Podcasts about abcdef

What do ICU clinicians really know about patient perspective of sedation and immobility? What are their personal wishes if they were intubated in the ICU? What do ICU providers really understand about the ABCDEF bundle and how is it going in the ICU community at large? I hit the halls at SCCM Congress to find out. www.DaytonICUConsulting.com

This Week's Panel - ElroyOMJ, Exe the Hero   Show Discussion - Exe and Elroy are back with another f-in sweet episode for your listening pleasure! Exe discusses a brand new f-in remaster, while Elroy gets f-in confused and discusses like 17 f-in games. Elroy also talks about the ABCDEF-in bingo challenge.   Games Mentioned: Exe - Tales of Graces f Remastered & the Hidden Shapes series Elroy - Hamster Playground, Arcade Islands: Volume 1, Atari Flashback Classics Volume 2, and Kartrider: Drift   ----- AH101 Podcast Show Links - https://tinyurl.com/AH101Links Intro music provided by Exe the Hero. Check out his band Window of Opportunity on Facebook and YouTube

Today on Beating Cancer Daily, Saranne brings a lighthearted and informative perspective to cancer detection. After a listener praises her for making cancer more approachable, Saranne realizes the impact humor can have in the fight against this illness. She recounts her own journey with Stage IV breast cancer and emphasizes the importance of regular cancer screenings, especially for skin cancer. Infusing humor into serious topics, she utilizes a Dr. Seuss-inspired rhyme to remember critical signs of skin anomalies and introduces the ABCDEF mnemonic from the Princeton Longevity Center as a practical self-checking method. "Catchy rhymes can save lives; check for brownish spots, dark black dots, and odd-shaped moles." ~ Saranne Today on Beating Cancer Daily: ·     Emphasize the importance of regular skin checks for early detection of cancer·     Use humor to make self-checking for skin cancer more approachable·     Explain a helpful mnemonic (ABCDEF) for remembering key signs of skin anomalies·     Share personal experience to illustrate that even those focused on one type of cancer should remain vigilant about others·     Encourage taking photos of any suspicious skin changes for comparison over time·     Highlight the importance of knowing your family history related to skin cancer·     Recommend consulting with healthcare providers when any changes are noticed·     Remind listeners to help each other with skin checks, especially in hard-to-see areas Resources Mentioned: Princeton Longevity Centerhttps://princetonlongevitycenter.com/ EWG Sunscreen Guidehttps://www.ewg.org/sunscreen/ The #1 Rated Cancer Survivor Podcast by FeedSpot and Ranked the Top 5 Best Cancer Podcast by CancerCare News, Beating Cancer Daily is listened to in more than 91 countries on six continents and has over 300 original daily episodes hosted by stage IV survivor Saranne Rothberg!   To learn more about Host Saranne Rothberg and The ComedyCures Foundation:https://www.comedycures.org/ To write to Saranne or a guest:https://www.comedycures.org/contact-8 To record a message to Saranne or a guest:https://www.speakpipe.com/BCD_Comments_Suggestions To sign up for the free Health Builder Series live on Zoom with Saranne and Jacqui, go to The ComedyCures Foundation's homepage:https://www.comedycures.org/ Please support the creation of more original episodes of Beating Cancer Daily and other free ComedyCures Foundation programs with a tax-deductible contribution:http://bit.ly/ComedyCuresDonate THANK YOU! Please tell a friend who we may help, and please support us with a beautiful review. Have a blessed day! Saranne

What do physicians understand of the ABCDEF bundle? What are their perceptions of early mobility? How are their teams practicing the ABCDEF bundle in their own units? What do physicians need to be able to lead an Awake and Walking ICU approach in their units? I interviewed physicians while attending the CHEST conference to find answers to these questions. Www.daytonICUConsulting.com --- Support this podcast: https://podcasters.spotify.com/pod/show/walkinghomefromtheicu/support

What happens when a visionary physician in a low-resource hospital in Bangledash leads his team to practice the ABCDEF bundle? How did this passionate team of ICU clinicians transform their care from automatic sedation and immobility to standardize mobility three times a day? How did they come to treat mobility as important and optional as an antibiotic? Dr. Mohammad Jhahidul Alam shares their story in this episode! --- Support this podcast: https://podcasters.spotify.com/pod/show/walkinghomefromtheicu/support

Fear of “liabilities” is often a barrier to keeping patients awake and mobile in the ICU. Yet, we know that the ABCDEF is evidence-based best practices. So what are the legal liabilities to a hospital, leadership, and bedside clinicians of current cultural practices? Maggie Ortiz, MSN, RN joins us now to share her expert perspective. Find Maggie at: www.advocatesfornurses.com Www.daytonicuconsulting.com --- Support this podcast: https://podcasters.spotify.com/pod/show/walkinghomefromtheicu/support

Although the ABCDEF bundle does not solely rest on the shoulders of nurses, their leadership is KEY. Andrea Silva, BSN, RN shares with his her journey to revolutionizing care in her ICU as an assistant nurse manager. Www.daytonicuconsulting.com --- Support this podcast: https://podcasters.spotify.com/pod/show/walkinghomefromtheicu/support

