The World of Critical Care

The following episode covers the basics of correctly setting up arterial lines, interpreting waveforms, troubleshooting, and removal. 

The following episode covers the critical physiological functioning of magnesium. The episode covers lab values, hypomagnesemia and Hypermagnesemia.    For further reading: I highly recommend Ak lectures for a serious physiological deep dive. https://aklectures.com https://emcrit.org/ibcc/hypomagnesemia/ https://emcrit.org/ibcc/hypermagnesemia/  

The following episode covers the basics of managing hyperkalemia in the ICU.        For further reading: https://emcrit.org/ibcc/hyperkalemia/  

Specific considerations of hypokalemia in the CVICU/CICU. 

The following episode covers the basics of hypokalemia. The episode discusses the three primary causes of hypokalemia, the clinical manifestations, and general resuscitation guidance.    For further reading: https://emcrit.org/ibcc/hypokalemia/  

The following episode covers the basics of potassium as an electrolyte in critical care. 

Nurse lead spontaneous breathing trials is a common aspect of recovering hearts in the CVICU. But SBT's are common in a wide variety of ICU settings. This episode covers the basics of successful SBT's. 

Hypernatremia occurs in up to one fourth of ICU patients. The following episode covers the basics of understanding the critical factors in hypernatremia.    For further reading: https://emcrit.org/ibcc/hypernatremia/  

One of the most common lab values I have questions about from new nurses is the SvO2 and how it is used as an approximation for cardiac output. As a followup up to the episode on taking hearts this episode considers one of the most common lab values used in critical care to approximate cardiac output. 

Caring for post operative CVOR patients can be one of the most rewarding and challenging shifts for a CVICU/ICU nurse. The following episode covers the basics of pre-operative assessment, intra-operative analysis, and post-operative care. By no means comprehensive, the episode seeks to cover the basics and provide a steady foundation for growth. 

The following episode covers the basics of hyponatremia. This episode is a bit longer than most but the prevalence of hyponatremia in critical care warrants a slightly longer conversation.  For further reading on hyponatremia: https://emcrit.org/ibcc/hyponatremia/  

The following episode covers the action potential in cardiac muscle cells with specific attention on the role of sodium.      For further learning: https://www.youtube.com/watch?v=uUbgcqo_IOg  

The following episode covers the action potential in a neuron. Specific attention is paid to the critical role of electrochemical gradients and concentration gradients established by sodium and potassium. This episode also serves as an overview of the action potential generally. 

The following episode provides part one of sodium physiology examining how the body regulates sodium levels via the renin-angiotensin-aldosterone system.    One of my favorite lectures on this topic: https://www.youtube.com/watch?v=NMWaKdO76NQ    

The following episode introduces the electrolyte sodium. Lab collection, general overview of physiological processes, and defining critical terms. The next episode will cover in depth the physiological processes dependent upon sodium. 

The following episode covers the basics of anti-platelet therapy. 

Massive transfusion can be a highly stressful event in the ICU. The following episode covers the basics of carrying out massive transfusion protocol.    For further reading: https://emcrit.org/ibcc/mtp/  

This episode covers the basics of the oral anticoagulant Eliquis. The episode covers the indications, mechanism of action, common dosing, reversal, and a comparison to Coumadin. 

This episode covers the history, mechanism of action, lab monitoring, indications, reversal and special considerations for Warfarin or otherwise known as Coumadin. One of the most common oral anticoagulants seen in critical care.    For further reading: https://emcrit.org/ibcc/coag/ https://emcrit.org/emcrit/reversal-safe-smart/ https://emcrit.org/ibcc/reverse/  

The following episode covers the basics of direct thrombin inhibitors. Specific attention is given to Argatroban and Bivalirudin. The episode covers mechanism of action, monitoring labs, and specific use cases. 

The following episodes provides clarity on the use of aPTT vs Xa lab vales for determining levels of heparin activity. 

The following episode begins the discussion of anticoagulation. The discussion includes the mechanism of action, routes of administration, dosing, initiation consideration, lab values (aPTT vs Xa), side effects, and reversal. The episode also examines the difference between heparin and low molecular weight heparin.    For further reading: https://emcrit.org/ibcc/heparin/ https://emcrit.org/ibcc/reverse/ https://emcrit.org/ibcc/thrombocytopenia/    

The following episode specifically focuses on the role of platelets in coagulation. This episode builds upon the previous episode, which focused on the clotting cascade, with a detailed discussion of the formation of the platelet plug and its unique interaction with the fibrin mesh produced by the clotting cascade. The stage is now set for a discussion of anticoagulants. 

