaries discourage residents from entering fellowship. The whole interview was actually really straightforward. Rabbits should be force fed every 6-8 hours at minimum. More respect from the physicians, more thinking involved, more camaraderie/teamwork with other nurses, you see cooler stuff. Most people are fine with just the crit care 1 year fellowship, even if you only have a month of trauma. And idk how true but I got a few recruiter offers in Florida for 550-650k. I'm doing ICU full time, have done so for the last 3 years. Everyone struggles. Critical care can be a bit tough to break into, PA school curriculum doesn't really address critical care, and there is a lot to know. Those 3 are must haves in my Opinion. A cardiologist is going to cover consults, read echos/nukes/TEEs and do clinic, often all in the same week. Having aortic root and valve replaced. " People should think really carefully about what is actually being bought when they buy "critical illness insurance. -low pay for trauma/critcare, pulm/crit care, anesthesia/crit care fellowship. Khan Academy has great video tutorials that are super in depth and easy to understand. you get 6 months military of credit for every 1 year of RN experience. I could list many more reasons - as long as you leave the Big University complex (well, many of them), it’s an awesome job. Any chance of getting some help from Aflac? Didn’t realize their scopes were so narrow. The Little ICU Book. Also HESI HINTS in the Hesi book are what you should definitely know. All the female crit care docs I know are either married with kids or getting married, first off. So when they're not working, it's just whoever has no As for anesthesia vs EM vs IM - all three pathways offer the opportunity to make resuscitation a major part of your job as a physician without fellowship needed (although TBH EM & Anaesthesia offer much more in the way of resuscitation and procedural competency). But you have far more options now. surgery. My practice is made up of a week of ICU rounding, a few days off, a 24-hour trauma call, a few days off, a call, a week of emergency surgeries, etc. This is a call to Aflac. No floor coverage. Three pathways: Medical critical care Anesthesia critical care Surgical critical care To get into medical you need to be IM, EM, and/or IM subspecialty To get into surg crit you need to be Gen Surg or EM To get into anesthesia crit you need to be Anesthesia or EM Also there is Pulm-Crit but only as a pathway from IM A subteddit devoted to the discussion of critical care medicine- in ALL of its various forms: ICU, Critical Care Transport, ED Critical Care, etc. One charge has a couple years of medsurg experience and the other has a few years of pacu experience (straight from nursing school). It was a rotation through a super great hospital's different critical care settings, like their ER, burn ICU, CVICU, etc. There is an app simply titled "ICU Trials" that I use often. In Texas a few of my buddies are starting off 375k at academic centers. I am graduating this fall (if I can even finish my hours d/t COVID lol) and have always been interested in critical care in nursing school. You can get a good quality rabbit food like Sherwood and run it through a grinder and then sift it well, HOWEVER, you absolutely need some CRITICAL CARE in this mixture to keep it the proper consistency. If they won’t eat any hay or food and are not going potty then it is time to critical care. The place I was at had straight crit and it’s filled every year since I was a student. Convince me why cards or pulm crit is better. General Surgery resident applying Surgical Critical Care/Trauma. EM CCM docs do a full range of procedures. The nurses on the floor need to be used to training new grads. Learn to be a critical care nurse and take on challenging assignments. In my country, you need to do 1 year of surgical ICU during your anaesthesia residency. YBG seems to be the gold standard. I like my nurses to be critical thinkers and more future oriented. Cards. 6. Reimbursement rates are set for APP so they justify the lower salary by stating they are billing lower even though with proper procedures administratively they are still billing 100%. Still feel dumb sometimes. In the medical icu, they are essentially internal Med patients on steroids, vented, and on pressors. Also some rural hospitals having difficulty staffing a 24/7 in house critical care doctor would have the CC doctor act as a consult service while maintaining their FM or IM New grad ADN to ICU. Most do anesthesia or internal medicine critical care. Many major metro areas have critical care PA jobs, especially in cardiac and neuro. You can be an Acute Care Surgeon without formal fellowship training. For new grad PA's, certainly doing a critical care residency makes it much easier. I love cards and I love pulm crit. Try and be helpful. Until providers across the board make a Union. Critical care providers often perform things such as rapid sequence induction, thoracostomies and We’re paid based on levels I-IV. Cards cc is mostly confined to ivory tower situations or you are doing one or the other. • 9 yr. Night float is 1 attending and 2 to 3 APPs. -IM 3yrs residency + 3yrs fellowship = 6yrs total. You should also join AACN if you haven’t-they have lots of courses online as A fellowship is not necessary and you will lose out on money. Difficult airway course in Maryland is a great one to attend if you'll be intubating patients. Ask the pilot to descent to 5,000 feet. If your state has an CCEMT-P course you could go that route, or you could look to a nation class like the University of Maryland A subteddit devoted to the discussion