When Michelle discovered her patient was paralyzed, it surprised the whole medical team. This patient who was previously mobile and recovering from septic shock was now paralyzed and ultimately diagnosed with spinal cord ischemia, but could early intervention have changed the outcome?In this episode, we discuss the causes, signs, diagnosis and treatment of spinal cord ischemia. Michelle shares powerful insights from her work in neurocritical care, including a technique for detecting easy-to-miss neurological changes.Tune in to find out how you can improve patient outcomes when managing spinal cord ischemia!Topics discussed in this episode:Michelle's passion for patient care and nurse advocacyCritical case study: discovering a spinal cord abscessHow the patient developed spinal cord ischemiaPathophysiology and signs of spinal cord ischemiaNeurological assessment tipsPeripheral versus central nervous system assessmentsDiagnostic criteria and the diagnostic processPrognosis and patient recoveryTreatment options and challengesThe role of the ABCDEF bundle in critical careConnect with Michelle:https://www.michellededeo.com/https://www.instagram.com/michellededeo/Listen to Michelle's podcasts, the SCRN Prep Podcast and Narrative Nurse Project Podcast!Get 20% off Michelle's Stroke Review Bootcamp with code RAPIDRN20!https://www.nicolekupchikconsulting.com/booksAndCourses/online-courses/61/stroke-review-bootcamp-case-studies-in-optimizing-careMentioned in this episode:Rapid Response and Rescue Intro CourseCONNECT

Overwhelm often comes from over-scheduling and bad planning. Katy Allen is the CEO of Artful Agenda & co-founder of Adulting App. She built her business based on her need for a better time management tool and her love for paper planners. Creatives and business owners manage a lot of things at once, and proper planning is crucial for productivity, but also for creativity. Katy and Jennifer share their experiences in creating business planners and which tips and tricks you can use to make the best out of your day, week, and year.  They also discuss why gentle structure in scheduling your day is important and allows creativity to flow naturally.Every day, you must ask yourself what can move the needle in your business, and should be addressed with priority, what can be done later or by someone else? These are all critically important because over-scheduling can damage the business. Use time blocking as a tool to more realistically maintain daily goals and avoid over-commitment.And don't forget, if your current methods aren't working, try new ones! Jennifer's Best Planner Ever is an amazing paper option, and Artful Agenda is an incredible digital option!  Both planners are there to help you tailor the planning system that will fit your unique needs and work style.  Never stop planning!Notes:

When patients have a primary language other than English (LOE), how does this impact their access to the ABCDEF bundle? Is it standardized to provide nonverbal communication in other languages in the hospital? Emily Zagreb's, MS, RN, CCRN joins us now to dive deep into her post-doctoral studies dedicated to this gap in critical care medicine. Episode citations and transcripts at: www.DaytonICUConsulting.com --- Support this podcast: https://podcasters.spotify.com/pod/show/walkinghomefromtheicu/support

"The day after the 4th of July I checked to see if my husband got to leave work early. I checked his location really quickly and was surprised when it showed him 5 minutes away parked in a ballpark parking lot. I text, no reply. I called, no reply. 5 minutes later he calls and says he is leaving work. I told him that I can see where he is and he is NOT leaving work. He had been off for about 15 minutes. So he initially lied. 3 hours later He says he was there because he was having a bad day and needed to take 5 minutes to himself. He says he cried but I didn't hear a sniffle on our phone call. Anyways, we finally talk today and he says he's depressed and then goes into ABCDEF that he is unhappy with me about. It wouldn't be a huge deal however we have had “trust” issues in the past. So what does the audience say? Is he lying or am I overreacting?"See omnystudio.com/listener for privacy information.

Bridgerton Season III part I is here!  This episode was recorded prior to part one premiere.  We're recapping the major similarities and differences between the books and film.  Plus, we present clever, fan-made Am I The A**hole Bridgerton edition for all of us to enjoy!The Duke and I – 3:33AITA for telling my wife I don't want kids, but in fact I just don't want them? – 8:28The Viscount Who Loved Me – 10:15AITA for tripping my mama's sister's fiancé and making him fall into the Serpentine? – 22:48An Offer From a Gentleman - 24:09AITA for thinking my brother's art skills are not good enough and so I bought his acceptance into art school without telling him? – 32:01Romancing Mister Bridgerton – 32:20AITA for befriending my former best friend's bully?– 49:29AITA for trying to find a husband for my daughters by any means necessary…? – 50:55To Sir Philip With Love – 51:21When He Was Wicked – 56:24Join us as we celebrate the Bridgerton books and film!DRAWING ROOM DISCUSSIONSCollaboration with our Bridgerton books + film + everything podcast @bridgerton2000Shonda Rhimes still has all eight books on the books“OFFICIAL, UNOFFICIAL BOOK REVIEW” – 3:33Julia QuinnBridgerton books 1-6www.juliaquinn.comwww.facebook.com/AuthorJuliaQuinnwww.instagram.com/juliaquinnauthorwww.ubookstore.com/books/collections/julia-quinnwww.shondaland.com“POT-TAIL PONDERING” –  60:51The Republic of Tea: Bridgerton Collection – Duke & Duchess (Honey Breakfast Tea), Anthony & Kate (Spiced Chai), and Featherington (Blood Orange Mimosa Tea)Season 3 Part 2 on June 13th!  What's your watch party plans???NEXT– Bridgerton GH & Ever After by Julia QuinnHosts - Toni Rose & Wendy WooEmail - litwallflowerspodcast@gmail.comFollow on www.instagram.com/litwallflowerspodcastShop at https://www.zazzle.com/store/lit_wallflowers/productsSocial Media https://linktr.ee/litwallflowersLit Wallflowers is part of the Frolic Podcast Network.  You can find more outstanding podcasts to subscribe to at Frolic.media/podcasts!

