Critical Care Practitioner: Recent Episodes
Jonathan Downham: Advanced Critical Care Practitioner, Teaching, Sharing and Interviewing.
- What is DKA? – The triad of hyperglycaemia, ketonaemia, and metabolic acidosis (JBDS 2023 definitions).
- Pathophysiology explained – Insulin deficiency, ketone production, and why potassium is so tricky.
- Clinical features – Polyuria, dehydration, Kussmaul breathing, acetone breath, and red flags for deterioration.
- Investigations – Capillary ketones, blood gases, electrolytes, ECG, and screening for precipitants.
- Management (UK guidelines) – Fluids first, fixed-rate insulin infusion, careful potassium replacement, and always treat the trigger.
- Pitfalls – Starting insulin before fluids, forgetting potassium, dropping glucose too quickly, or missing the underlying cause.
- Case vignette – A young woman with type 1 diabetes presenting in DKA, walking through priorities and pitfalls in real time.
🔑 Key takeaways:
- DKA = fluids first, insulin second, potassium throughout.
- Monitor closely and stick to the JBDS 2023 UK protocol.
- Always identify and treat the precipitating cause.
Mobilisation in the ICU raises two big questions: is it safe, and will staff embrace it?
In this discussion, Jonathan explores both sides of the story:
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Safety first:
- Large prevalence studies show mobilisation is happening, though often inconsistently.
- A systematic review of 1,800+ sessions found serious adverse events in only 0.6% — most minor and short-lived.
- Even patients on CRRT can safely mobilise with planning, adequate staff, and the right equipment.
- Consensus guidelines outline clear safety screens, covering oxygen, ventilator settings, vasopressors, and line security.
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Culture and barriers:
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Staff concerns include safety fears, deep sedation, lack of hands, limited kit, and “whose job is this anyway?”
- Interviews reveal gaps in knowledge and confidence, differing beliefs about risks and benefits, and role confusion between professions.
- Success breeds success: once teams see mobilisation working, attitudes shift.
- Daily goals, interdisciplinary huddles, and local champions help make mobilisation the default, not the exception.
Takeaway: Mobilisation in ICU is both safe and achievable — but safety checks alone aren’t enough. Embedding it into everyday culture is the real key to making it routine.
Summary For much of critical care history, immobility was the norm: patients were sedated, kept still, and “protected.” But decades of research have revealed the hidden costs — profound muscle wasting, delirium, and long-term disability.
Jonathan explores how our understanding of mobilisation in ICU has evolved — from the recognition of harm caused by bedrest, to the first landmark studies proving that early movement is both feasible and beneficial.
From Bedrest to Better: Why Mobilise in ICU? * ICU-acquired weakness: Patients can lose 15–20% of muscle mass within the first week of critical illness. * Long-term outcomes: ARDS survivors tracked for five years showed persistent disability and reduced independence. * Sedation & delirium: Deep sedation increases delirium risk; mobilisation reduces both incidence and duration. * Physiological rationale: Even minimal movement supports cardiovascular tone, respiratory function, circulation, and cognition. * Core message: Bedrest is not neutral — it is actively harmful. Mobilisation offers protection for both brain and body.
Proof in Practice: The First Mobilisation Trials * Feasibility (Morris et al., 2008): Protocol-led mobilisation cut time to first mobilisation (5 vs 11 days), with no increase in adverse events. * Landmark RCT (Schweickert et al., 2009):
+ Early PT/OT + daily sedation interruption vs SAT alone.
+ 59% vs 35% regained independence at discharge.
+ Patients had less delirium and spent fewer days ventilated.
- Implementation (Needham et al.): Demonstrated how embedding mobilisation into daily ICU practice improves outcomes and serves as a model for quality improvement.
- Core message: Early mobilisation is not only possible — it improves patient-centred outcomes safely.
Key Takeaways * Bedrest and heavy sedation accelerate weakness, delirium, and disability. * Mobilisation is both biologically plausible and clinically effective. * Early trials proved feasibility, safety, and functional benefits. * Success requires:
+ Lighter sedation targets and daily SATs.
+ Interdisciplinary teamwork (nursing, PT/OT, medical).
+ Structured protocols and safety screens.
Overall message: Mobilisation should no longer be an afterthought in ICU. It is a therapeutic intervention — one that supports recovery, preserves dignity, and helps patients walk out of intensive care with more than just survival.
Sedation practices in the ICU have evolved dramatically over the past decade — but are we truly following the evidence?
In this episode of The Critical Care Practitioner Podcast, Jonathan takes you through the key milestones in sedation guidance, the persistent gap between recommendations and real-world practice, and the emerging shift toward human-centered, wakeful care.
What You’ll Learn in This Episode: * PAD Guidelines (2013) & beyond: How Barr et al. and later ATS/CHEST summaries shaped modern sedation practice. * Where we fall short: Why deep sedation is still common and the barriers to lighter, protocolised care. * Human-centered sedation: The move from “snowed and stable” to “awake and engaged.” * Future directions: Personalised sedation, integrated bundles, non-pharmacologic strategies, and technology-driven monitoring. * Practical takeaways: Simple steps you can apply on your next shift — from setting clear sedation targets to working as a team toward wakefulness and recovery.
Key Takeaway Sedation is not passive. It’s an active, daily decision that influences survival, recovery, and dignity. The future of ICU care is one where wakefulness is a therapeutic goal — not a risk
Overview In this episode we explore the three main sedatives used in critical care and how to choose the right agent for the right patient.
Highlights
- Benzodiazepines: once the workhorse of ICU sedation, but now linked to more delirium and longer ventilation. Still useful in alcohol withdrawal and seizures.
- Propofol: rapid on/off, easy to titrate, helpful for daily sedation holds and neuro assessments. Watch for hypotension, lipid issues, and the rare risk of infusion syndrome.
- Dexmedetomidine: provides light, cooperative sedation with minimal respiratory depression and less delirium, though bradycardia and hypotension are common drawbacks.
Takeaway No single “best” sedative exists. Match the drug to the patient’s needs and clinical goals — and remember, keeping sedation light is often more important than which agent you use.
We’ve explored the history of sedation in ICU, the impact of daily awakening trials, and the risks of deep sedation. In this episode, we focus on how to embed that evidence into practice — through the use of structured sedation protocols.
Protocols don’t just provide guidance; they transform everyday ICU culture, reduce variation in care, and improve outcomes. But implementing them isn’t always easy. This episode explores the why, what, and how of sedation protocols — and the cultural shift they demand.
What You’ll Learn in This Episode * 🏥 Why protocols were needed: how variation in sedation practices led to prolonged ICU stays and unpredictable patient journeys. * 🧪 What makes up a sedation protocol: RASS targets, daily sedation holds, nurse-led titration, and structured decision-making. * 📊 Evidence that protocols work: from Brook’s 2000 trial to the PAD guidelines and beyond. * 🔄 Barriers to implementation: fear of agitation, staff training gaps, inconsistent documentation, and cultural resistance. * 🛠️ Real-world examples: quality improvement projects that boosted compliance and shortened ventilation times. * 🎯 Protocols as safety nets: creating safe, evidence-informed defaults while leaving room for clinical judgment.
Key References * Brook AD, et al. JAMA. 2000. * Martin J, et al. Intensive Care Med. 2001. * Mehta S, et al. Lancet. 2008. * Barr J, et al. Crit Care Med. 2013 (PAD Guidelines). * Schmidt GA, et al. ATS/Chest Guidelines. 2016. * Mehta S, et al. Crit Care Med. 2012. * Ferraioli S, et al. BMJ Open Qual. 2019.
Takeaway Message Sedation protocols are not about rigid rules — they’re about shared standards, safety, and empowerment. They help us move from practice variation to consistent, evidence-based care that improves both efficiency and patient outcomes.
If your ICU already uses a protocol, engage with it fully. If not, perhaps it’s time to start the conversation
Episode 3 – Sedation Depth: How Deep Is Too Deep? In this third part of our sedation series, we explore one of the biggest game-changers in ICU practice: sedation depth.
For years, the approach was “sedate and stabilise” — often to deep levels. But mounting evidence tells a different story: early deep sedation, especially in the first 48 hours, worsens outcomes.
📉 The risks of deep sedation
- Higher hospital and 180-day mortality (SPICE study, Shehabi et al., 2013)
- Longer time to extubation and ICU stay
- Increased long-term disability
🧠 Sedation and delirium
- Strong links between deep sedation and ICU delirium (Ely et al., 2005; Tanaka et al., 2014)
- Delirium predicts worse survival and cognitive outcomes
🏥 Impact on ventilation and recovery
- More time ventilated
- Higher risk of infections
- Longer ICU and hospital stays
🛠️ Strategies for safer practice
- Set clear sedation targets (RASS –1 to 0)
- Protocolised, nurse-driven sedation adjustment
- Start light and reassess frequently
- Deep sedation only when clearly indicated (e.g., severe ARDS, TBI, refractory agitation)
Takeaway: Early deep sedation is a modifiable risk factor. The mantra is simple: “light unless otherwise indicated.” Less really is more — and safer.
In this episode, I explore the origins and evolution of the daily sedation hold — also known as the spontaneous awakening trial (SAT) — one of the most influential shifts in ICU sedation practice.
I unpack the key trials that demonstrated SATs could safely reduce ventilation time and ICU stay, and examines how these findings became standard care. But it's not all straightforward — SATs come with implementation challenges, especially when protocols are already in place.
Key topics:
- The evidence behind daily sedation interruption
- How SATs reduce ventilation and improve survival
- Why some ICUs still hesitate to adopt them
- What makes implementation successful in real life
- How SATs have reframed sedation from passive to purposeful
Kress et al. (2000). Daily interruption of sedative infusions in critically ill patients.
Girard et al. (2008). Awakening and breathing controlled trial.
Mehta et al. (2012). Daily sedation interruption in protocolized sedation: RCT.
Ferraioli et al. (2019). Quality improvement project on SAT compliance.