of critical care medicine- in ALL of its various forms: ICU, Critical Care Transport, ED Critical Care, etc. 04. I have a better relationship with surgeons, medical sub specialists, nurses, and just about everyone in the hospital. I think in my clinical scenario it was something like a septic patient had been admitted to ITU and had 2L of fluid but was still hypotensive and tachycardic. “ICU advantage” on YouTube seems like a good resource for nurses, a few of the icu nurses I work with watch them. They give no support to their staff because they have no experience at all. Whites Fast Facts for Critical Care. amycakes12. They're very short, to the point, and a good resource if you're going for the CCRN or CMC. Some do ecmo cannulation, trachs as well. It will straight up tell you “you do not need to know this for the test. Two books my preceptor recommended to me were Fast Facts for Critical Care by Kathy White and The ICU Book by Paul Marino. 5M) and there's this Gender Specific 100k or up to 50% of Face Value (2. American Thoracic Society is THE international Critical Care conference. Just prepping and doing an exam won’t meet the criteria in and of themselves. Freezing may extend the shelf-life of the product by slowing oxidation and vitamin degradation, but too many freeze-thaw cycles can have negative effects The ICU call schedule varies significantly depending on where you go. I switched from med/surg to critical care. 14. It's written by the University of Washington and is a great resource with ICU specific topics and algorithms. Most of these have websites as well but I like podcasts to listen while I’m running or on my commute. I'm looking for the best online prep course to get my CCP-C or FP-C. He also said there's less burnout among doctors and less end-of-life care/management. They also have a money back guarantee. Which residency in your opinion is the best pathway? Then there's length of training: -Anesthesiology: 4yrs residency + 1 yr fellowship = 5 yrs total. Kupchicks CCRN and CMC review books are good to. And it needs to be at least 4-6 months orientation imo. The advertising is so happy happy hiding behind small print. But expect competition from NPs. One of my friends is making 600+ at an HCA hospital but he also does neuro crit and is opening a neuro icu. Pros: More time with patients, more stuff to figure out on them. The focus for the year is critical care management of surgical and trauma patients, but they also often are expected to be involved in the trauma service, including operatively. There's also your competitiveness as a candidate. Rough time for 6 months + higher pay, or more hours + less pay + semi rough ~3 months (at new ICU job if you don't stay at the same site you did fellowship). That's obviously anecdotal and biased though so take This gives employers monopoly and keeps resident pay low. ago. I would wait. •. Hi! I took my first job out of school in a very busy CTICU (taking care of cardiac/aortic/thoracic surgery cases, heart transplants, ECMO and LVADs etc). clinical echo self-assessment tool by Asher and Klein - 1000+ questions - did all the questions twice (minus irrelevant chapters) and took detailed notes. g. 2. You can find many, many hospitalist gigs at smaller shops where the ICU is open, sometimes with or without intensivist back up. I bought them both and I'm really pleased with them! May be a little outdated, but I used www. How often you see an elderly patient admitted in ICU for various reasons and despite every efforts, passing away or becoming comfort care in few days. The PICU specialist I was shadowing was advocating to go the Peds route as opposed to adult critical care. I highly recommend Flight Bridge Ed. I work with a strong team, and i genuinely mean that. There are some emcrit YouTube videos on basic procedures like central lines. Usually people have to do some CC or Anaesthetics (/ICU) SRMOing before getting on. It could be anywhere from 8, 10, 12, or 14 hour shifts. 7. Noninvasive Positive Pressure Ventilation (NIPPV) BiPAP or CPAP. Cons: More time with patients (it really depends on the pt), where I work it is much more physical in critical Army Reserve Critical Care Nurse. This deck is not meant as a primary study aid for exams, rather, it should be used once firm foundations are established as this deck gets into the weeds. This is the stats from this years match, technically CC alone was the most competitive speciality based on lowest %matched: Applications: 367. Look for new grad icu programs - mine was in Boston. If you are looking to get into critical care transport medicine I would encourage you to look into a CCEMT-P certification class. 🤷🏼‍♂️. But there is still high demand for people to provide care in all these specialities. The lifestyle can be rather brutal when you're on (as in, awake for the majority of 1-2 weeks straight), but most NCC physicians have hospitalist-type schedules, where they're 1 week on / 1 week off, or 2 on / 2 off. They offer a satellite campus of the CCEMT-P class nearby me but I also found the University of Florida Critical Care Paramedic program that can be done online that you come to Florida to do a cadaver lab and have two days of clinicals, and the Creighton University Critical Cara Critical care fellowship is the more important one as its boarded. " I’m a surgical intensivist. EM programs generally have graduated autonomy, example being they generally are only allowed to care for level 3 traumas. b) Raise the patient's head to diglet point and give 5 mg Mew IM. Due to COVID, I lost my preceptorship that was so difficult for me to get. Aflac critical care. hf xj il mp jw tj wy go ej cq