Bridgerton Season III part I is here!  This episode was recorded prior to part one premiere.  We're recapping the major similarities and differences between the books and film.  Plus, we present clever, fan-made Am I The A**hole Bridgerton edition for all of us to enjoy!The Duke and I – 3:33AITA for telling my wife I don't want kids, but in fact I just don't want them? – 8:28The Viscount Who Loved Me – 10:15AITA for tripping my mama's sister's fiancé and making him fall into the Serpentine? – 22:48An Offer From a Gentleman - 24:09AITA for thinking my brother's art skills are not good enough and so I bought his acceptance into art school without telling him? – 32:01Romancing Mister Bridgerton – 32:20AITA for befriending my former best friend's bully?– 49:29AITA for trying to find a husband for my daughters by any means necessary…? – 50:55To Sir Philip With Love – 51:21When He Was Wicked – 56:24Join us as we celebrate the Bridgerton books and film!DRAWING ROOM DISCUSSIONSCollaboration with our Bridgerton books + film + everything podcast @bridgerton2000Shonda Rhimes still has all eight books on the books“OFFICIAL, UNOFFICIAL BOOK REVIEW” – 3:33Julia QuinnBridgerton books 1-6www.juliaquinn.comwww.facebook.com/AuthorJuliaQuinnwww.instagram.com/juliaquinnauthorwww.ubookstore.com/books/collections/julia-quinnwww.shondaland.com“POT-TAIL PONDERING” –  60:51The Republic of Tea: Bridgerton Collection – Duke & Duchess (Honey Breakfast Tea), Anthony & Kate (Spiced Chai), and Featherington (Blood Orange Mimosa Tea)Season 3 Part 2 on June 13th!  What's your watch party plans???NEXT– Bridgerton GH & Ever After by Julia QuinnHosts - Toni Rose & Wendy WooEmail - litwallflowerspodcast@gmail.comFollow on www.instagram.com/litwallflowerspodcastShop at https://www.zazzle.com/store/lit_wallflowers/productsSocial Media https://linktr.ee/litwallflowersLit Wallflowers is part of the Frolic Podcast Network.  You can find more outstanding podcasts to subscribe to at Frolic.media/podcasts!

In this episode of the Mom Owned and Operated podcast, Rita Suzanne and Dr. Lulu discuss raising a family, running a business and remembering yourself.Dr. Lulu is a multiple award-winning Queer, Nigerian-born pediatrician, Bestselling author, LGBTQ+ educator, TEDx speaker, corporate consultant, CEO of Dr. Lulu's Coaching & Consulting Lounge and chief host of Moms 4 Trans Kids Podcast.  She is a mother of 3, one of whom is a transgender young adult woman. She is CEO of Dr. Lulu's PRIDE Corner, a family-centered gender-affirming coaching practice and she also helps support employee-parents at the workplace with her AllyBridgeConnection program. Her “Allies in White Coats” program helps healthcare professionals become culturally competent allies to mitigate health inequities plaguing the LGBTQ+ community.  She was interviewed by Oprah Winfrey for her work in LGBTQ+ advocacy. Dr. Lulu's current focus is helping communities support and affirm Black transgender kids one family at a time.  You can connect with Dr. Lulu on her website, Instagram, LinkedIn and YouTube.  Support the Show.Tired of business as usual? Join a community that's rewriting the rules. Proven strategies to attract more clients and boost your income Free weekly networking events to expand your reach Authentic relationships and support from fellow entrepreneurs All the details are here: https://ritasuzanne.com/community P.S. You can find more interviews at momownedandoperated.com and learn about working with Rita at ritasuzanne.com/apply/

It has been claimed that ICU early mobility is a "new and temporary fad". Is walking intubated patients really that new? Let's start in 1970 and work our way through decades of research that continues to reaffirm that true mastery of the ABCDEF bundle gives patients the best chance to survive and thrive in and after the ICU. Episode citations and transcript at www.daytonicuconsulting.com --- Support this podcast: https://podcasters.spotify.com/pod/show/walkinghomefromtheicu/support

Cuentahabientes, ¿de pronto se dieron cuenta que les salió un lunar o nuevo o uno que ya tenían cambió de forma? Viene Polo de Velasco, nuestro dermatólogo de cabecera a explicarnos todo sobre los lunares y sobre todo, cuando es momento de ir corriendo con el especialista. Hosted on Acast. See acast.com/privacy for more information.