Schmidt et al. (2016). ATS/Chest guidelines on sedation minimization
In this episode, I explore how sedation practices in critical care have evolved over time — from the routine use of deep, continuous sedation to the early evidence that challenged it. You'll hear about pivotal studies that revealed the risks of over-sedation, the emergence of structured sedation protocols, and the beginnings of a culture shift toward lighter, more patient-centered care.
Key topics:
- The rise of continuous sedation in early ICU care
- Landmark studies questioning deep sedation
- Early implementation of sedation protocols
- How sedation culture began to change
Kress et al. (1998). The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation.
Brook et al. (2000). A prospective evaluation of empiric versus protocol-based sedation and analgesia.
Novaes et al. (1999). Stressors in ICU: perception of the patient, relatives, and health care team.
Martin et al. (2001). Sedative and analgesic practice in the intensive care unit: the results of a European survey
This is a conversation I had with Francesca Trotta, a nurse from Rome who is at the last stages in her PhD. This was at the BACCN conference in Aberdeen in 2024.
This is a chat I had with David Wightwick who is the CEO of UK Med a humanitarian medical aid charity. This happened at the BACCN 2024 conference in Aberdeen.
This is a conversation I had with professor Tim Buchman who is Professor of Surgery and founding director at the Emory Centre for Critical Care in the US. We discuss the advent of Advanced Practice in the US and how it will inform the same developments in the UK
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AI is here! How will it effect us and how can we use it, or not use it to help with our work? Aarti gives some easy to understand explanations of the key concepts.
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AI is here! How will it effect us and how can we use it, or not use it to help with our work? Aarti gives some easy to understand explanations of the key concepts.
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.
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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.
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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'
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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'
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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
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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.
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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.
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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.
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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.
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This study entitled "Prone Positioning in Severe Acute Respiratory Distress Syndrome" was published in 2013 and its aim was to evaluate the effect of early application of prone positioning on outcomes of patients with severe ARDS. It was a multicentre, prospective, randomised controlled trial mainly in French Hospitals. The primary outcome was 28 day mortality. Recruited patients had […]
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Let’s improve our understanding of the capnograph. Very valuable when caring for your patient.
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We all go grab the essential equipment when we need to intubate the patient. Buts what’s it all for? In this podcast I cover some of this. If you want to join me on FREE 15 Minute Friday go find the Critical Care Practitioner page on Facebook.
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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.
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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?
A new series which I am hoping to provide weekly taken from the live streams I am running across social media- this weeks topic- the basic ventilator screen. Lets go through some of those buttons.
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EA new series which I am hoping to provide weekly taken from the live streams I am running across social media- this weeks topic- Peak and Plateau Pressures. What are they and why does it matter?
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A new series which I am hoping to provide weekly taken from the live streams I am running across social media- this weeks topic- PEEP.
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A new series which I am hoping to provide weekly taken from the livestreams I am running across social media- this weeks topic- PEEP
Believe it or not we don't intubate people to put them on a ventilator. Rather we put them on the ventilator because we have had to intubate them. So why do we need to intubate them? Let's work our way through using an ABCDE approach. Airway The patients airway may be compromised. This could be initially supported […]
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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
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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.
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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!
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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 Models for a Post-Intensive Care Syndrome Clinic - Targeted Goals and Barriers. http://www.learnicu.net/Communications/Critical-Connections/Archives/Pages/Models-for-a-Post-Intensive-Care-Syndrome-Clinic---Targeted-Goals-and-Barriers.aspx THRIVE Post ICU Clinic Collaborative. https://www.sccm.org/Research/Quality/THRIVE/THRIVE-Post-ICU-Clinic-Collaborative
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 […]
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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. Interview Questions for Advanced Critical […]
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This is an episode I recorded with Professor Stephen Brett, outgoing President of the Intensive Care Society at the State of the Art meeting 2016 about the merits of the ICU Follow Up Clinics. During the conference, he had had a pro-con debate with Brian Cuthbertson who is Chief of the Department of Critical Care Medicine at […]
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This episode is in conjunction with my friends over at JICScast Segun Olusanya and James Day. We met with Dr Anna Batchelor, Carole Boulanger and Gavin Denton to discuss the role of the Advanced Critical Care Practitioner, its impact on the service as a whole and what the future may look like for this growing […]
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Cricoid pressure is the application of backwards pressure on the cricoid cartilage to occlude the oesophagus. Originally described by Sellick in 1961, he described how pressure applied at the level of the 5th cervical vertebrae obstructed the lumen of the oesophagus. This manoeuvre is performed to minimise the risk of gastric aspiration should the patient […]
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The third in the series with Ollie Poole (@RespReview) on mechanical ventilation. Ollie goes into some more detail on the phases of the breath. This requires some visualisation of the waveform involved. Below is the video from YouTube that Ollie originally produced which should help with that. Irma Bilgrami does a great job of breaking […]
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Another busy time in the world of the Critical Care Practitioner! This episode focuses on a discussion I had with Kaye Rolls (@Kaye_rolls) Clinical Nurse Consultant at the Intensive Care Coordination & Monitoring Unit (ICCMU). She and I had a Twitter discussion around a couple of articles she had read about the use of social media […]
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NOT The Two Ronnies…but The Two Jonnys….and Twitter! This is the another episode of an exciting new podcast project with Jonny Wilkinson (@WilkinsonJonny) who is an anaesthetist and Intensive Care Consultant at Northampton hospital He has a website, Critical Care Northampton, from where he does regular reviews of some of the many issues one can find […]
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In this episode I talked to Jennifer Cotton (@sonomojo) who runs the website Sonomojo which is a guide to ultrasound education and she talks about her reasons for setting up the site. The aim of the site is about connecting people to resources about ultrasound. Jennifer is just about to become a doctor and has worked […]
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I have covered some aspects of PTSD already in CCP Podcast 041: PTSD in Critical Care when I chatted with Dorothy Wade about some of her research. This gave me great food for thought, so I went to read some of the plentiful research out there. I posted this recently but also decided to release my […]
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Lynn Schallom is a research scientist at the Barnes-Jewish Hospital in St. Louis. She published a paper ‘Head of Bed Elevation and Early Outcomes of Gastric Reflux, Aspiration, and Pressure Ulcers’ in the American Journal of Critical Care in January 2015. Head of Bed Elevation There is a conflict between the need to keep a patients head […]
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Nicol (@nicchik90) is an RN and an author over in the US. She also has a website over at nicolekupchikconsulting.com 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 […]
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Why Won’t My Patient Sleep! The Intensive Care patient will often lie awake at night, eyes wide open, clearly with no intention of sleeping. So why won’t the intensive care patient sleep? Perhaps we need to understand what happens during normal sleep and take it from there….. Stages of sleep Sleep is divided into non-rapid […]
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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. Interview Questions for Advanced Critical Care Practitioners […]
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ACCPs skills are many and varied as those of you who do the job will know. My friend Gavin Denton (@DentonGavin) has conducted 3 different audits along with his colleagues at the Heart of England NHS trust. In this podcast he presents some of the very interesting findings. I think it proves that we are very worth the time […]
The post CCP Podcast 084: Audits on some ACCPs skills with Gavin Denton. appeared first on Critical Care Practitioner.
David Barton is Head of Department of Nursing at Swansea University and has been very involved in the development of the Advanced Nurse Practitioner role both locally and nationally. This discussion centres around his history and some of the issues in the development of the role as well as some thoughts for the future. There […]
The post CCP Podcast 006: Chat with David Barton appeared first on Critical Care Practitioner.
I love the world of social media. It was through the medium of Twitter that I was able to connect with James DuCanto (@jducanto)who is an anesthesiologist at Aurora Health Care in Wisconsin. Gavin Denton (@DentonGavin) and I picked his brains about some of the pitfalls in intubation especially for those not so experienced but […]
The post CCP Podcast 028: James DuCanto Talks Intubation appeared first on Critical Care Practitioner.
Three more papers of the month for us to peruse. This time Gavin (@DentonGavin) and I are also joined by Sean Munnelly (@seanmunn). The CLASSIC trial. Restricting volumes of resuscitation fluid in adults with septic shock after initial management: the CLASSIC randomised, parallel-group, multicentre feasibility trial. Hjortrup et al. Intensive Care Med. 2016 Nov;42(11):1695-1705. Epub […]
The post CCP Podcast 061: Papers of the Month: March 2017 appeared first on Critical Care Practitioner.
“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, […]
The post CCP Podcast 094: Magnesium for the win. appeared first on Critical Care Practitioner.
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 […]
The post CCP Podcast 101: Palliative Care appeared first on Critical Care Practitioner.
NOT The Two Ronnies…but The Two Jonnys….and Twitter! This is an exciting new podcast project with Jonny Wilkinson (@WilkinsonJonny) who is an anaesthetist and Intensive Care Consultant at Northampton hospital He has a website, Critical Care Northampton, from where he does regular reviews of some of the many issues one can find on Twitter. During this podcast, […]
The post CCP Podcast 076: The Two Jonnys September 2017 appeared first on Critical Care Practitioner.
This is a chat about the ICU patient with problems with their swallow or dysphagia, I had with Martin Brodsky (@MBBrodskyPhD), who is an Assistant Professor of Physical Medicine and Rehabilitation at the Johns Hopkins University School of Medicine. He is a clinician, researcher and educator with interests in swallowing and swallowing disorders, head and […]
The post CCP Podcast 060: My Critical Care Patient Can’t Swallow! Why? appeared first on Critical Care Practitioner.
I think this might be one of the most important podcasts I have ever done along with the next in the series. This is the first of two podcasts covering the latest NCEPOD paper on Non-Invasive Ventilation. This can also be found on the NCEPOD web page, but they also kindly agreed to allow me […]
The post CCP Podcast 077: NCEPOD 2017 Acute Non-Invasive Ventilation: Inspiring Change. appeared first on Critical Care Practitioner.
