The Critical Care Practitioner

This is a chat with Rowan Grieves who works in Belfast about her journey to become an ACCP and the hurdles she had to overcome when starting this new role.

Direct download: Rowan_final.mp3
Category:general -- posted at: 2:59am EST

This was originally a Facebook livestream with an ex patient- Carol Billian, Christine representing ICU Steps, a group helping support ICU survivors and Peter Nydahl from Germany who also aims to support the same group.

Direct download: Pt_Diaries.output.mp3
Category:general -- posted at: 8:24am EST

This is a chat I had with Dr Daniel Watkin about his QI project to assess compliance with the guidelines and how they went about improving it.


You can find the paper here- 'Beyond Audit: Embracing QI methodology to drive improvements in lung-protective ventilation'

This is a chat with Tamas Szakmany about the paper 'Impact of early tracheostomy versus late or no tracheostomy in nonneurologically injured adult patients: a systematic review and meta analysis' and his editorial 'When more could mean less intervention: the tale of tracheostomy timing in critical illness'

Direct download:
Category:general -- posted at: 6:26am EST

This is a chat with professor John Laffey about the WEAN_SAFE study. 

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Direct download: John_Laffey_final.mp3
Category:general -- posted at: 10:49am EST

A discussion with Michelle about the recent paper she played a part in discussing the conversation s we have, or don't about Do No Resuscitate orders.

The experiences of adult patients, families, and healthcare professionals of CPR decision-making conversations in the United Kingdom: A qualitative systematic review.


Direct download: Michelle-HartantoV1.0final.mp3
Category:general -- posted at: 6:13am EST

Brigitta and colleagues have just published 'The rate and assessment of muscle wasting during critical illness: a systematic review and meta-analysis.'

Some important and interesting discussion points.

Direct download: Brigitta_ICUAW_final.mp3
Category:general -- posted at: 8:34am EST

Great discussion with Dr Emma Ridley a dietitian from Australia about how they planned to look after the nutritional requirements of COVID patients. A lot of pointers about how we care for their needs when they haven't got COVID too. 

Direct download: Emma_Ridley.mp3
Category:general -- posted at: 8:21am EST

Vikki has been a clinical lead for Organ Donation in the past so I spent some time picking her brains about the role of the Organ Donation team and how that affects how we look after our patients. Lots of really valuable insights. 
Direct download: Vikki_SNOD.mp3
Category:general -- posted at: 11:45am EST

This is an important trial to start our look at Proning and the research supporting it.

I am going to continue this series of podcasts by looking at the other evidence.

Direct download: PROSEVA_trial_short.m4a
Category:general -- posted at: 11:29am EST

Let's get a better understanding of what that waveform is telling us!

Direct download: Free_Friday_End_Tidal.m4a
Category:general -- posted at: 12:42pm EST

Let’s talk about the equipment we use when we decide to intubate our patients. Some understanding of their features is helpful.

Direct download: New_Project.m4a
Category:general -- posted at: 2:41pm EST

It could be that they have dropped quickly or slowly. Either way its sensible to have a thought process ready so that you might be able to solve it! This is what I cover in this podcast.
Direct download: FREE_Friday_Why_are_my_patients_sats_dropping.mp3
Category:general -- posted at: 10:45am EST

A new series which I am hoping to provide weekly taken from the livestreams I am running across social media- this weeks topic- why do we intubate our patients?

Direct download: FREE_Friday_Why_do_we_intubate.mp3
Category:general -- posted at: 10:15am EST

A new series which I am hoping to provide weekly taken from the livestreams I am running across social media- this weeks topic- the basic ventilator screen. Lets go through some of those buttons.

Direct download: FREE_Friday_Basic_Vent_Screen.mp3
Category:general -- posted at: 1:37pm EST

A new series which I am hoping to provide weekly taken from the livestreams I am running across social media- this weeks topic- Peak and Plateau Pressures. What are they and why does it matter?