Cuentahabientes, ¿de pronto se dieron cuenta que les salió un lunar o nuevo o uno que ya tenían cambió de forma? Viene Polo de Velasco, nuestro dermatólogo de cabecera a explicarnos todo sobre los lunares y sobre todo, cuando es momento de ir corriendo con el especialista. Hosted on Acast. See acast.com/privacy for more information.

Parenting is often portrayed as a challenging and arduous task, filled with sleepless nights, tantrums, and constant worry. However, what if we challenged this narrative and embraced the idea that parenting can actually be easy? In this episode of the Moms for Trans Kids podcast, Dr. Lulu discusses the misconception that parenting is hard and shares her perspective on why parenting can actually be easy. She challenges the belief that parenting is inherently difficult and highlights the top three mistakes parents make that contribute to this perception. Dr. Lulu emphasizes the importance of unconditional love, empowering children, and creating safe spaces for them. Key Takeaways Parenting is easy when approached with unconditional love and acceptance. The belief that parenting is hard is often a result of societal conditioning and the desire to control outcomes. Parents should empower their children and create safe spaces for them to thrive. The ABCDEF process (Awareness, Believe, Create, Decide, Empower, Feel) can help parents navigate the journey of parenting their queer children. It is important to feel and process all the emotions that arise when a child comes out as LGBTQ+. Website: ⁠⁠www.dr-lulu.com⁠⁠ IG @drlulutalkradio Linkedin: ⁠⁠www.linkedin.com/in/DrLulu/⁠⁠ Youtube: @drlulutalkradio ⁠⁠Facebook⁠⁠ ⁠⁠Linktree Links and Resources

Have you ever thought of communication as a vital sign for patients in the intensive care unit? In this episode, you will hear Kali Dayton, DNP AGACNP and critical care outcomes consultant, share her passion for using evidence that promotes what she terms "Awake and Walking ICUs." Communication is key to the ABCDEF bundle – a group of interventions associated with helping patients do better in the ICU and in their lives afterward. Kali is also host of the Walking Home from the ICU and Walking You Through the ICU podcasts. For more information visit: radicalnursetalk.com

What happens when resources and staffing are dedicated to providing high touch and high compliance with the ABCDEF bundle? How does adequate staffing, interdisciplinary team dynamics, and quality protocols impact patient outcomes and financial benefits? What is the "secret sauce" of successfully weaning patients from the ventilator? Sam Nimah and Phillip Norris share with us the exemplary work happening at Trivent care. Episode transcriptions and citations found at: www.daytonicuconsulting.com ***Early Mobility Conference April 14-16th in Orlando, FL*** https://www.earlymobility.com/2024conference --- Support this podcast: https://podcasters.spotify.com/pod/show/walkinghomefromtheicu/support

After decades of research and effort, why is there a persistent struggle to truly practice the ABCDEF bundle? Are antiquated sedation practices because nurses are unwilling to change, or is it because they are unsupported and untrained in the risks and realities of sedation? Even when training is provided in the classroom, what do nurses learn at the bedside? How does poor leadership impact sedation and mobility practices at the bedside? Are nurses safe to question long-held habits and beliefs? "April" joins us now to share her experiences entering the ICU and how the ABCDEF bundle is really being practiced. www.daytonicuconsulting.com ***Early Mobility Conference April 14-16th in Orlando, FL*** https://www.earlymobility.com/2024conference --- Support this podcast: https://podcasters.spotify.com/pod/show/walkinghomefromtheicu/support

As parents, we have been conditioned to believe that parenting is hard. We have been told that it is a constant struggle filled with challenges and difficulties. But what if I told you that parenting is actually easy? What if I told you that it is all about unconditional love, empowerment, and acceptance? Today, we are going to explore this idea and challenge the misconceptions surrounding parenting. In this episode of the Moms for Trans Kids podcast, Dr. Lulu discusses the misconception that parenting is hard and shares her belief that parenting can actually be easy. She challenges the idea that parenting is inherently difficult and highlights the top three mistakes that parents make, which contribute to this belief. Dr. Lulu emphasizes the importance of unconditional love, letting go of control, and avoiding the need to predict the outcome of parenting. She also introduces her ABCDEF approach to easy parenting, which includes awareness, acceptance, creating safe spaces, deciding to accept your child, empowering your child, and feeling all the emotions that come with parenting a queer child. Key Takeaways Parenting is easy when approached with unconditional love and acceptance Mistakes parents make, such as believing parenting is hard and trying to control their children, contribute to the belief that parenting is difficult Creating safe spaces and empowering your child is essential for easy parenting Feeling all the emotions that come with parenting a queer child is important, but it's crucial to process them away from your child Links and Resources Website: www.dr-lulu.com IG @drlulutalkradio Linkedin: www.linkedin.com/in/DrLulu/ Youtube: @drlulutalkradio Facebook https://www.facebook.com/profile.php?id=100082578953611&mibextid=LQQJ4d DeeDee ⁠https://www.linkedin.com/in/deedee-lloyd-3283a8255⁠ Jenni  https://www.linkedin.com/in/jenniholder Amber: https://www.linkedin.com/in/amberhollowell