CCP Podcast 026 was myself and Ken Spearpoint (@K_G_Spearpoint) talking about some of the issues around Crew resource Management. We continue the conversation in this episode and maybe even arrive at some conclusions….maybe!! [table id=1 /] [Stitcher_Radio_Logo] [get_in_touch_with_jonathan] CCP Podcast 026 was myself and Ken Spearpoint (@K_G_Spearpoint) talking about some of the issues around […]
The post CCP Podcast 027: Crew Resource Management Continued appeared first on Critical Care Practitioner.
Dorothy Wade works as a chartered health psychologist in the Critical Care Unit at UCH. She is registered as a practitioner psychologist with the Health and Care Professions Council, and has a PhD in psychology and health care evaluation from University College London. She is available to support patients, families and staff in Critical Care. […]
The post CCP Podcast 041: PTSD in Critical Care. appeared first on Critical Care Practitioner.
The psychology of our patients, their relatives and the staff we work with is under discussion in this podcast. I managed to get Megan Hosey (@DrMeganHoseyPhD), a psychologist from Johns Hopkins, Dr Julie Highfield (@DrJulie_H), a psychologist from Cardiff and Dorothy Wade (@dwadepsych) a psychologist from London together to discuss these important issues. We talk about […]
The post CCP Podcast 086: Psychology of patients, relatives and staff. appeared first on Critical Care Practitioner.
Happy Christmas all! A usurper (Jesse Spurr- Injectable Orange) takes the reins in this episode which allows Jonathan to talk about himself. Hope thats not too narcissistic! Some old guests make an appearance as well. Hope you enjoy it and Have a great Christmas. [table id=1 /] [Stitcher_Radio_Logo] [get_in_touch_with_jonathan] Happy Christmas all! A usurper […]
The post CCP Podcast 021: Jesses’ Show! appeared first on Critical Care Practitioner.
In this podcast I carry on my conversation with Ollie Poole (@respreview) about some of the issues with mechanical ventilation. We talk about the different types of breath and why we use them. This then helps us identify some of the very confusing terms the ventilator companies use when describing their ventilator modes. We somehow […]
The post CCP Podcast 034: Mechanical Ventilation…Types of breath. appeared first on Critical Care Practitioner.
This is a discussion I had with Liz Staveacre (@lizzys39) who is Senior Critical Care Outreach Clinical Nurse Specialist at Northwick Park Hospital. Her Masters’ dissertation looked at the factors that influence whether nurses will escalate the patient when it is necessary. From the discussion, it would seem that there is still some work to be done. It […]
The post CCP Podcast 062: Escalate the Patient! appeared first on Critical Care Practitioner.
Levosimendan for the Prevention of Acute Organ Dysfunction in Sepsis Gavin and I try to peel apart the layers of the LeoPARDS Trial which assesses the benefits of levosimendan for the prevention of organ dysfunction in sepsis. It’s another interesting study which actually asks more questions that it answers, but all questions we may try to answer […]
The post CCP Podcast 050: LeoPARDS Trial appeared first on Critical Care Practitioner.
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 post CCP Podcast 100: The Two Jonnys Season Two! appeared first on Critical Care Practitioner.
Bethan Bishop is Head of Innovation and Industry Engagement at the Heart of England NHS Trust in Birmingham. In this podcast she discusses how this role came about, having come from a background in the Pharmaceutical industry. She works as part of the MIDRU team which aims to help in the innovation process. She is […]
The post CCP Podcast 007: Chat with Bethan Bishop appeared first on Critical Care Practitioner.
TEAM is a program of research to evaluate the effect of early mobilisation to assess functional recovery and patient-centered outcomes of ICU survivors. Carol Hodgson is one of the lead clinicians in this project, She will be presenting at the 2015 Intensive Care Society State of the Art conference, so this is an opportunity to […]
The post CCP Podcast 039: Early Mobilisation- Get Them Moving! appeared first on Critical Care Practitioner.
The Intensive Care Society, Faculty of Intensive Care Medicine, Difficult Airway Society and the Royal College of Anaesthetists have combined to provide the ‘Guidelines for the management of tracheal intubation in critically ill adults‘. The main part of the document covers Plan A to Plan D when performing this procedure. This is well worth a read […]
The post CCP Podcast 083: Guidelines for Tracheal Intubation in Critically Ill Adults 2017 appeared first on Critical Care Practitioner.
Myself and Tracey Starkey-Moore (@TraceyStarkeyMo) led a @WeNurses chat on the 1st October about Advanced Practitioners. You can find the Summary on the discussion on the WeCommunities website with the relevant key word clouds. Tracey and I then got together with Gavin Denton (@DentonGavin) and Jemma Owen (@JemmaOwen1) to discuss some of the key issues […]
The post CCP Podcast 038: WeNurses Tweet Chat About Advanced Practitioners appeared first on Critical Care Practitioner.
The post CCP Podcast 099: Segun and Jonathan talk fluids- Part I appeared first on Critical Care Practitioner.
This episode features a chat with Fiona Moffat who is a lecturer in Physiotherapy and practising physiotherapist. She was involved in some LEAN thinking and is now interested in early mobilisation in the critical care world. As a social scientist she is also interested in how we get to normalise new technologies or interventions in health […]
The post CCP Podcast 040: Why Won’t We Change? appeared first on Critical Care Practitioner.
Characterisation of sleep in intensive care using 24-hour polysomnography: an observational study. This was a very enlightening discussion with Rosalind Elliott from Sydney about her study. Our poor ITU patients are struggling to get any decent sleep- what can we do to help them? Rosalind Elliott qualified as a nurse in London, England in the […]
The post CCP Podcast 045: Simple Things to Help Them Sleep. appeared first on Critical Care Practitioner.
This is an episode featuring Dr Paul Wischmeyer (@Paul_wischmeyer) who is a doctor at the Department of Anesthesiology and Duke Clinical Research Institute, Duke University Medical Center. I noticed he had tweeted about a presentation (Surviving the ICU-The Patient Experience: What Patients Need Their Doctors to Know) he gave which was available on YouTube and […]
The post CCP Podcast 059: Surviving the ICU-The Patient Experience appeared first on Critical Care Practitioner.
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 […]
The post CCP Podcast 090: Mechanical Ventilation with Thomas appeared first on Critical Care Practitioner.
NOT The Two Ronnies…but The Two Jonnys….and Twitter! This is the fourth episode of an exciting new podcast project with Jonny Wilkinson (@WilkinsonJonny) who is an anaesthetist and Intensive Care Consultant at Northampton hospital He has a website, Critical Care Northampton, from where he does regular reviews of some of the many issues one can find […]
The post CCP Podcast 072: The Two Jonnys Do Twitter July 2017 appeared first on Critical Care Practitioner.
In this podcast episode I was lucky enough to have a discussion with Ollie Poole who is a respiratory therapist in Canada. I came across Ollies’ YouTube site Respiratory Review and was very impressed with his series on mechanical ventilation helping to explain some of the terminology and reasoning behind how we ventilate patients. He […]
The post CCP Podcast 018: Mechanical Ventilation…. appeared first on Critical Care Practitioner.
Reducing ventilator associated pneumonia in adult patients through high standards of oral care: A historical control study Lee Cutler, Paula Sluman. Intensive and Critical care Nursing. 2014 Consultant Nurse Lee Cutler discusses the study he was involved in with his colleague Paula Sluman. Ventilator associated pneumonia is a big problem in the critical care environment so […]
The post CCP Podcast 023: Wash Your Mouth Out!! appeared first on Critical Care Practitioner.
Happy Christmas…thats all! Happy Christmas…thats all!
The post CCP Podcast: Happy Christmas 2015 appeared first on Critical Care Practitioner.
RSI My good friend Dr. Nitin Arora and I had a discussion about the various combinations of drugs which can be used during a rapid sequence induction or RSI and the reasons for giving them. Sometimes its not always evident why the doctor wants the drugs he asks for. Hopefully, in this podcast, some of […]
The post CCP Podcast 048:RSI- Which Drug? appeared first on Critical Care Practitioner.
This is a conversation I had with Marcus Peck (@ICUltrasonica) who is the chair of the FICE committee (Focussed Intensive Care Echocardiography) and Hannah Conway who is an ACCP at Glenfield Hospital and is VERY qualified when it comes to ultrasound and echocardiography. It would seem that Marcus and colleagues are very keen for us to do echo! […]
The post CCP Podcast 082: FICE…Just Do It! appeared first on Critical Care Practitioner.
In this podcast episode, Gavin Denton and I look at three recent papers, breaking them down to try to help us and you understand some of their conclusions and how they reached them. Our notes can be found below. Video laryngoscopy vs direct laryngoscopy on successful first pass orotracheal intubation amongst ICU patients. JAMA Jan […]
The post CCP Podcast 055: Papers of the Month appeared first on Critical Care Practitioner.
I have been an advocate of using YouTube for many years now and one of the YouTube resources I have used for a while now is that created by Dr Eric Strong. I love his style and he teaches a lot of subjects which I encounter in critical and emergency care. People often ask me […]
The post CCP Podcast 016: The Strong Arm of Eric…YouTube Learning appeared first on Critical Care Practitioner.
Gavin Denton and I get together again to review a couple of recent papers that have some bearing on our practice. Welcome to the Papers of the month. This month we cover Check Up- Position- “A Multicenter, Randomized Trial of Ramped Position vs Sniffing Position During Endotracheal Intubation of Critically Ill Adults” and the APRV trial –BILEVEL-APRV […]
The post CCP Podcast 085: Papers of the Month March 2018 appeared first on Critical Care Practitioner.
This is a conversation I had with Martin Horton (@chuckyhorton), Aimee Wright (@AimsleyW) and Ashleigh Lowther (@ashleighlowther) about an ACP conference they are planning on the 6th October 2017 at Birmingham City Football Club. The agenda looks great and it will also be a fabulous networking opportunity. Its also very reasonably priced! Go here to book your […]
The post CCP Podcast 075: ACP Conference 6th October 2017 appeared first on Critical Care Practitioner.
Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN) This is an update and expansion of the previous nutrition guidelines and this is a summary of the some of the key points. I […]
The post CCP Podcast 053: Nutrition Guidelines appeared first on Critical Care Practitioner.
In my second podcast I think I set the scene for one of the tools I am going to use the most for the rest of the series, and in the podcast I explain why, going into some depth about Twitter. I also talk about the new History Taking and Examination course and my new […]
The post CCP Podcast 002: Twitter, Google Hang Outs and Speakpipe! appeared first on Critical Care Practitioner.
AKI: 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 https://kdigo.org/guidelines/. Interview Questions […]
The post CCP Podcast 098: Bryan talks AKI appeared first on Critical Care Practitioner.
Shiela Pantrini has been developing the educational route for the Advanced Clinical Practitioners along side Garry Swann at the Heart of England NHS Trust. She tells us how this occurred and the principles that drove it. We also go on to discuss the plans for the future and what would make a good potential practitioner. […]
The post CCP Podcast 022: ACP’s Education, Education, Education. appeared first on Critical Care Practitioner.
Ken Spearpoint and I talk about Crew resource management as it relates to the cardiac arrest scenario. I love talking with Ken as he is so knowledgeable and puts his points across so well. i found it really interesting to chat with him about this. I have broken it down into two parts as we […]
The post CCP Podcast 026: Crew Resource Management…What? appeared first on Critical Care Practitioner.
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 […]
The post CCP Podcast 089: Cath and Jonathan chat about BTS2018 appeared first on Critical Care Practitioner.
Psychological well being, health related quality of life and memories of intensive care and a specialised weaning centre reported by survivors of prolonged mechanical ventilation. Intensive and Critical Care Nursing Volume 30, Issue 3, Pages 145–151, June 2014 The lead author of this paper Louise Rose very kindly agreed to discuss this article and some of […]
The post CCP Podcast 013: Mind and Body appeared first on Critical Care Practitioner.
This is a discussion which follows on from CCP Podcast 077: NCEPOD 2017 Acute Non-Invasive Ventilation: Inspiring Change. In this episode, I have a chat about the NCEPOD findings with one of the authors, Mark Juniper and with Vicky Mummery a physio who is very involved in improving practice at her trust. I think this discussion […]
The post CCP Podcast 078: NCEPOD 2017 Acute Non-Invasive Ventilation: Further Discussion. appeared first on Critical Care Practitioner.
I made contact with Dr Segun Olunsanya via Twitter to discuss some of the issues around the fluid management of the sick patient. He in turn persuaded a couple of others involved in ITU. This has led to this fascinating discussion around this issue and it is one of the podcasts I am most pleased […]
The post CCP Podcast 014: How Much Fluid? appeared first on Critical Care Practitioner.
Extracorporeal membrane oxygenation or ECMO is one of those treatments we sometimes need to think about with our very sick patients. I recently had to make a referral to my local centre and doing so made me wonder what it is that the ECMO centres want from us to make the path smoother. So I […]
The post CCP Podcast 087: ECMO- How can I make the best referral? appeared first on Critical Care Practitioner.
Claire is a staff nurse at the Heart of England NHS Trust and is very passionate about her job. She has only been qualified for about 6 months at the time of the interview, but her passion for nursing is very evident in the interview. She also discusses her role as a Caremaker which you […]
The post CCP Podcast 008: Chat with Claire Flatt appeared first on Critical Care Practitioner.
Episode number three features a discussion with Robin a colleague and friend in the trust I work in. We discuss the varied elements to his job which include training, keeping up with current practice and audit. Team management at the arrest situation is also discussed and mention of crisis resource management. [maxbutton id=”1″] The Rage […]
The post CCP Podcast 003 : Interview with Robin Davies, Lead Resuscitation Officer. appeared first on Critical Care Practitioner.
Selecting the intervention in Intubated patients: Evidence, Guidelines and Clinical Application This is a chat with Rachael Moses (@rachaelmoses) who is a consultant respiratory physiotherapist. I noticed from a twitter post that she had been at a meeting and presented on the above topic. She was kind enough to chat with me for the podcast. […]
The post CCP Podcast 056: Got to help them cough! With Rachael Moses appeared first on Critical Care Practitioner.
Simon Cooper is an Associate Professor at Monash University in Australia and developed the First2Act website which looks at the management of the deteriorating patient using multi media teaching tools. The website is a free resource and will prove very helpful for those trying to work with this kind of patient. Some of the links […]
The post CCP Podcast 017: Simon is one of the First 2 Act. appeared first on Critical Care Practitioner.
Jonny Wilkinson (@wilkinsonjonny) and Dave Lyness (@Gas_Craic) were not at the Intensive Care Society State of the Art in person but both followed very closely via social media. Jonny has summarised a lot of the key points on his website Critical Care Northampton and in this podcast, we all discuss some of the issues raised. […]
The post CCP Podcast 081:The Two Jonnys at ICSSOA 2017 (and Dave). appeared first on Critical Care Practitioner.
Very short episode…listen and you will hear why. See you in September 2015!! [table id=1 /] [Stitcher_Radio_Logo] [get_in_touch_with_jonathan] http://traffic.libsyn.com/criticalcarepractitioner/CCP_break.mp3 Very short episode…listen and you will hear why. See you in September 2015!! [table id=1 /] [Stitcher_Radio_Logo] [get_in_touch_with_jonathan]
The post CCP Podcast- Summer Break appeared first on Critical Care Practitioner.
NOT The Two Ronnies…but The Two Jonnys….and Twitter! This is the second episode of an exciting new podcast project with Jonny Wilkinson (@WilkinsonJonny) who is an anaesthetist and Intensive Care Consultant at Northampton hospital He has a website, Critical Care Northampton, from where he does regular reviews of some of the many issues one can find […]
The post CCP Podcast 066: The Two Jonnys Do Twitter May 2017 (2) appeared first on Critical Care Practitioner.
Desarmenien. The chronic critical illness: a new disease in intensive care. Swiss Med Wkly 2016;146:w14336 This paper is one from the Swiss Medical Weekly 2016 and is a description of the efforts to develop what they call a multi modal care management approach to those patients at risk of chronic critical illness. They call these […]
The post CCP Podcast 052: Chronic Critical Illness appeared first on Critical Care Practitioner.
This is a very interesting chat I had with Dr Bronwen Connolly who is a Consultant Clinical research Physiotherapist and an NIHR post-doctoral research fellow about early mobilisation in the critical care. She was asked to present at the ICS SOA 2016 to summarise key evidence published in 2016 examining physical rehabilitation in critical illness and […]
The post CCP Podcast 058: Early Mobilisation. Do we know it works? appeared first on Critical Care Practitioner.
In this podcast episode, Gavin Denton and I look at three recent papers, breaking them down to try to help us and you understand some of their conclusions and how they reached them. Our notes can be found below. Dynamic light application therapy to reduce the incidence and duration of delirium in intensive care patients: […]
The post CCP Podcast 057: Papers of the Month appeared first on Critical Care Practitioner.
A prospective randomised trial comparing insertion success rate and incidence of catheterisation-related complications for subclavian venous catheterisation using a thin-walled introducer needle or a catheter-over-needle technique Kim, B. G. Kim, Y. J. Lim, Y. T. Jeon, J. W. Hwang, H. C. Kim, Y. H. Choi and H. P. Park http://dx.doi.org/10.1111/anae.13543 Gavin Denton and I […]
The post CCP Podcast 049: Central Venous Catheter- Which Needle? appeared first on Critical Care Practitioner.
Another look at some of the recent Papers of the Month to catch our eyes. This time Gavin (@DentonGavin) and I look at two papers, one focussing on the use of Ultrasound with central lines and the other a study in African children and the possibility of heart failure being caused by fluids. Myocardial and […]
The post CCP Podcast 064: Papers of the Month May 2017 appeared first on Critical Care Practitioner.
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 The Content on the website is provided for FREE as is the podcast. You could […]
The post CCP Podcast 097: Cath and Rachael tell us about the ERS conference 2018 appeared first on Critical Care Practitioner.
NOT The Two Ronnies…but The Two Jonnys….and Twitter! This is the third episode of an exciting new podcast project with Jonny Wilkinson (@WilkinsonJonny) who is an anaesthetist and Intensive Care Consultant at Northampton hospital He has a website, Critical Care Northampton, from where he does regular reviews of some of the many issues one can find […]
The post CCP Podcast 068: The Two Jonnys Do Twitter June 2017 appeared first on Critical Care Practitioner.
NOT The Two Ronnies…but The Two Jonnys….and Twitter! This is an exciting new podcast project with Jonny Wilkinson (@WilkinsonJonny) who is an anaesthetist and Intensive Care Consultant at Northampton hospital He has a website, Critical Care Northampton, from where he does regular reviews of some of the many issues one can find on Twitter. During this […]
The post CCP Podcast 063: The Two Jonnys Do Twitter: May 2017 appeared first on Critical Care Practitioner.
Hyponatremia: 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. Interview Questions for Advanced Critical Care Practitioners The […]
The post CCP Podcast 096: Hyponatremia appeared first on Critical Care Practitioner.
I was lucky to be asked to give a presentation about the role and the training of the Advanced Critical Care Practitioner at the 14th Critical Care Symposium in Manchester this year. This is the audio from that meeting as a podcast and I have also linked to the video with audio and slides combines. […]
The post CCP Podcast 065: ACCP Presentation at Critical Care Symposium 2017 appeared first on Critical Care Practitioner.
This is a discussion with Garry Swann. Garry is the Consultant nurse lead in the Emergency Department at the Heart of England NHS Trust and is one of the main driving forces behind the development of the Advanced Clinical Practitioner roles at this trust. This is an innovative way of solving some of the medical staffing […]
The post CCP Podcast 015: The Power of Practitioners? appeared first on Critical Care Practitioner.
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 […]
The post CCP Podcast 088: Chat about NTI2018 appeared first on Critical Care Practitioner.