Direct download: FREE_Friday_Peak_and_Plateau_Pressures.mp3
Category:general -- posted at: 7:31am EST

A new series which I am hoping to provide weekly taken from the livestreams I am running across social media- this weeks topic- PEEP
Direct download: FREE_Friday_PEEP.mp3
Category:general -- posted at: 1:25pm EST

Direct download: Ash_Lowther_Final.mp3
Category:general -- posted at: 8:24am EST

Catherine presented recently at the BACCN conference discussing some of the issues our patients have when they leave the intensive care and how we might help.

Direct download: Catherine_White.mp3
Category:general -- posted at: 8:16am EST

Tell me who you are and where you work- Paediatric Nurse Consultant
What is your background- Paediatirc nurse
Why did you decide to go into advanced practice- Career options limited, spotted job opportunity
What was your biggest struggle during your training- academia and developing clinical knowledge
What was the part you found less difficult than you thought you would- Adapting into the clinical role
Give one question you would ask at interview- What is their enthusiasm for advanced practice.
Name one resource you have found most useful- Don't forget the bubbles website
Who do you admire most professionally.- Katie Barnes- developed advanced practice framework

Direct download: POF_Nathan_Griffths_Final.mp3
Category:general -- posted at: 6:00am EST

Tell me who you are and where you work- Medicine/renal
What is your background- Paramedic
Why did you decide to go into advanced practice- Longevity for career. Opportunities limited in para medicine
What was your biggest struggle during your training- Belief and role transition. Dis jointed learning

What was the part you found less difficult than you thought you would- clinical examination and procedures
Give one question you would ask at interview- would ask the interviewers how they were going support the 4 pillars
Name one resource you have found most useful- social media/podcasts/journal
Who do you admire most professionally.- Jerry Mortimer, now a lecturer, but always very inspirational

Direct download: POF_Kay_Murphy_Final.mp3
Category:general -- posted at: 6:00am EST

Direct download: POG_Gareth_Ward_Final.mp3
Category:general -- posted at: 6:00am EST

Direct download: POF_Jamie_Hyde-Watt_Final.mp3
Category:general -- posted at: 6:00am EST

Direct download: ARDS_and_proning_final.mp3
Category:general -- posted at: 6:00am EST

Direct download: Julie_harper_Final.mp3
Category:general -- posted at: 6:00am EST

What Matters to Patients and Their Families During and After Critical Illness: A Qualitative Study

Direct download: Catherine_Auriemma_Final.mp3
Category:general -- posted at: 6:00am EST

Direct download: Practitioners_on_Fire_Sarah_Shipley.mp3
Category:general -- posted at: 6:00am EST

Direct download: Michael_Rosen_Final.mp3
Category:general -- posted at: 6:00am EST

Direct download: Brigitta_Fazzini_Final.mp3
Category:general -- posted at: 6:00am EST

Direct download: Lina_Bergman_Final.mp3
Category:general -- posted at: 6:00am EST

Direct download: POF_Pete_Chessum_Final.mp3
Category:general -- posted at: 6:00am EST

Direct download: Lou_Gallie_Final.mp3
Category:general -- posted at: 6:00am EST

Direct download: POF_Joanne_Fisher_Final.mp3
Category:general -- posted at: 6:00am EST

'Critically ill patients' experience of agitation: A qualitative meta-synthesis' Nursing in Critical Care 2021

Direct download: Samantha_Freeman_Final.mp3
Category:general -- posted at: 6:00am EST

Direct download: POF_Martin_Horton_Final.mp3
Category:general -- posted at: 6:00am EST

Direct download: Joanne_Brown_final.mp3
Category:general -- posted at: 6:00am EST

Direct download: POF_Matt_Fowler_Final.mp3
Category:general -- posted at: 6:00am EST

Direct download: Rachael_Moses_POF_Final.mp3
Category:general -- posted at: 6:00am EST

Direct download: Carol_Billian_Final.mp3
Category:general -- posted at: 6:00am EST

Direct download: POF_Sally_Squires_Final.mp3
Category:general -- posted at: 6:00am EST

A revisit of one of my most popular episodes- mechanical ventilation with respiratory therapist Ollie Poole.

Direct download: CCP_018_from_the_vault.mp3
Category:general -- posted at: 6:00am EST

Sean and I chat about his experiences as an ACCP and he tells us of his struggles and those things that were not as difficult as he expected.