What is EARLY mobility? Why is it so vital that the ICU community advance past passive range of motion for intubated patients? What are the main barriers that prevent us from mastering the E of the ABCDEF bundle? If we're not doing highest level of mobility for most of our patients, are we truly practicing the ABCDEF bundle?  Heidi Engel, DPT, joins us now to clear the air about early mobility.  Podcast citations and transcripts found at ⁠www.daytonicuconsulting.com⁠ --- Support this podcast: https://podcasters.spotify.com/pod/show/walkinghomefromtheicu/support

The normality of delirium in the ICU is often mistaken for benign. What does it really mean to "assess, prevent, and treat delirium"? Are we treating a positive CAM score with the same urgency as a positive tropinin? If we are automatically starting deliriogenic medications on every patient immediately upon intubation, are we truly practicing the "D" of the ABCDEF Bundle? Dr. Austin shares with us the full picture of the "D" of the ABCDEF bundle. Citations and transcriptions for all episodes found at www.daytonicuconsulting.com ***Early Mobility Conference April 14-16th in Orlando, FL*** https://www.earlymobility.com/2024conference --- Support this podcast: https://podcasters.spotify.com/pod/show/walkinghomefromtheicu/support

Is the C of the ABCDEF bundle only for avoiding benzodiazepines? How do we fully practice the "C" of the bundle and how does this impact patient care and outcomes? If we are automatically starting sedation without evaluation, are we truly practicing the ABCDEF bundle? John W. Devlin, PharmD, BCCCP, MCCM, FCCP joins us in this episode to share his expertise on best sedation and analgesia practices in the ICU. Episode citations and transcriptions found at: www.daytonicuconsulting.com --- Support this podcast: https://podcasters.spotify.com/pod/show/walkinghomefromtheicu/support

Speaker: Dr. Konstantin Zubelevitskiy No disclosures Objectives: •Introduce the ICU Liberation initiative •Define PADIS guidelines and ABCDEF bundle •Discuss the importance of pain management in the ICU setting •Compare valid and reliable pain assessment tools •Identify challenges in assessing pain •Introduce effective strategies to prevent and manage pain •Discuss working with opioid-dependent patients •Review the case scenario

Sarah gets payback. Eva's She-E-O business panel ends in disaster. Tommy enters the chat, and Sarah finds herself wishing for her old life back.  Supported by:   First Round's On Me (FROME), a dating app for people who want to date intentionally and actually meet in person for a real date.   Get the app here: https://bit.ly/fromexbadinfluencer If you like Bad Influencer, find us on IG and TT @emeraldaudionetwork and try out these other titles!   The Royals of Malibu   The Key of Love  Rainbow Girl  See omnystudio.com/listener for privacy information.

How did the ABCDEF bundle come to be and what is its true objective? What barriers are causing the ICU community to fall short of full compliance with the bundle and what is the future of the ABCDEF bundle? Michele Balas, PhD, RN shares with us her insights as one of the founders of the ABCDEF bundle. This episode kicks of our 8-episode series dedicated to each element of the ABCDEF bundle. We're going to be going back to the basics and diving deep into how to truly practice the ABCDEF bundle in our ICUs. www.DaytonICUConsulting.com ***Financial Benefits of the ABCDEF Bundle Webinar*** October 18th, 2022 at 12pm EST Register here: https://us02web.zoom.us/j/4173781755?pwd=RHFhYml0Vlc2ZTNJcEJiVURIS1hrQT09 --- Support this podcast: https://podcasters.spotify.com/pod/show/walkinghomefromtheicu/support

How do hospital-acquired pressure injuries (HAPIs) occur in the ICU and why is the ABCDEF bundle such a powerful tool to prevent HAPIs? How do HAPIs impact healthcare costs, staff workload, patient quality of life, and overall survival? Wound Care Karen joins us in this episode to explore the crisis of hospital-acquired pressure injuries in the ICU. Check out the Wound Care Karen Podcast here! Episode transcript and citations found at www.daytonicuconsulting.com --- Support this podcast: https://podcasters.spotify.com/pod/show/walkinghomefromtheicu/support

Individuals and teams are transforming patient outcomes through the adaptation of the ABCDEF bundle. Hear a compilation of their inspiring successes in this episode! www.daytonicuconsulting.com --- Support this podcast: https://podcasters.spotify.com/pod/show/walkinghomefromtheicu/support

We know that stroke patients are at high risk of poor cognitive, physical, and psychological outcomes. How does delirium impact their outcomes and how can we better protect patients from additional brain injury from delirium? Rosa Hart, BSN, RN, SCRN from the "Stronger After Stroke" joins us now to explore the struggles, barriers, and importance of the ABCDEF bundle for stroke patients in the neuro ICU. Check out the "Stronger After Stroke Podcast" here! Episode transcription and citations found at: www.daytonicuconsulting.com --- Support this podcast: https://podcasters.spotify.com/pod/show/walkinghomefromtheicu/support