Welcome to the first ever podcast from Critical Care Practitioner. This is an exciting project for me and I hope one that will continue to develop and improve over time. The intention is to cover a variety of subjects from those directly linked to critical care such as research, learning resources, websites involved in critical […]
The post CCP Podcast 001: Introduction and Interview with Teresa Chinn from @WeNurses appeared first on Critical Care Practitioner.
PLEASE go to www.life-saver.org.uk to see the fantastic job this podcasts interviewee has done of making the teaching of basic life support so much easier. I was blown away when I came across it, even as an experienced ALS team member. It sucks you in and gets you involved. To the novice it is a wonderful […]
The post CCP Podcast 031: From Lifesaver to LightSabre!! appeared first on Critical Care Practitioner.
ICU acquired weakness or polyneuropathy An interview with Dr John Kress, an ITU physician from the University of Chicago. Dr Kress is a highly respected and well published doctor with an interest in ICU acquired weakness or polyneuropathy, one of his more well known papers being ” Daily Interruption of Sedative Infusions in Critically Ill Patients […]
The post CCP Podcast 012: Get my feet to the floor…please! appeared first on Critical Care Practitioner.
How high should I sit my patient? Should we measure the angle of the bed? I was lucky enough to be able to chat to Louise Rose again. She and I first had a conversation back on CCP Podcast 013: Mind and Body. In this episode we talk about a study she was involved in, […]
The post CCP Podcast 042: What angle should I sit my patient at? appeared first on Critical Care Practitioner.
This is the second of a series of podcasts with Ollie Poole who was a respiratory therapist in Canada and is now doing his medical training. You can listen to the first episode if you wish… CCP Podcast 018: Mechanical Ventilation…. We go back to some of the basics here, discussing some of the reasons and […]
The post CCP Podcast 024: Mechanical Ventilation….the basics. appeared first on Critical Care Practitioner.
Wendy Sinclair (@wlasinclair) is a lecturer in childrens nursing at Salford University and has been there for the last eight years. She started using Twitter about a year ago as a way of engaging the Salford Nursing Students. Also to see how they could use social media in both a professional and social capacity. She […]
The post CCP Podcast 033: Calling all students…. appeared first on Critical Care Practitioner.
Kirsten Kingma (@surferkirst) is currently a medical student, traning to be one of the Doctors in South Africa who started her health care career as a paramedic We start by talking about the role of the paramedic in South Africa and how the different funding system impacts upon health care. We also talk about the […]
The post CCP Podcast 032: Hello South Africa! appeared first on Critical Care Practitioner.
I am lucky enough to get to chat to Teresa Chinn from @WeNurses. I first spoke with Teresa on my very first podcast and since then we have both grown our various enterprises. Teresa has been awarded an MBE in the New Years honours list this year and it is thoroughly deserved for all her […]
The post CCP Podcast 025: Teresa Gets A Gong! appeared first on Critical Care Practitioner.
It’s no secret that I love a good SMACC. For those that don’t know this stands for social media and critical care and has been a conference in Australia held over the last two years. The last conference was on Australia’s Gold Coast and the philosophy behind these conferences is summed up by free open […]
The post CCP Podcast 009: SMACC me hard! appeared first on Critical Care Practitioner.
Simon Hayward (aka @sonophysio) is a great advocate of lung ultrasound in the critical care patient. He currently is running a very popular course with one of his medical colleagues to help introduce people to this technique. He is busy! We talk about the reasons for doing so as well as discussing the recent conference […]
The post CCP Podcast 074: Lung Ultrasound with Sonophysio appeared first on Critical Care Practitioner.
Non-pharmacological interventions for sleep promotion in the intensive care unit Cochrane Database Syst Rev. 2015 Oct It is well-known that patients in the intensive care units do suffer from a lack of sleep and frequent sleep disturbances. So how can we help the ITU patient sleep? This is a Cochrane review looking at the efficacy […]
The post CCP Podcast 044: Helping The ITU Patient Sleep. appeared first on Critical Care Practitioner.
This episode of the Critical Care Practitioner is going to focus on some of the other podcasts I listen to which influence my practice as a critical care practitioner and which I think will be useful to those of you pout there who want to keep up to date with current practice and thinking. How […]
The post CCP Podcast 004 : Great Medical Podcasts to Listen To. appeared first on Critical Care Practitioner.
My friend and colleague Dr Nitin Arora (@aroradrn) has just completed his Focussed Intensive Care Echocardiography (FICE) course and has managed to complete the 50 required scans in 63 days! It can be done. Segun (@iceman_ex) and I chat with him about his experience. Interview Questions for Advanced Critical Care Practitioners The Content on the website […]
The post CCP Podcast 080: Nitin does FICE….quickly! appeared first on Critical Care Practitioner.
This podcast is a discussion with one of the main organisers of the SMACC event later this year, Oli Flower (@OliFlower). The conference is looming fast, in June of this year in Chicago. We discuss the past conferences and the ethos behind them and the upcoming one. Oli is also involved with the Intensive Care Network […]
The post CCP Podcast 030: SMACC it! appeared first on Critical Care Practitioner.
“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 (http://www.critcon.org). The episode discusses maturing as a provider […]
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“Have you ever wanted the speaker to fail?” In this episode of the podcast I speak with Dr Ross Fisher (@ffolliet) about presentation skills. Many of us have sat through ‘death by powerpoint’ and have come away non the wiser afterwards. Having watched a lot of TED talks I can testify that a good presentation […]
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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 […]
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This episode features Ken Spearpoint. Ken is Consultant Nurse, Resuscitation, Hammersmith Hospital & Principal Lecturer, Medical Simulation, University of Hertfordshire. Ken is very experienced in the area of resuscitation, having been working in this field since the 1990’s. He has seen the service develop a lot in that time and that is discussed in the podcast. […]
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I was fortunate to be able to have a good chat at the ICS State of the Art 2016 conference with Roger Harris (@RogerrdHarris), Danni Bear (@Danni_Dietician), Ella Segaran @ESegaran) and Todd Rice about their interpretation of the Nutrition Guidelines released last year. Todd is one of the original authors and both Ella and Danni […]
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A follow up discussion from my chat with Garry Swann in episode 15 of CCP Podcast. Garry is the Consultant nurse lead in the Emergency Department at the Heart of England NHS Trust and is one of the main driving forces behind the development of the Advanced Clinical Practitioner roles at this trust. The plans we […]
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The three boys get together again to talk about the papers of the month. A Multicenter, Randomized Trial of Ramped Position versus Sniffing Position during Endotracheal Intubation of Critically Ill Adults Semler et al, 2017. Clinical question. In critically ill adults requiring endotracheal intubation, does the ramped position increase the lowest oxygen saturation […]
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I was lucky enough to be invited to the Home Mechanical Ventilation Conference in June 2017 by Rachael Moses (@rachaelmoses) and Professor Nick Hart (@NickHartThorax) and this is one of the presentations I thought you might like to hear. Bariatric surgery has become almost routine now and Andrew Jenkinson tells us why. Diets will never seem […]
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In an attempt to further my understanding of some of the methods used in research Gavin Denton (@dentongavin) and I had a discussion about the SepsisPAM trial below. This is a new approach on the podcast and one which I hope people will find useful. We go through the article using a systematic approach, and […]
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The Intensive Care Society, Faculty of Intensive Care Medicine, Difficult Airway Society and the Royal College of Anaesthetists have combined to provide the 'Guidelines for the management of tracheal intubation in critically ill adults'. The main part of the document covers Plan A to Plan D when performing this procedure. This is well worth a read and in this podcast, I go through the various stages and what they recommend.
This is a conversation I had with Marcus Peck (@ICUltrasonica) who is the chair of the FICE committee (Focussed Intensive Care Echocardiography) and Hannah Conway who is an ACCP at Glenfield Hospital and is VERY qualified when it comes to ultrasound and echocardiography.
It would seem that Marcus and colleagues are very keen for us to do echo! So lets do it!
My friend and colleague Dr Nitin Arora (@aroradrn) has just completed his Focussed Intensive Care Echocardiography (FICE) course and has managed to complete the 50 required scans in 63 days! It can be done. Segun (@iceman_ex) and I chat with him about his experience.
Interview Questions for Advanced Critical Care Practitioners
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This is a discussion which follows on from CCP Podcast 077: NCEPOD 2017 Acute Non-Invasive Ventilation: Inspiring Change. In this episode, I have a chat about the NCEPOD findings with one of the authors, Mark Juniper and with Vicky Mummery a physio who is very involved in improving practice at her trust.
I think this discussion adds a lot to the last podcast and well worth a listen.
I think this might be one of the most important podcasts I have ever done along with the next in the series. This is the first of two podcasts covering the latest NCEPOD paper on Non-Invasive Ventilation. This can also be found on the NCEPOD web page, but they also kindly agreed to allow me to release it as a podcast for those of you who want to listen to it on the go. Once you have heard this one go to the next podcast 077 where I chat to Dr Mark Juniper one of the leads of the paper and Vicky Mummery a physiotherapist involved in quality improvement on this very subject.
Interview Questions for Advanced Critical Care Practitioners
I was lucky enough to be invited to the Home Mechanical Ventilation Conference in June 2017 by Rachael Moses (@rachaelmoses) and Professor Nick Hart (@NickHartThorax) and this is one of the presentations I thought you might like to hear. Bariatric surgery has become almost routine now and Andrew Jenkinson tells us why. Diets will never seem the same again after hearing this!
Interview Questions for Advanced Critical Care Practitioners
The Content on the website is provided for FREE as is the podcast.
You could help support this work by going to Amazon via this link. This means that I will earn a small commission from any purchases you make with NO extra cost to yourself.
Thank you.
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Simple- My take of DasSMACC Day 3!
Interview Questions for Advanced Critical Care Practitioners
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Simple...DasSMACC Day 1- me summarising what happened. Great day-fabulous networking.
Interview Questions for Advanced Critical Care Practitioners
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You could help support this work by going to Amazon via this link. This means that I will earn a small commission from any purchases you make with NO extra cost to yourself.
Thank you.