Direct download: Sean_Final.mp3
Category:general -- posted at: 3:46am EST

This is a discussion with Shannon Fernando on his recent paper in the BMJ about some of the mental health issues survivors of Critical care may have. 

Suicide and self harm in adult survivors of critical Illness: a population based cohort study.

Direct download: Shannon_Fernandes_final.mp3
Category:general -- posted at: 6:00am EST

Robin and Lee both joined me to talk about their journey on the advanced practice route and to share their advice.

Direct download: Rodin_and_Lee_POF_final.mp3
Category:general -- posted at: 8:42am EST

My good friend and colleague Rob Fenwick (@robfenwick) and I chatted about the article he was involved in "Productivity of Advanced Clinical Practitioners in Emergency Medicine: A 1-year dual-centre retrospective analysis

Rob is an Advanced Clinical Practitioner in the West Midlands in the Emergency Medicine department. He is also one of the members of the fabulous podcast The Resus Room (@TheResusRoom) which I highly recommend!

Direct download: Rob_Fenwick_July_2020_final.mp3
Category:general -- posted at: 9:48am EST

This is a discussion with Dr Mark Ramzy, an EM and Critical Care Doctor in Pittsburgh. 

His infographic on the various options open to us in the treatment of the patient with ARDS caught my eye on twitter so I managed to chat to him about it.

Direct download: Mark_ARDS.mp3
Category:general -- posted at: 7:01am EST

I am joined by Yogesh Apte, a doctor based in Australia, who recently went through a plan, do, study, act cycle with his team in critical care to ensure they prone well and safely. The article this is based on is below.

Prone positioning in patients with acute respiratory distress syndrome, translating research and implementing practice change from bench to bedside in the era of coronavirus disease 2019

Direct download: Yogesh_9_02_21_final.mp3
Category:general -- posted at: 3:40am EST

This is a discussion I had with several others on Facebook Live about setting up and the use of ICU Follow Up Clinics. Some of those on the panel were new to it and some had existing clinics so shared valuable information.

Direct download: ICU_Follow_up.mp3
Category:general -- posted at: 6:47am EST

Kimberley Kirkbright presented her poster at the recent virtual BACCN 2020 conference. She is a keen user of in situ simulation in her department and has set up a program to make it effective. We can all learn something from this.

Direct download: Kimberley_Begg-_BACCN_Poster.mp3
Category:general -- posted at: 6:10am EST

Here my friend Jon White (@TechNurseJon) chats with Suzanne Lee (@TheHappyLass) founder of Pivotal Reality, VR AR Consultancy for apps with purpose and VR for Dementia specialist, about how we could start thinking about VR in Critical Care.

Direct download: SuzanneLeeFinal2_mixdown_final.mp3
Category:general -- posted at: 10:10am EST

David Aaronovitch (@DAaronovitch) is a journalist, author and regular reporter with The Times. He was also an intensive care patient and suffered with a frightening delirium. We discuss this along with Dr Julie Highfield (@DrJulie_H) to see how we as intensive care practitioners can help.

Direct download: Delirium_julie_highfield_and_David_final_edit.mp3
Category:general -- posted at: 6:29am EST

A conversation between Zudin Puthucheary, Senior lecturer and consultant in intensive care medicine, Dr Caroline Sampson, consultant in Anaesthesia and Critical Care, deputy director for Adult ECMO, Glenfield Hospital and Dr Dan Harvey, Intensive care consultant, Nottingham University Hospitals and a member of the legal and ethical advisory group of the Intensive Care Society who is the author of "CRITCON-Pandemic Levels: a stepwise ethical approach to clinician responsibility." 

Direct download: Zudin_Ethics_COVID_1st_edit.mp3
Category:general -- posted at: 5:36am EST

A conversation between Zudin Puthucheary, Senior lecturer and consultant in intensive care medicine, Julia Hadley, also a consultant in critical care and lead for the Royal London guidelines for tracheostomy in the COVID patient and Dr Brendan McGrath who is the national clinical lead for the same. 