It goes without saying that nurses are the gatekeepers of patient outcomes in the ICU. Do ICU nurses *really* aspire to care for unresponsive and atrophying bodies? How does the ABCDEF Bundle impact the nursing role, skillset, and job fulfillment? James Fletcher, BSN, RN seems to fit the mold of a nurse that would thrive solely with the flashy skills of an ICU RN. He shares with us the impact nurses can make by using "soft-skills" and human touch in the ICU. He is brining joy back to nursing with the ABCDEF bundle. www.daytonicuconsulting.com --- Support this podcast: https://podcasters.spotify.com/pod/show/walkinghomefromtheicu/support

We know that early mobility is a potent tool to prevent and treat ICU delirium. How does it impact cognitive function 1 year after discharge? What do "Early" and "Mobility" REALLY mean? How has drastic variation in methodology in the research led to the confusion and conflict we now see in early mobility practices? How can we optimize early mobility in the ICU? Is it safe and feasible to mobilize most patients within 48 hrs after intubation? Is there evidence to support restrictive mobility parameters by ventilator settings, vasopressors, etc.? How can intensivists lead and support their teams to master the full ABCDEF bundle? Dr. Bhakti Patel shares with us her recent research and invaluable insights. See transcript and citations for this episode at: www.daytonicuconsulting.com --- Support this podcast: https://podcasters.spotify.com/pod/show/walkinghomefromtheicu/support

The mission to create Awake and Walking ICUs is not a brand new endeavor. Dr. Juli Barr, an early PAD and ICU liberation founder, shares with us the tools needed to master the ABCDEF bundle. www.daytonicuconsulting.com --- Support this podcast: https://podcasters.spotify.com/pod/show/walkinghomefromtheicu/support

Delirium is acute brain failure. It's not just an unavoidable consequence of being hospitalized, it is a condition that can be prevented and treated! That's why Rapid Response RN has teamed up with some of our favorite nursing podcasts for a pod crawl devoted to delirium.In this episode, Kati Kleber, MSN RN and host of the FreshRN® Podcast, joins our discussion on treating patients with delirium and avoiding its long-term effects. We go over the ABCDEF bundle, common mistakes new nurses make in regards to delirium, and the importance of family engagement in its treatment.You'll also hear an inspiring story of how host Sarah Lorenzini used creative solutions, combined with a nurse's secret weapon (their intuition!), to get a patient with delirium out of the ICU and away from the harmful effects of sedation.Listen to this stop on the pod crawl for a lesson in delirium treatment, interdisciplinary collaboration, and patient advocacy!Topics discussed in this episode:Difficulties with Sarah's delirium patientHow she overcame tough circumstances and helped the patientThe ABCDEF bundle to prevent deliriumBenefits of family engagementWhy you shouldn't undervalue physical therapyHow nurses can work together as a team to help patientsWhether or not we should keep intubated patients sedatedChanging procedures with new researchImportant advice Sarah has for new nursesNursing culture on social mediaTo hear the rest of the episodes in this podcrawl go to upmynursinggame.com/podcrawlKati Kleber, MSN RN is a nurse educator, author, national speaker, host of the FreshRN® Podcast, and owner of FreshRN® – an online platform created to educate, encourage, and motivate newly licensed nurses in innovative ways.You can find her at https://www.instagram.com/kati_kleber/If you would like to check out Sarah's 1hr, 1 CE course, go to: http://www.rapidresponseandrescue.comTo get the FREE Rapid Response RN Assessment Guide and the coupon code for $10 off the cost of the course, message Sarah on Instagram @TheRapidResponseRN and type the word PODCAST!This episode was produced by Podcast Boutique http://www.podcastboutique.comMentioned in this episode:AND If you are planning to sit for your CCRN and would like to take the Critical Care Academy CCRN prep course you can visit https://www.ccrnacademy.com and use coupon code RAPID10 to get 10% off the cost of the course!

Massimo Di Lecce intervista Francesca Cipollone, Presidente dell'Associazione bambini con diabete e famiglie.

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2023 SCCM PharmD Speakers Part II 02:18 – Acute Ischemic Stroke Mgmt Updates with Salia Farrokh, PharmD, BCCCP, FNCS 13:30 – Ketamine's Role in Opioid-Sparing Analgesia with Luma Succar, PharmD, BCCCP 24:00 – Incorporating Lidocaine in Multimodal Pain Regimens with Chelsea Lopez, PharmD, BCCCP 43:19 – Choice of Analgesic/Sedatives in ABCDEF bundle with Joanna Stollings, PharmD, FCCP, FCCM, BCPS, BCCCP 58:54 – Constipation in the Critically Ill with Melissa Santibañez, PharmD, BCCCP 74:40 – Practical Aspects of Immunotherapy in the ICU Heather May, PharmD, FCCM, BCPS, BCCCP 92:27 – Updates on CAR-T Products and Toxicity Management with Anne Rain Brown, PharmD, BCCCP, FCCM 103:37 – Immunomodulator Drug Highlights with Tuqa Alkhateeb, PharmD, PhD 118:18 - Empiric Anerobic Antibiotics in the ICU with Kevin Betthauser, PharmD, BCCCP 134:37 – Pharmacotherapy Adjustments in Obesity with Bethany Shoulders, PharmD, BCCCP PharmacyToDose.Com  @PharmacyToDose  PharmacyToDose@Gmail.com