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This is an important update from Carole Boulanger and Dr Simon Gardener at the 5th NAACCP conference in London 2017 about some of the changes anticipated for the ACCP body and how they hope the future will pan out. It is only short but full of lots of useful, and very encouraging information.
Interview Questions for Advanced Critical Care Practitioners
The Content on the website is provided for FREE as is the podcast.
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Thank you.
I was lucky to be asked to give a presentation about the role and the training of the Advanced Critical Care Practitioner at the 14th Critical Care Symposium in Manchester this year. This is the audio from that meeting as a podcast and I have also linked to the video with audio and slides combines. Hope you find it useful.
Myself and Jonny Wilkinson, an Intensivist from Northampton in the UK discuss some of the key topics to have passed by our Twitter streams over the last few days. This ranges from Sepsis to POCUS and a new use for Aspirin.
Many key sites are highlighted and these can be found in Jonnys fabulous website.
We are hoping that this is something we can do on a regular basis.
This is a chat about the ICU patient with problems with their swallow or dysphagia, I had with Martin Brodsky (@MBBrodskyPhD), who is an Assistant Professor of Physical Medicine and Rehabilitation at the Johns Hopkins University School of Medicine. He is a clinician, researcher and educator with interests in swallowing and swallowing disorders, head and neck cancer, neurologic communication disorders, and ethics. Jackie McRae (@Daisy_project) also joined us and she is a speech and language therapist and an NIHR research fellow undertaking a PhD to investigate intensive care practice in identifying and managing swallowing problems in cervical spinal cord injury (The Daisy Project).
In this conversation, we discussed martins latest research paper "Recovery from Dysphagia Symptoms after Oral Endotracheal Intubation in Acute Respiratory Distress Syndrome Survivors" Annals of the American Thoracic Society2017 as well as exploring the causes of the swallow problems and some of the ways we can help prevent them.
Lots of food for thought and perhaps raises many questions for us to ponder.
This is a very interesting chat I had with Dr Bronwen Connolly who is a Consultant Clinical research Physiotherapist and an NIHR post-doctoral research fellow about early mobilisation in the critical care.
She was asked to present at the ICS SOA 2016 to summarise key evidence published in 2016 examining physical rehabilitation in critical illness and also consider methodological trial design features in interpretation of results.
It would seem from the discussion that one of the main problems with the research is that there is no agreement on the end points which should be measured.
Some of the papers discussed were:
A Randomised Trial of an Intensive Physical Therapy Program for Patients with Acute Respiratory Failure
Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial
Standardised Rehabilitation and Hospital Length of Stay Among Patients With Acute Respiratory Failure: A Randomised Clinical Trial.
Interview Questions for Advanced Critical Care Practitioners
My good friend Dr. Nitin Arora and I had a discussion about the various combinations of drugs which can be used during a rapid sequence induction and the reasons for giving them. Sometimes its not always evident why the doctor wants the drugs he asks for. Hopefully, in this podcast, some of this can be cleared up.
I ran Nitin through his paces and presented him with three different scenarios in which different drugs might be required. He passed with flying colours!
LIFTL- Rapid Sequence Induction
Rapid Sequence Intubation: Medications, dosages, and recommendations
This episode is in conjunction with my friends over at JICScast Segun Olusanya and James Day. We met with Dr Anna Batchelor, Carole Boulanger and Gavin Denton to discuss the role of the Advanced Critical Care Practitioner, its impact on the service as a whole and what the future may look like for this growing body of health care workers.
I also go on to say that I am now moving to Warwick Hospital in my role as an Advanced Critical Care Practitioner, and leaving the Emergency Medicine Department behind. I have learned a vast amount whilst there but the Intensive Care Unit is where I feel most comfortable.
Non-pharmacological interventions for sleep promotion in the intensive care unit Cochrane Database Syst Rev. 2015 Oct
It is well-known that patients in the intensive care units do suffer from a lack of sleep and frequent sleep disturbances.
This is a Cochrane review looking at the efficacy of nonpharmacological interventions for sleep promotion in the critically Ill adults in the intensive care units.
Perhaps one of the main results to come from this Cochrane review was the poor quality of the studies that they included. They initially included 30 trials, giving them a total of 1569 participants. However the quality was generally low or very low and as a consequence only three trials, those concerning earplugs or eye masks or both, provided data it suitable for two separate meta-analysis.
I would like in this podcast just to summarise some of the articles that they actually looked at when considering how to optimise the patient’s sleep in the intensive care unit and the various methods used.
Why Won't My Patient Sleep! The Intensive Care patient will often lie awake at night, eyes wide open, clearly with no intention of sleeping. So why won't the intensive care patient sleep? Perhaps we need to understand what happens during normal sleep and take it from there.....
Stages of sleep Sleep is divided into non-rapid eye movement and rapid eye movement phases. The non-rapid eye movement stage is further divided into three different stages. The third of these, stage N3, is significant for its role in restorative processes.
Rapid eye movement sleep occupies 20% to 25% of the total sleep period. The brain is highly active in this period is associated with dreaming.
The circadian rhythms which drive the sleep wake cycle is regulated by adenosine and melatonin. One helps us sleep the other helps us keep awake.
What happens during sleep? During sleep there is a loss of compensatory responses, such as shivering and sweating. The body temperature reaches its lowest point during the latter part of sleep and then rises prior to awakening.
Voluntary control of respiration is lost during sleep. Moving from being awake to the early phases of sleep is marked by a reduction in minute volume. Due to relaxation of upper respiratory muscles, increased airway resistance, and diminished central respiratory drive hypoventilation can occur which will increase arterial PCO2 levels.
During non-rapid eye movement sleep increased parasympathetic tone causes a decreased blood pressure, heart rate and systemic vascular resistance.
There is more variability during rapid eye movement sleep. There may be bursts of vagal activity and along with decreased sympathetic tone there may be bradyarrhythmias and sinus pauses.
Growth hormone and prolactin peak during sleep. Cortisol levels are also at their lowest level after sleep onset. Thyroid stimulating hormone is inhibited during sleep and will increase with sleep deprivation.
Sleep in ICU Patients in intensive care commonly report poor sleep quality and surveys of survivors have shown that sleep deprivation ranks among the top three major sources of anxiety and stress during their stay in intensive care.
50% of their sleep will occur during daytime hours, and the average approximately 41 sleep periods per 24 hours each one lasting approximately 15 minutes. They commonly go through the first two stages of sleep without then moving onto the latter stage and rapid eye movement sleep. In other words they have broken light sleep without the restorative stages needed.
Causes of sleep disruption. Noise- staff conversations, alarms, telephones and televisions are commonly quoted as being the causes of the noise within the intensive care unit. The recommendation is for maximum hospital noise levels of 45 dB during the day and 35 dB at night. Commonly however both daytime and night time noise levels routinely exceed 80 dB.
Patient care activities- patients in intensive care may experience 40 to 60 interruptions each night due to activities such as patient assessments, vital signs and is, equipment adjustment and medication administration to name a few.
Light- intensive care survivors have reported that light is less disruptive than noise and patient care activities. However it is known that nocturnal melatonin secretion in intensive care patients can be suppressed, causing further difficulties in sleeping.
Mechanical ventilation- the patient that is ventilated as compared to the patient that isn’t is more likely to suffer from sleep deprivation. This is due to factors such as increased ventilatory effort, abnormal gas exchange, and patient ventilator dysynchrony. Other factors may include endotracheal tube discomfort, ventilator alarms, suctioning, positioning, and frequent assessments.
Pic courtesy AJC1
Medications-some commonly used medications in intensive care can have profound effects on sleep quantity and quality. The sedation we use with many of the patients in intensive care is also disruptive to sleep. For example opiates such as fentanyl and morphine inhibit rapid eye movement sleep, profoundly suppress the latter stages of non-rapid eye movement sleep and can provoke awakening at night. Benzodiazepines and opiates are also associated with delirium in critically ill patients.
Propofol suppresses the latter stages of non rapid eye movement sleep whereas dexmedetomidine has been shown to enhance this stage of sleep in a rat model.
Psychological consequences of sleep deprivation in critically ill patients. Delirium- delirium is associated with patient mortality, increase cost and length of stay and long-term cognitive impairment. It is possibly difficult to say whether sleep deprivation directly contributes to delirium but circadian rhythm disturbance, sedating medications and opiates contribute to both delirium and sleep disruption.
Psychiatric disturbances- survivors of critical illness often experience frightening flashbacks, nightmares, anxiety, and mood disturbances related to their intensive care stay.
Post-traumatic stress disorder has been shown in 10% to 39% of intensive care unit survivors during their first year after the intensive care unit stay. Post-traumatic stress disorder symptoms have been present in up to 45% of those discharged and is still present in 24% at 8 years after intensive care unit discharge.
Depression among survivors is also very common and has been shown to be present in 28% of patients within the first year of intensive care unit discharge. In those that suffered from ARDS the prevalence of depression is a size 46% at one year and 23% at two years after discharge.
Many studies have demonstrated depressive symptoms and increase levels of fatigue anxiety and stress in healthy participants undergoing total or partial sleep restriction. Sleep disruptions in the critically ill patient may be contributing to post intensive care unit psychiatric disorders. This is possibly not that well understood at the moment.
Cognitive dysfunction-impairment of memory, attention, concentration, language, mental processing speed, visuospatial abilities and executive function have all been shown to have been affected following critical illness. Some of the causes are thought to include delirium and sedating medications.
Due to neuro cognitive dysfunction many intensive care unit survivors experience challenges with daily functioning, social isolation and difficulties returning to work.
Quality of life-health-related quality-of-life concerns one’s perception of overall well-being and incorporates measures of physical, mental, emotional, and social functioning. Critical illness is associated with long-term impairments in quality of life for many years after intensive care unit discharge chronically reduce sleep also leads to reductions in quality of life.
With all of this in mind it would seem important therefore to try to promote whatever we can to help the patient to sleep whilst in the vertical care department. How can we do this? What measures can we take? Do you already take measures in your department? If you do, how are you sure they make any difference?