Direct download: Trache_in_COVID19_CCP_ver.mp3
Category:general -- posted at: 11:15am EST

Ollie (@respreview) is now a Doctor, having been a respiratory therapist. He has made a video over on YouTube breaking down the SCCM guidelines. He very kindly agreed that this could also be made into a podcast for those that would rather just listen. Thanks Ollie.

Direct download: Ollie_Poole_SCCM_Guidelines_Mech_Vent_COVID.mp3
Category:general -- posted at: 6:22am EST

I was very lucky to be contacted by Dr Zudin Puthucheary, Senior Lecturer and Consultant in Intensive Care Medicine, who asked me to record this conversation between himself and Dr Jim Buckley, Consultant in Intensive Care medicine, and Dr Brijesh Patel, Clinical Senior Lecturer and Consultant in Cardiothoracic Intensive Care. 

This discussion focuses on what is potentially the early stages of the crisis the NHS is about to face. Lots of great insights to take away!

Direct download: Zudin_et_al_COVID_ep_1_v_1.0.mp3
Category:general -- posted at: 4:57pm EST

This a an audio version of the espresso teaching on the BACCN website which you can find here-

Direct download: Preparing_to_Prone_BACCN.mp3
Category:general -- posted at: 8:13am EST

I got together with my good friend Dr Segun Olusanya (@iceman_ex) to talk about the use of paralysis in ARDS and the Rose Trial. Segun picked this apart for us in his post at The Bottom Line  and he and I chat about this and its implications. 

Direct download: ROSE_Trial_with_Segun.mp3
Category:general -- posted at: 8:39am EST

This is a conversation I had with Jon White (@TechNurseJon) and Kelley Reep (@reepRN) about their new Twitter chats and the aims and objectives of them. We also wax lyrical about the benefits of Twitter as a whole!

Direct download: Chat_with_Jon_and_Kelley.mp3
Category:general -- posted at: 8:06am EST

Thomas Piraino (@respresource) kindly joined me to talk about a paper he had been involved in writing recently regarding the evidence behind APRV-  "Airway Pressure Release Ventialtion in patients with acute respiratory distress syndrome: not yet we still need more data!". I think it will make me less likely to use it in the future. 

Direct download: Thomas_Nov_2019.mp3
Category:general -- posted at: 11:13am EST

One of my colleagues, Rachel Williams (@rawbubbles9), and her team are working very hard to get the patients moving and then hopefully home sooner whilst on the wards. This involves a number of methods including reindeer!

Direct download: Chat_with_Rachel_Williams_edited.mp3
Category:general -- posted at: 10:14am EST

My contacts at the American Association of Critical Care Nurses put me in touch with Jill Guttormson, the author of Nurses’ Attitudes and Practices Related to Sedation: A National Survey It seems we are still not great at doing the sedation hold and this is an attempt to find out why. Some interesting points raised I think.

Direct download: Chat_with_Jill_re_sedation_holds.mp3
Category:general -- posted at: 5:09am EST

Pressure Injuries at Intensive Care Unit Admission as a Prognostic Indicator of Patient Outcomes 
©2019 American Association of Critical-Care Nurses doi:
This is a chat with the lead author of this paper Dr William McGee.
"Pre-existing pressure injuries can serve as a predictive clinical marker for longer hospitalization and increased odds of mortality, especially when other data aren’t available, according to a study published in the June issue of Critical Care Nurse.
The research team from Baystate Medical Center in Massachusetts found that pressure injuries that were present upon admission to the ICU could be used to quickly and objectively identify patients who may require additional care. The statistical analysis revealed that pressure injuries were associated with significantly longer hospital lengths of stay, regardless of mortality outcome. Among patients with pressure injuries at admission, mechanical ventilation and dialysis were more common, as was the overall severity of illness. Readmission to the ICU during the same hospitalization occurred more frequently for patients with pressure injuries."
Direct download: chat-with-dr-mcgee_recording-1_2019-09-05--t11-42-35am--ccpractitioner.mp3
Category:general -- posted at: 9:29am EST

Paul uses this A-Z checklist for every patient on the ward round. Here he takes us through it to add to our understanding of some of the issues we need to consider when assessing our patients.