Diagnoses can be really confusing. There's depression, anxiety, PTSD, personality disorders, DID, and all the other things. Then there's acronyms like MDD, GAD, OCD, and the list goes on. It can be even more confusing when different people in your body have different diagnoses. We want to talk about what these diagnoses can actually look like and what some of the symptoms are. Our hope is that this will help you feel less alone in some of the symptoms you may be experiencing and help to make sense of the sometimes conflicting feelings that someone with DID can have. This podcast may contain themes of trauma, flashbacks, self-harm, and suicidal ideation. This podcast was produced using Anchor. We WANT to hear from you, for real! So email us at mypuzzlepiecespodcast@gmail.com. We look forward to your email! --- Support this podcast: https://anchor.fm/mypuzzlepieces/support

In this episode we welcome critical care nurse practitioner, Kali Dayton, DNP, AGACNP. Kali is a member of the Society of Critical Care Medicine and host of the ‘Walking Home From The ICU' podcast. Kali works closely with international ICU teams to help transform patient outcomes. They focus on early mobility and management of delirium in the ICU. She joins us to chat about her early days and experience in the ICU, sedation in patients and the effects of mobility of patients in the ICU, medications, how she helps with patient healing and more. Kali tells us about what inspired her to start her podcast and shares a story about her experience with an ICU survivor.SPONSORBETTERHELPBetterHelp is the largest online counseling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet, and affordable access to a licensed therapist. BetterHelp makes professional counseling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use discount code “solvinghealthcare"TRANSCRIPTKK: We are on the brink of a mental health crisis. This is why I am so appreciative of the folks over at BetterHelp everybody the largest online counseling platform worldwide to change the way people get help with facing life's challenges by providing convenient, discreet, and affordable access to licensed therapists. BetterHelp makes professional counseling available anytime, anywhere through a computer, tablet, or smartphone. Sign up today go to better health.com And use a promo code solving healthcare and get 10% off signup fees.SP: COVID has affected us all and with all the negativity surrounding it, it's often hard to find the positive. One of the blessings that has given us is the opportunity to build an avenue for creating change. Starting right here in our community discussing topics that affect us most such as racism and health care, maintaining a positive mindset, creating change the importance of advocacy, and the many lessons we have all learned from COVID. If you or your organization are interested in speaking engagements, send a message to kwadcast99@gmail.com or reach out on Facebook @kwadcast or online at drkwadwo.caKK: Welcome to ‘Solving Healthcare', I'm Kwadwo Kyeremanteng. I'm an ICU and palliative care physician here in Ottawa and the founder of resource optimization that one, we are on a mission to transform healthcare in Canada. We're going to talk with physicians, nurses, administrators, patients and their families because inefficiencies, overwork and overcrowding affects us all. I believe it's time for a better health care system that's more cost effective, dignified, and just for everyone involved. KK: Kwadcast nation super exciting episode I got flowing with you. We got Kali Dayton. She is a nurse practitioner that has taken ICU delirium, ICU mobility so seriously, she's got her own consulting firm. She also has her own podcast ‘Walking from the ICU'. Such a great phenomenon. So, we got her you'll hear this episode. It's a live cast that we did a couple of weeks ago. I'm just proud of her. Someone that's taken getting people healthier and out of the ICU and functional seriously, and we need more of that going on right now. We're only gonna see higher demands. So, without further ado, I'm gonna bring Kali on but first, check out our latest newsletter, kwadcast.substack.com It has everything Kwadcast, our episodes, or newsletter, guest blog appearances, guest vlog appearances, you're gonna love it. Kwadcast.substack.com Check it out. Without further ado, I want to introduce you to Kali Dayton. Welcome to the podcast.KD: Thank you so much for having me on. I've been following your podcast; I appreciate your mission. I see a lot of our objectives are in line.KK: Oh 100% 100%. So, Kali, can you walk us through your story? You're a nurse practitioner. That is, like I said, changing the outlook for critically ill patients. How did you get here?KD: Absolutely. I'm sure a lot of my listeners know my story very well. I started out as a brand-new nurse, many years ago, over a decade ago, in awake and walking ICU. That's just what I call it now. That's the term that I've coined to describe what they do there. In the interview in my naivete, I was just excited to be there. I had no idea what they were talking about when they asked, ‘Would you be willing to walk patients that are on ventilators?' and I was willing to do anything, right. I was just brand new graduate. I said yeah, of course absolutely teach me everything. I didn't understand the magnitude of that question until probably three to eight years later. Because when I started working there, no one made a big deal out of it, for decades and that ICU it's a medical surgical ICU, its high acuity, they've had a COVID ICU throughout the pandemic. They've maintained it this practice of allowing almost every patient to wake up, usually right after intubation, unless there's an actual indication for sedation. What's been intubated on mechanical ventilation is not an indication for sedation. So, unless they have an inability oxygen with movement, seizures and cranial hypertension, something like that, otherwise they are awake. They're reoriented and they're allowed to communicate, tell us what they need. We manage their pain according to what they tell us. They're usually mobilizing shortly after within hours after intubation, and throughout the day, and throughout