How high should I sit my patient? I was lucky enough to be able to chat to Louise Rose again. She and I first had a conversation back on CCP Podcast 013: Mind and Body. In this episode we talk about a study she was involved in, which looked at the use of meters to measure the angle of the bed when nursing the ITU patient. We also go onto discuss whether it matters if we do this at thirty degrees or forty five degrees.
The use of bed-dials to maintain recumbent positioning for critically ill mechanically ventilated patients (The RECUMBENT study): Multicentre before and after observational study.
We also go on to chat about some of the issues with mobilising the critical care patient at a much earlier stage than perhaps most of us do currently. This is an issue I discussed with Carol Hodgson in CCP Podcast 039: Early Mobilisation- Get Them Moving! It is becoming a subject close to my heart and one that I think I may investigate further in the future.
The Intensive Care Society have now released ALL of their presentations as podcasts for you to listen to for FREE. This is fabulous and I strongly recommend that you go over to their website to have a look. The conference was great and I hope you will consider trying to get there next year.
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podcast.
Dorothy Wade works as a chartered health psychologist in the Critical Care Unit at UCH. She is registered as a practitioner psychologist with the Health and Care Professions Council, and has a PhD in psychology and health care evaluation from University College London. She is available to support patients, families and staff in Critical Care.
PTSD Post traumatic stress disorder is defined as a condition of:
- persistent mental and emotional stress
- occurring as a result of injury or severe psychological shock
- typically involving disturbance of sleep and constant vivid recall of the experience
- with dulled responses to others and to the outside world.
and its something the critical care patient can experience after discharge from the department. Dorothy and I discuss many of the issues involved and some of the things we can do to help minimise this problem.
ICONStudy
Intrusive memories of hallucinations and delusions in traumatized intensive care patients: An interview study.
What explains the prevalence of post traumatic stress disorder, depression, anxiety and poor quality of life after intensive care?
Investigating risk factors for psychological morbidity three months after intensive care: a prospective cohort study
Identifying clinical and acute psychological risk factors for PTSD after critical care: a systematic review.
This episode features a chat with Fiona Moffat who is a lecturer in Physiotherapy and practising physiotherapist. She was involved in some LEAN thinking and is now interested in early mobilisation in the critical care world. As a social scientist she is also interested in how we get to normalise new technologies or interventions in health care and what are the barriers to those interventions.
She is presenting at the ICS State of the Art conference 2015 and so it was interesting to get to chat to her about some of the issues.
Demystifying theory and its use in improvement Davidoff et al.
Barriers and facilitators to early mobilisation in Intensive Care: A qualitative study. Carol Hodgson et al
Normalisation Process Theory- Carl May
Motomed- physical training in bed!
Lynn Schallom is a research scientist at the Barnes-Jewish Hospital in St. Louis. She published a paper 'Head of Bed Elevation and Early Outcomes of Gastric Reflux, Aspiration, and Pressure Ulcers' in the American Journal of Critical Care in January 2015.
Head of Bed Elevation There is a conflict between the need to keep a patients head elevated to reduce the incidence of oesophageal reflux and consequent pneumonia, and the prevention of pressure ulcers. Can we do both? In her very small study Lynn seems to show that head of bed elevation is important and that we can. She also highlights some other areas of concern, one of which is the use of the trendelenberg position when sliding patients up the bed. This would seem to put patients at increased risk of aspiration as their secretions are encouraged to run in the 'wrong' direction!
"Have you ever wanted the speaker to fail?" In this episode of the podcast I speak with Dr Ross Fisher (@ffolliet) about presentation skills. Many of us have sat through 'death by powerpoint' and have come away non the wiser afterwards. Having watched a lot of TED talks I can testify that a good presentation can make a massive difference to what you learn and whether you will be back for more.
Ross tells us some very simple techniques to help us improve the way we put our message across. I think you will find a lot of useful pointers.
I include below some of the books that we mention as well. I have read them all and I can highly recommend them.
You can find Ross's website at prezentationskills.blogspot.co.uk/
In this podcast I carry on my conversation with Ollie Poole (@respreview) about some of the issues with mechanical ventilation. We talk about the different types of breath and why we use them. This then helps us identify some of the very confusing terms the ventilator companies use when describing their ventilator modes.
We somehow manage to bring some puppies into the conversation too!! If you want more from Ollie then go to his fantastic YouTube site where he covers other subjects too.
Thyroid Storm Chapter: Review of Diagnosis and Treatment of Thyroid Storm - emcrit http://t.co/v8qQMMZh35 #FOAMed
— foambase (@foambase) May 17, 2015
Thyroid Storm Dr Scott Weingart (@emcrit) does his usual brilliant job over at EMCRIT explaining some of the issues in this condition. This is one I have encountered in ITU so I found particularly interesting.
Are you an Advanced Practitioner in any specialty? Then you need to come to this meeting. This is the 3rd year this has been held in Coventry and gives us all a chance to network. Also priced very reasonably so you have no excuses.
Some good speakers lined up talking about:
An Analysis of UK wide advanced practice programmes.
Advancing Nursing in gerontology.
Challenges of Advanced Practice across primary and secondary care.
In the afternoon there are going to be chances to have a chance to review your anatomy of various systems using the state of the the art Surgical Training centre, followed by workshops in writing a publication, presenting a business case and undertaking research.
Come along and help mold the changes we are all making.
Wendy Sinclair (@wlasinclair) is a lecturer in childrens nursing at Salford University and has been there for the last eight years. She started using Twitter about a year ago as a way of engaging the Salford Nursing Students. Also to see how they could use social media in both a professional and social capacity. She is also working towards a PhD in Social Media and Professional Conduct.
We are also joined by Neil Withnell (@neilwithnell) is a senior lecturer in mental health nursing and Moira McCoughlin (@levylass) who is a childrens nurse and senior lecturer.
An interesting discussion is had by us all about the benefits of social media when used well and the empowering of their students. This is a model that others should follow.
I also want to point out a conference which is happening in Coventry in July. This is the 3rd National Advanced Practitioner conference. You can click on the image below for a link to the application form.
This is not an expensive day and it would be great to be able to network with other practitioners. I am pushing people to go from my trust, so lets all the do the same. See if we can overwhelm them with interest. I am hoping that I will be able to let you all know the format of the day by the 11th May. So watch out for my tweets!
FOAMed has been helpful as always. Salim Rezaie has put together a great post about Seepsis and some of the current practices, along with a podcast and his slides which he used at a recent conference. Click on the copy of the tweet below from @drwillangus.
ICYMI: Sepsis Care in 2015 -> Sepsis Trilogy, Goal MAP, Hb transfusion, & more http://t.co/KQoni3s8Iu #FOAMed #FOAMcc pic.twitter.com/0zZNPi1pJS
— Salim R. Rezaie (@srrezaie) May 6, 2015
I am also tweeting like fury about this years Intensive Care State of the Art meeting in December of this year. Its going to be a good one I think and I hope to be well involved on the social media side of things via @ganesh_ICM who is doing a fabulous job of putting things together. Click on the tweet below to see what he is up to, and please retweet if when you see it!
Go to http://t.co/KrRBCgdWtL live now! To register for this years ICS State of the Art conference. #icssoa2015 pic.twitter.com/U8kc4lQbnd — Jonathan Downham (@ccpractitioner) May 6, 2015 [table id=1 /]
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PLEASE go to www.life-saver.org.uk to see the fantastic job this podcasts interviewee has done of making the teaching of basic life support so much easier. I was blown away when I came across it, even as an experienced ALS team member.
It sucks you in and gets you involved. To the novice it is a wonderful learning resource, to the experienced it is great revision.
Martin Percy was the director and we talk about some of the barriers he came up against when raising the funding and one or two great stories that came about. One of those stories gives this episode its title!
FOAMed
The results of the PROMISE trial are out and rather than redo what everyone else has already done I will just point you in the direction of my colleague Simon Laing (@laing_simon) who has summarised it nicely on the HEFTEMCAST podcast.
I will also quote from Steve Mathieu (@stevermathieu75) on The Bottom Line:
"Both groups in this study were actually well matched for most interventions. The main difference was in the use of continuous SCVO2 measurement and CVP to guide management. Perhaps we should not completely dismiss the term 'EGDT'. Afterall, our 'usual care' consists of early intervention and goal directed therapy. The goal... to continue to reduce mortality with high standard and consistent quality care."
A point I seem to remember making on a podcast with the ARISE trial authors some months ago.
The guys over at FOAMCast have just released a podcast that tries to explain some of the confusing research terms. If you are like me, then any research term can become confusing. This is a good episode and I am hoping that they will add more in the future.
Antibiotic sensitivity spectra is the focus of a tweet by Pietro Isotti, (@pietroisotti) a nursing student in Italy. This is a nice PDF of the range of sensitivities and the antibiotics used.
The third in the series with Ollie Poole (@RespReview) on mechanical ventilation. Ollie goes into some more detail on the phases of the breath. This requires some visualisation of the waveform involved. Below is the video from YouTube that Ollie originally produced which should help with that.
Irma Bilgrami does a great job of breaking down some of the principles of mechanical ventilation in her SMACC talk. She approaches it in a similar way to analysing the ECG waveform.
FOAMed
Delayed Sequence Intubation-
DSI in pts requiring intubation & NOT tolerating preox or peri-intubation procedures http://t.co/vCZX2e10hL #FOAMed pic.twitter.com/3G5MvLiKv7
— Salim R. Rezaie (@srrezaie) February 24, 2015
A new study in Annals of Emergency Medicine seems to support the process of delayed sequence intubation in those patients that will not tolerate pre-oxygneation or peri intubation procedures. EmCrit has a nice algorithm on his site (he was involved in this study) which breaks the process down simply and The Bottom Line has reviewed the paper in question. Scott has also done is usual great job in helping us understand this through his podcast:
Life in the Fast Lane breaks the process down in some more detail.