Direct download: PHW_A2Z.mp3
Category:general -- posted at: 12:45pm EST

In this episode Bryan discusses some of the issues with pain, agitation and delirium with the pharmacist Komal Pandya. 

We all try to understand how to help our patients and sometimes get it wrong, but lets continue to work hard to improve.


Jakob SM, Ruokonen E, Grounds RM, et al. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. Jama. 2012;307(11):1151-60.

Mehta S, Burry L, Cook D, et al. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial. Jama. 2012;308(19):1985-92.

Pandharipande PP, Pun BT, Herr DL, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. Jama. 2007;298(22):2644-53.

Riker RR, Shehabi Y, Bokesch PM, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. Jama. 2009;301(5):489-99.

Shehabi Y, Howe BD, Bellomo R, et al. Early Sedation with Dexmedetomidine in Critically Ill Patients. The New England journal of medicine. 2019;380(26):2506-17.

Direct download: Pain_Agitation_-_8_8_19_4.32_PM.mp3
Category:general -- posted at: 4:02pm EST

Sue Brierley Hobson is a dietitian in Wales and was part of a recent study looking into the efficacy of volume based feeding. We chat about this and the PERFect protocol.

Safety and efficacy of volume-based feeding in critically ill, mechanically ventilated adults using the 'Protein & Energy Requirements Fed for Every Critically ill patient every Time' (PERFECT) protocol: a before-and-after study.

Direct download: Sue_Brierley_hobson.mp3
Category:general -- posted at: 6:36am EST

Dr Paul Hughes Webb chats with me about how we define aneamia and what we can do about it for our patients.

Direct download: PHW_Aneamia.mp3
Category:general -- posted at: 11:34am EST

The last podcast from the NTI2019 and this was with other practitioners who all use Social Media to help others learn. This was a great conversation and a great way to wrap up. Thanks NTI I had a great time.

Direct download: Social_media_group_and_goodbye.mp3
Category:general -- posted at: 8:43am EST

Maureen A Seckel chatted about some of the studies she had noticed over the last year related to sepsis and I then went on to discuss proning with Danette Mitchell and how she had implemented an education program in her unit.

Direct download: Sepsis_studies_and_proning.mp3
Category:general -- posted at: 8:34am EST

Michael H Ackerman and Dr. Tom S. Ahrens chat with me about some of the recent changes in sepsis management. (Spoiler alert- not many to talk about!)

Direct download: Sepsis_management.mp3
Category:general -- posted at: 8:23am EST

Brandy Venable and I discuss how we can utilise QR codes to create just in time learning for the staff in critical care.

Direct download: QR_codes.mp3
Category:general -- posted at: 8:14am EST

What are the heamodynamics we should be concerned with and should we be measuring them?

Direct download: Eugene_Mondor.mp3
Category:general -- posted at: 7:58am EST

Jason developed life threatening sepsis after catching the H1N1 virus. He spent a lot of time in ITU, but then decided to become an ITU nurse. This gives him a unique perspective.

Direct download: Jason_Kirchik.mp3
Category:general -- posted at: 12:53pm EST

@onlyintheicu is the twitter handle of a nurse who has experienced some mental health issues including an attempted suicide. She and I  discuss the implications of this increasing problem for ICU staff

Direct download: OnlyintheICU.mp3
Category:general -- posted at: 12:49pm EST

Sometimes handing over our patients problems to another health care provider can be done badly not getting us the response we need. How can we improve that?

Direct download: Sean_and_Barbera.mp3
Category:general -- posted at: 12:45pm EST

I finally met Sean Dent who posts very regularly on Facebook and Instagram and is also someone I follow and interact with on Twitter. We also chat with Sarah Wells who is trying to help new and junior nurses by supporting them via social media.

Direct download: Sean_and_sarah.mp3
Category:general -- posted at: 4:54pm EST

Nicole Kupchik presented some of the key studies of the last year. Here she covers some of them for us with Anna Rodriguez

Direct download: Nicole_Kupchik_NTI2019.mp3
Category:general -- posted at: 4:49pm EST

Ruth Kleinpell, Teresa Rincon and Denise Ward chat with Bryan Boling about the development of Telehealth in The USA. 

