The Critical Care Practitioner

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 EDT

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 EDT

Pressure Injuries at Intensive Care Unit Admission as a Prognostic Indicator of Patient Outcomes 
 
©2019 American Association of Critical-Care Nurses doi:https://doi.org/10.4037/ccn2019530
 
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 EDT

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 EDT

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.

https://www.ncbi.nlm.nih.gov/pubmed/22436955

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.

https://www.ncbi.nlm.nih.gov/pubmed/?term=mehta+2012+sedation+interuption

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.

https://www.ncbi.nlm.nih.gov/pubmed/18073360

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.

https://www.ncbi.nlm.nih.gov/pubmed/?term=sedcom+2009

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.

https://www.ncbi.nlm.nih.gov/pubmed/31112380

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

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT

@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 EDT

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT

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. https://www.ncbi.nlm.nih.gov/pubmed/29929705
 
 
Direct download: CCP_Podcast_104_Post_Intensive_Care_Syndrome.mp3
Category:general -- posted at: 11:27am EDT

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 www.barbaramclean.com.
 
Repessé et al. Acute Cor Pulmonale in ARDS, 2015 https://www.ncbi.nlm.nih.gov/pubmed/25560864
 
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 EDT

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 EDT

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): https://www.capc.org/
 
 
The Society of Critical Care Medicine has more information about the Care and Communication Bundle: http://learnicu.net/Communications/Critical-Connections/Archives/Pages/Improving-Palliative-Care---The-Care-and-Communication-Bundle.aspx
Direct download: CCP_Podcast_101_Palliative_Care.mp3
Category:general -- posted at: 5:48am EDT

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