Cervical Collars-
"CERVICAL COLLARS SLASHED FROM GUIDELINES |" http://t.co/jLcPZVCxca #FOAMed Not just any guidelines - ILCOR guidelines!! This is huge! — UNM Wilderness Med (@UNM_WildMed) February 12, 2015
ILCOR (International Liaison Committee on Resuscitation) have published some draft guidelines on the use of cervical collars which does not recommend their use. Scancrit covers some of this in his blog and, like him, I will quote what they actually say:
"We suggest against spinal motion restriction, defined as the reduction of or limitation of cervical spinal movement, by routine application of a cervical collar or bilateral sandbags (joined with 3-inch-wide cloth tape across the forehead) in comparison to no cervical spine restriction in adults and children with blunt suspected traumatic cervical spinal injury (weak recommendation, very low quality of evidence).Values and preferences statement: Because of proven adverse effects in studies with injured patients, and evidence concerning a decrease in head movement only comes from studies with cadavers or healthy volunteers, benefits do not outweigh harms, and routine application of cervical collars is not recommended."
Intensive Care Society State of the Art Meeting December 2015
An interesting early steer from @icsmeetings #icssoa2015 consultation. Add your views! http://t.co/nRdSk0a5KN pic.twitter.com/k56pOT6W3a
— GaneshSuntharalingam (@Ganesh_ICM) February 15, 2015
I have had the recent privilege of being introduced to Ganesh Suntharalingam (@Ganesh_ICM) who is involved in the committee with the Intensive Care Society for the State of the Art meeting later this year. He is gathering a team around him who will help make some changes to the format of this excellent conference. He tweeted some results from a survey he published which makes some very interesting reading. What I found exciting is that others feel, like me, that publication of some of the presentations for those not able to attend would be valuable. This is the FOAMed principle in practice. You can continue to add your own views via this link. Advanced Critical Care Practitioner Conference-
3rd National ACCP conference 3rd July hosted by FICM @ RCoA only £40. Save the date !@accpuk @ccpractitioner — CAROLE BOULANGER (@BOULANGERCAROLE) February 16, 2015
Conference details can be found here.
Ken Spearpoint and I talk about Crew resource management as it relates to the cardiac arrest scenario. I love talking with Ken as he is so knowledgeable and puts his points across so well. i found it really interesting to chat with him about this. I have broken it down into two parts as we both had so much to say, so the second part will be podcast 027 next time.
This is the second of a series of podcasts with Ollie Poole who was a respiratory therapist in Canada and is now doing his medical training. You can listen to the first episode if you wish... CCP Podcast 018: Mechanical Ventilation....
We go back to some of the basics here, discussing some of the reasons and goals of mechanical ventilation.
I came across Ollies' YouTube site Respiratory Review and was very impressed with his series on mechanical ventilation helping to explain some of the terminology and reasoning behind how we ventilate patients. He breaks down the issues in a logical, well ordered format....so go and listen to them.
Our plan is to have a series of chats about mechanical ventilation based around his YouTube videos, so watch this space!
Shiela Pantrini has been developing the educational route for the Advanced Clinical Practitioners along side Garry Swann at the Heart of England NHS Trust. She tells us how this occurred and the principles that drove it. We also go on to discuss the plans for the future and what would make a good potential practitioner.
Two of the courses which contribute to the Masters programme were mentioned and the links for them are here:
Warwick University- Clinical Examination Skills for Health Care Professionals
Warwick University- Clinical Investigations and Diagnostics for Health Care Professionals
Happy Christmas all! A usurper takes the reins in this episode which allows Jonathan to talk about himself. Hope thats not too narcissistic!
Some old guests make an appearance as well. Hope you enjoy it and Have a great Christmas.
In this podcast episode I was lucky enough to have a discussion with Ollie Poole who is a respiratory therapist in Canada.
I came across Ollies' YouTube site Respiratory Review and was very impressed with his series on mechanical ventilation helping to explain some of the terminology and reasoning behind how we ventilate patients. He breaks down the issues in a logical, well ordered format....so go and listen to them.
Our plan is to have a series of chats about mechanical ventilation based around his YouTube v ideos, so watch this space!
SMACC US programme is now out and it looks fabulous! A great variety of subjects over 3 days. I think the biggest problem will be deciding which lectures to go to. I am hoping to have a chat with Oli Flower in the future to discuss some of their plans.
The History Taking and Clinical Examination course I ran in Walsall went very well in September, and we have now booked another one 23-25th Febraury 2015. If you want to come along and join us then please do.
If you found this teaching about mechanical ventilation useful then let me know? Should we do more or less of this kind of thing. I want to be able to provide useful things to my audience so would be grateful for the feedback.
Simon Cooper is an Associate Professor at Monash University in Australia and developed the First2Act website which looks at the management of the deteriorating patient using multi media teaching tools.
I have been an advocate of using YouTube for many years now and one of the YouTube resources I have used for a while now is that created by Dr Eric Strong. I love his style and he teaches a lot of subjects which I encounter in critical and emergency care.
People often ask me which book they should read around various subjects and instead of pointing them to books I direct them to YouTube. If you find the right teacher, the visual element and voice over provided by YouTube I believe is a much better way to learn.
There are many more YouTube learning resources:
Andrew Wolf is an Assistant Professor & the Coordinator for Online Education at the University of Rochester School of Nursing. In addition to teaching physiology and pathophysiology, Andrew works as an acute care nurse practitioner for a general surgery service. His past clinical experience includes thoracic surgery, surgical intensive care, and oncology.
Armando Hasudungan "I am not a doctor or professor, I am a student. I make these videos cause I enjoy art and science. Im not saying im 100% correct in all my videos. But I do try to obtain the information from credible sources."
Bozeman Science "Paul Andersen teaches science at Bozeman High School in Bozeman, MT. He is the 2011 Montana Teacher of the Year."
Handwritten Tutorials is a source of entirely FREE easy-to-understand medical tutorials
Interactive Biology "Many People struggle with Biology. I try to make it EASIER and FUN"
KhanAcademymedicine " Our mission is to provide a world-class education for anyone, anywhere. This channel includes Khan Academy videos on Medicine, presented by Rishi Desai, MD. All Khan Academy content is available for free at www.khanacademy.org."
MedCram " Medical Topics Explained Clearly by World-Class Instructors. Free medical lectures for health care professionals and students. Review for USMLE, MCAT, PANCE, NCLEX, NAPLEX, NDBE, school and board examinations. SPEAKER: Roger Seheult, MD Clinical and Exam Preparation Instructor. Board Certified in Internal Medicine, Pulmonology, Critical Care, and Sleep Medicine.
Respiratory Review "These videos will cover many areas of respiratory care including: Gas Exchange at the Alveoli, Principles of Mechanical Ventilation, ABG interpretation, Pulmonary Function Testing and hopefully many more. I am a Registered Respiratory Therapist (RRT) working in Halifax NS, Canada. I'm also part of a critical care research team in Halifax, and have published my own papers as well."
Terry Shaneyfelt
"These are my videos about
1) Evidence based medicine
2) Perioperative evaluation and management
3) Teaching"
I hope you love these YouTube videos as much as I do. if you know any others then get in touch and let me know.....
I made contact with Dr Segun Olunsanya via Twitter to discuss some of the issues around the fluid management of the sick patient. He in turn persuaded a couple of others involved in ITU. This has led to this fascinating discussion around this issue and it is one of the podcasts I am most pleased with.
ICU-Acquired Weakness and recovery from Critical Illness. N Engl J Med 370;17 nejm.org april 24, 2014
An interview with Dr John Kress, an ITU physician from the University of Chicago. Dr Kress is a highly respected and well published doctor with an interest in ICU acquired weakness, one of his more well known papers being " Daily Interruption of Sedative Infusions in Critically Ill Patients Undergoing Mechanical Ventilation" which discussed the use of sedation breaks in the critically ill patients in intensive care.
Dr Kress very kindly agreed to help me understand some of the principles involved in this paper.
Another busy time in the world of the Critical Care Practitioner! This episode focuses on a discussion I had with Kaye Rolls (@Kaye_rolls) Clinical Nurse Consultant at the Intensive Care Coordination & Monitoring Unit (ICCMU).
She and I had a Twitter discussion around a couple of articles she had read about the use of social media by health care professions.
The first was "Social media: the way forward or a waste of time for physicians?" J R Coll Physicians Edinb 2013; 43:318–22. This is an article in two parts giving opposite sides of the argument. Both Kaye and I certainly disagree with one of them!
The second article was "Twelve tips for using social media as a medical educator" Medical Educator 2014; 36: 284–290 which offers a number of hints for making the most of this valuable resource.
The recent Celebration Day Jamby many involved in the NHS Change Day was a webinar led by Helen Bevan, a lady I am hoping to speak to in the near future. This was a fabulous day and very interesting...its the way of the future!
Should we still be doing cricoid pressure? There are some very strong opinions out there. Minh Le Cong was kind enough to join me to discuss this important issue and we sort of arrived at a conclusion!
Bethan Bishop is Head of Innovation and Industry Engagement at the Heart of England NHS Trust in Birmingham. In this podcast she discusses how this role came about, having come from a background in the Pharmaceutical industry.
She works as part of the MIDRU team which aims to help in the innovation process. She is also involved with the Birmingham Science City initiative which is a partnership of public, private and HE sectors that aims to develop, use and promote science, technology to stimulate innovation to improve economic prosperity and quality of life.
There is a mention of the document "Innovation Health and Wealth" an important government paper and of the Academic Health Science Networks.
Bethan is obviously very passionate about her role in her Trust and working in partnership with others both within and outside the NHS will help make a difference to the ways we work.
Chat with David Barton Head of Department of Nursing at Swansea University. Discussion around the development and the roles of the Advanced Practitioners and his role in strategic planning of the future for the roles.
In this episode Critical care Practitioner chats with Ken Spearpoint, Consultant Nurse in Critical care and lead in a Masters degree in Medical Simulation. We also go onto to talk about the whys and wherefores of medical simulation.