Direct download: Ruth_Kleinpell.mp3
Category:general -- posted at: 2:23pm EST

Nicole presented on the implications of genetics on medicine management with our patients. Anna Rodriguez chats to her about it. Oh, and we finish with a Game of Thrones chat (no spoilers)

Direct download: Nicole_Frederick_and_Anna_Rodriguez_NTI2019.mp3
Category:general -- posted at: 2:12pm EST

Jon White chats with Nancy and Gayle about what makes staffing levels safe and how we can ensure that we keep our staff healthy,

Direct download: Nancy_Blake_and_Gayle_Lukar_NTI2019.mp3
Category:general -- posted at: 1:45pm EST

Bryan Boling chats with Daniel and Brandi about some of the liver problems our patients can have at the #NTI2019

Direct download: Bryan_with_Brandi_and_Daniel_NTI2019_final_mix.mp3
Category:general -- posted at: 11:10am EST

Megan (@nursenoodles) is president elect at the conference this year and in this episode she chats with Jon (@technursejon) about her upcoming work, social media and how she got that Twitter name!

Direct download: Megan_Brunson_and_Jon_White_190519_NTI2019.mp3
Category:general -- posted at: 1:54pm EST

One of the reasons our patients cannot sleep is because of all the noise we make at night. Is the answer just to make less noise? How can we do this? Will it make a difference? I chat with Julie Darbyshire (@JLDarbyshire) whose PhD is on this subject to find out more. 

Direct download: chat-with-julie_recording-1_2019-03-29--t12-25-14pm--ccpractitioner.mp3
Category:general -- posted at: 8:15am EST

There are now Advanced Practitioners appearing across the world of nursing, physiotherapy and paramedicine to mention just a few.

Here Bryan and I chat with Ruth Kelinpell who is the President of the Society of Critical Care Medicine about how these roles developed, what is happening today and what may happen in the future.

Lots of interesting points raised and some great food for thought.

Direct download: APPs_in_Critical_Care_-_2_7_19_4.31_PM.mp3
Category:general -- posted at: 6:12am EST

What happens to our patients after they leave the ICU? ICU patients are more complex even after discharge. They have a lot of post-discharge needs that make them unique and not every primary care provider is equipped to deal with them. That's why a number of centers are starting to develop ICU recovery clinics that see patients after they are discharged. Today on the podcast, I'm joined by Dr. Ashley Montgomery-Yates, an attending physician in the Pulmonary and Critical Care Medicine division at the University of Kentucky and director of UK's ICU Recovery Clinic.
Comprehensive care of ICU survivors: Development and implementation of an ICU recovery center.
Direct download: CCP_Podcast_104_Post_Intensive_Care_Syndrome.mp3
Category:general -- posted at: 11:27am EST

The right ventricle is often overlooked in critical care in favour of the attention to the left side of the heart. But acute right heart failure is important and today on the podcast we discuss its implications for critical care.
My guest is Barbara McLean, a critical care nurse practitioner from Atlanta, GA. You can follow her on twitter @criticalbarbara or her website at
Repessé et al. Acute Cor Pulmonale in ARDS, 2015
Chemla et al. Haemodynamic evaluation of pulmonary hypertension, 2002
Haddad, et al. Right Ventricular Function in Cardiovascular Disease, 2008
Mebazza, et al. Acute right ventricular failure - from pathophysiology to new treatments, 2004
Jardin, et al. Monitoring of right‐sided heart function, 2005
McLean, et al. Hemodynamics of Acute Right Heart Failure in Mechanically Ventilated Patients with Acute Respiratory Distress Syndrome, 2015
Direct download: Acute_Right_Heart_Failure_-_1_17_19_9.49_AM.mp3
Category:general -- posted at: 5:35am EST

I was lucky enough to be able to join Tanj and Dale Needham in this conversation at the ICS State of the Art conference 2018 in London. We discuss some of the ongoing issues with delirium in the critical care patient and how we might help them in prevention.