The following episode provides a general overview of the clotting cascade. Focus is given to understanding terms such as clotting factors, zymogens, enzymes, cofactors, and proteases. Emphasis is given to understanding the extrinsic, intrinsic, and common pathway. Below are a list of helpful visual explanations of the clotting cascade I have found beneficial over the years. As always I appreciate any and all feedback on how to better this resource.  Resources:   Blood Clotting Cascade   Activation of Coagulation Cascade   Hematology | Hemostasis: Coagulation Cascade   Coagulation cascade | Human anatomy and physiology | Health & Medicine | Khan Academy

The following episode covers the basics of platelet administration in critical care. The episode focuses on the general function, measurement, and administration of platelets. Platelets have several unique administration requirements that need to be remembered! Next weeks episode will cover the clotting cascade and platelet function in much greater detail. Below are two valuable links to dive into the various causes of thrombocytopenia.  Further reading: https://emcrit.org/ibcc/thrombocytopenia/ Further listening: https://podcasts.apple.com/us/podcast/the-intern-at-work-internal-medicine/id1338378584?i=1000414997402  

The following episode covers the basics of cryoprecipitate (Cryo) use in critical care. The episode covers the formation of cryo, administration basics, common uses and indications. 

The following episodes covers the basics of FFP administration in critical care. 

PRBC's or packed red blood cells are one of the most common blood products administered in critical care. The following episode covers the importance of red blood cells, understanding hemoglobin and hematocrit levels, how lab levels are attained, some of the common reasons to transfuse, transfusion basics, and the critical transfusion associated complications. 

Ringer's Lactate, lactated ringers, LR, Hartmann's solution are all terms used to describe this incredibly versatile crystalloid. The episode covers some of the indications and contra indications of LR administration with a brief overview of common misconceptions. 

The following episode considers the role crystalloids play in critical care. The episode considers how the mechanism of action differers from that of colloids. Considerations are given to understanding how tonicity and osmolality can influence the effect of crystalloid solutions in the body. Specific attention is given to saline solutions with the next episode covering lactated ringers. 

Amidst the continual busyness of the ICU we often forget the power of taking time to pause with our patients and their families, to understand where we are at, and where we are going. Years in the ICU has taught me that often the most important reality of care is the perception of care by patients and their families. Taking time every shift to walk families through the plan of care and answer questions remains one of the most valuable but often overlooked aspects of critical care. 

Colloids are often misunderstood and take a backseat to crystalloids. The following episode dives into their mechanism of action and the critical role they play in maintaining colloidal osmotic pressure. Albumin takes center stage in the episode as one of the primary colloids administered in the ICU. 

Amidst the continual busyness of the ICU we often forget the power of taking time to pause with our patients and their families, to understand where we are at, and where we are going. Years in the ICU has taught me that often the most important reality of care is the perception of care by patients and their families. Taking time every shift to walk families through the plan of care and answer questions remains one of the most valuable but often overlooked aspects of critical care. 

The last month of training in the ICU present a unique blend of excitement and trepidation. This episode covers your last few weeks of training in the ICU. For preceptors of ICU nurses this is a critical time to help work on weaknesses, build confidence, and ensure the nurse is ready to take on their first solo shifts. 

After the initial two weeks in the ICU now the fun begins. Weeks 3-8 lay the critical foundations of ICU patient care. Often these weeks are the most difficult for new nurses as they constantly feel overwhelmed. Taking care of two ICU patients while also trying to understand the why behind everything.  As a preceptor it often is equally difficult to navigate high level education with ICU patient care. This episode covers some basic daily foundations to succeed as a new nurse in the ICU and as a preceptor training new nurses. These weeks are hard, but if done correctly they are incredibly rewarding. 

This episode covers your first two weeks in the ICU out of nursing school. Often these first two weeks are daunting, both for new nurses of those training them! The episode covers preparation before the first shift, essentials to bring on your first day, and lays out a potential path for each successive shift that best supports new nurses. This episode has both new nurses and preceptors in mind. As a new nurse you may find yourself in a ICU and your preceptor has no clear goals for each shift or you're a new preceptor and you are struggling to know where to begin. Equipment discussed in this episode include the Weltool M6 diagnostic penlight, Pyrsiva medical emergency trauma sheers, and Littmann Cardiology IV/Master of Cardiology stethoscopes.     

Should you go right into the ICU out of nursing school? This is a question I get asked frequently as a professional preceptor in the ICU. Take a listen as I explain why new graduate nurses are the ideal ICU nursing candidates. Additionally the episode considers important aspects to consider when choosing the right ICU culture to support your professional growth.