Direct download: Dale_Needham.mp3
Category:general -- posted at: 6:12am EST

Palliative Care in the ICU

All too often, we see critical care and palliative care as opposites, but they really go together nicely. Today on the podcast, we talk with Dr. Jessica McFarlin (@JessMcFarlinMD) about palliative care and how we can integrate it into the care of our ICU patients.
Center to Advance Palliative Care (CAPC):
The Society of Critical Care Medicine has more information about the Care and Communication Bundle:
Direct download: CCP_Podcast_101_Palliative_Care.mp3
Category:general -- posted at: 5:48am EST

The Two Jonnys are back!

We have had a break but time we got together again. In this podcast Jonny Wilkinson (@wilkinsonjonny) and I discuss the latest post on his fabulous website breaking down some of the new stuff out there on the internet relevant to our practice. Lots of food for thought. Go and look at the website too if you wish- well worth the visit.


Direct download: The_Two_Jonnys_Season_Two.mp3
Category:general -- posted at: 8:06am EST

Fluids- WTF!

I am very confused by the fluid discussions that seem to be constantly ongoing and changing! Which fluids to give, how much, when etc, etc. I am hoping to learn something during this mini-series starting with this discussion with Segun Olunsanya- @iceman_ex. We talk about some of the physiology involved. Stick with it- I learned something and hope you will too!

Direct download: Segun_and_Jonathan_Talk_about_IFAD2018.mp3
Category:general -- posted at: 7:22am EST


Acute Kidney Injury is a common complication in the ICU. Today we discuss it with Dr. Juan-Carlos Aycinena, a critical care nephrologist at the University of Kentucky. Dr. Aycinena refers to the KDIGO guidelines, those, along with a lot of other great guidelines and information about renal disease can be found at

Direct download: AKI_Bryan_098.mp3
Category:general -- posted at: 12:47pm EST

This is a discussion I had with Cath and Rachael, both senior physios about the European Respiratory Society 2018. We also talk about how they finance some of the conferences they attend. Food for thought.

Interview Questions for Advanced Critical Care Practitioners

Direct download: Cath_and_Rachael_tell_us_about_ERS.mp3
Category:general -- posted at: 11:21am EST

Continuing with our mini-series on electrolyte disturbances, today we talk with Aaron Cook about hyponatremia in the ICU. Aaron is a clinical pharmacist at the University of Kentucky specializing in Neurocritical Care. We discuss some of the causes and treatments of hyponatremia in critically ill patients.
Direct download: Hyponatremia_-_9_24_18_2.29_PM.mp3
Category:general -- posted at: 11:43am EST

This is the second chat with Thomas Piraino (@respresource) who is a Clinical Specialist in mechanical ventilation at the Centre of Excellence in Mechanical Ventilation, St. Michael’s Hospital.

We are moving onto some of the more complex modes of ventilation here with more variability and tweekability being offered by the ventilator.

Direct download: Thomas_epsiode_2.mp3
Category:general -- posted at: 9:15am EST

"Magnesium For the Win!"- with Bryan Boling.
Guest: Habib Srour
Dr. Srour is an attending in the Anesthesia Critical Care Division at the University of Kentucky where I practice. 
The episode is the first in a mini-series on electrolyte imbalances in the ICU. I hope to record an episode on hyponatremia soon. 
In the episode, we talk about a few studies that I said we'd link in the show notes:
Fawcett WJ, Haxby EJ, DaleDA. Magnesium: physiology and pharmacology. Br J Anaesth. 1999 Aug;83(2):302-20
Bhudia SK, Cosgrove DM, Naugle RI, Rajeswaran J, Lam BK, Walton E, et al. Magnesium as a neuroprotectant in cardiac surgery: a randomized clinical trial. J Thorac Cardiovasc Surg. 2006;131:853-61.
Koinig H, Wallner T, Marhofer P, Andel H, Hörauf K, Mayer N. 1998. Magnesium sulfate reduces intra- and postoperative analgesic requirements. Anesth Analg. 1998 Jul;87(1):206-10.
Speziale G, Ruvolo G, Fattouch K, et al. Arrhythmia prophylaxis after coronary artery bypass grafting: regimens of magnesium sulfate administration. Thorac Cardiovasc Surg 2000; 48: 22–6. 
Dorman BH, Sade RM, Burnette JS, et al. Magnesium supplementation in the prevention of arrhythmias in pediatric patients undergoing surgery for congenital heart defects. Am Heart J 2000; 139: 522–8. 
Minato N1, Katayama Y, Sakaguchi M, Itoh M. Perioperative coronary artery spasm in off-pump coronary artery bypass grafting and its possible relation with perioperative hypomagnesemia. Perioperative coronary artery spasm in off-pump coronary artery bypass grafting and its possible relation with perioperative hypomagnesemia.
Puri GD, et al. The Effect of Magnesium Sulphate on Hemodynamics and Its Efficacy in Attenuating the Response to Endotracheal Intubation in Patients with Coronary Artery Disease. Anesth Analg. 1998 Oct;87(4):808-11.
Pasternak, et al. The effect of preoperative magnesium supplementation on blood catecholamine concentrations in patients undergoing CABG. Magnes Res. 2006 Jun;19(2):113-22



Direct download: Bryan_Boling_Magnesium_for_the_win.mp3
Category:general -- posted at: 7:33am EST

Nicol (@nicchik90) is an RN and an author over in the US. She also has a website over at  where she has many other great resources for others in the profession to use. She recently presented at NTI Boston 2018 and. amongst other subjects, she discussed some of the recent papers we should all be aware of which might impact on our practice in the future.   Fascinating discussion and I certainly learned something! I'm hopeful I can get her back next year.

Direct download: Nicole_Kupchik.mp3
Category:general -- posted at: 11:51am EST

"Practicing Critical Care Like an Adult"

This is the first podcast with my new co-host Bryan Boling without me! He has chosen to have a discussion with Brandon Oto (@critconcepts).
Brandon is a PA in the Washington DC area who also writes a blog called Critical Concepts ( 
The episode discusses maturing as a provider as is based on a blog post he wrote recently. I think we can all take something from this one. 
Direct download: Bryan_Practice_like_an_adult.mp3
Category:general -- posted at: 2:18pm EST

I would like to introduce you all to Bryan Boling (@bryanboling) who is a critical care nurse practitioner over in the States. He is going to be a regular contributor to the podcast and he has many ideas and topics he wants to cover. In this episode, we talk about the differences and similarities of the practitioner role in the UK and USA.

Direct download: Bryan_and_Jonathan.mp3
Category:general -- posted at: 6:50am EST

I thought it was time we explored the subject of mechanical ventilation again and so I reached out on Twitter and am now joined by Thomas Piraino (@respresource) who is a Clinical Specialist in mechanical ventilation at the Centre of Excellence in Mechanical Ventilation, St. Michael’s Hospital.

We start with the basic modes and what is actually happening in those modes. You are going to have to concentrate on this one. Hopefully, this will be a series of podcasts to help us all understand better the process of mechanical ventilation.

Direct download: Mechanical_Ventilation_with_Thomas.mp3
Category:general -- posted at: 10:36am EST

I was lucky enough to be joined by Cath Edwards (@cathedwards_1), a physio up in Lancashire. She attended this years British Thoracic Society 2018 Summer meeting. So I picked her brains about what she heard there. It sounds like a great conference and I think one I will be trying to attend in the future. 

Interview Questions for Advanced Critical Care Practitioners

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Direct download: Cath_and_Jonathan_talk_about_BTS_2018.mp3
Category:general -- posted at: 6:18am EST

In May of this year, the American Association of Critical Care Nurses held their National Teaching Institute & Critical Care Exposition.  NTI2018. By UK standards this is huge with over 9,500 delegates and 350 presentations to go to! I followed this conference via social media so kind of experienced it. I also watched the Facebook Livestreams they did at the end of each day and was lucky enough to get to chat with the three nurses involved in this: Jon (@technursejon), Marissa (@marissa_labate) and Anna (@anna_the_nurse). Lots of great things happened there and I hope I might be able to be there in person next year.


Direct download: Chat_about_NTI2018.mp3
Category:general -- posted at: 6:56am EST