their time on the ventilator. So that was completely normal. No one told me ‘Hey, Kali, this is the gold standard of care. This is the model for all early mobility protocols in the world' Everyone knows about this ICU. No one told me that. So, I spent a few years there thinking that that was normal critical care, medicine, knowing none the wiser. Then I became a travel nurse, and I went to other ICUs in the in the United States. My very first contract when I walked into the ICU, it just felt different. But I knew I expected things to feel different, right? It's a new environment. But everyone was in bed. Everyone looked like they were asleep. There were very few signs of life, and I got my patient assignment, and the patient was sedated and on the ventilator. I didn't know why they were sedated. I wanted to continue my routine, do a neuro exam, hopefully get the patient in the chair ready for physical therapy, because that was my routine, in the wake & walk ICU. A lot of times physical therapy comes out of that patient is in the chair waiting for the physical therapist, take them on a walk even on the ventilator. So, I asked my orientee nurse, ‘Hey, can I get this patient up and take him for a walk?' and she looked at me in horror and said, ‘No, they're on the ventilator. They're intubated' What didn't make sense to me, because I've cared for at least hundreds, maybe even 1000s of patients that were on the ventilator and were awake and walking. I had no idea what she was talking about. I said, ‘I know that they're intubated. But why are they sedated?' ‘Because they're intubated?' and I say, ‘Okay, but why are they sedated?' and we went in circles. That was the first time it ever crossed my mind that a patient would be automatically sedated, just because they were intubated. I quickly realized that that was the common perspective throughout the ICU, that I was the odd man out there. Here's the thing. Despite my years of experience, treating patients like that, I knew how to do it. I didn't know why we did it. No one had taught me what sedation actually does. No one taught me what it's actually like for patients, and how much it changes outcomes. So, in that environment, I didn't have the tools to support my approach and my practices and to advocate for my patients. I was still kind of a new nurse, and I was, you know, you just had to fit in in the ICU. There's so much peer pressure, there's the culture is such a huge part of it. I ended up just taking the ‘When in Rome' approach and I just went with what I was surrounded with, and I ended up following along sedating my patients. I didn't really obviously know the difference. I mean, I saw a difference in outcomes. I saw patients stay on the ventilator for far longer. I missed the human connection, I noticed that there were a lot of tracheostomies and nursing home and LTech discharges that I did not see the way can walk in ICU 93% of survivors from that high acuity medical surgical ICU that I came from, went straight home after the after the ICU.KK: That is nuts. That is nuts.KD: That's what I thought was normal. So, I was noticing things, but I couldn't really put my finger on it. I couldn't advocate and I just went with it. Right. I even laughed at some of the nursing jokes about yeah, I hope my patient sedated, and totally snowed today. Thinking that that was funny, and it wasn't till years later that I was in grad school. Of course, even in my acute care doctorate program, nothing was mentioned about sedation or mobility practices. It was just assumed even in our case studies, it was assumed that if a patient came in with pneumonia, they were going to be sedated if they were on a ventilator. I was on a plane ride, and I sat next to a survivor. When he heard that I was a nurse and ICU nurse, the color dropped from his face. He started telling me about his experience over four years before that moment when he was a patient. He told me what it was like to be on a ventilator. He just barely mentioned the ventilator. All he could fixate on was what it was like to be in the middle of a forest with his limbs nailed to the ground and trees were falling down on him and he couldn't run away. Demons were coming to the sky and lots of things that he still couldn't talk about, because he was so deeply traumatized. I was stranger on this plane and he's sobbing to me, telling me about what he experienced. Of course, I wanted to diagnose him and I said ‘it sounds like you had ICU delirium' but that meant nothing to him. I came to realize as I listened with real empathetic ears, that that wasn't just a nightmare. Those weren't hallucinations. Those were vivid and real. He was psychologically scarred as if he physically lived through those scenarios. I was really shaken. I really hoped that he was one in a million, because he was telling me that for year after discharge, it was really difficult to relearn how to sit, stand, walk, swallow, that was really hard. The hardest part was that for year after discharge, every time he closed his eyes, he would be lost back in that forest back in that scenario, and he could not sleep. So, the depression, anxiety, physical disability, I didn't ask about the cognitive function because I didn't enough know enough to know that he wouldn't be at high risk of having post ICU dementia. He said that he still had not returned to his career. His life was over. He said ‘I know I feel bad even telling you this, I should be grateful to the ICU to him for saving my life, but my life is over. The life I knew before the ICU is gone. I lost my life in the ICU. If I were ever to become sick, I would never cross a toe back into the ICU. He was a DNR/DNI in his 40s, with no other real comorbidities because he never wanted to live through that again. I think what he meant by that was ICU delirium. I had worked in the ICU about six years. We have never I never heard anyone talk about anything like that. So, I thought this must be a fluke, he must be one in a million. So, I went survivor groups. I thought I would have to post and ask survivors questions. No, the second I got into survivor group, I just scroll through and almost all their posts were about the trauma suffered under sedation and these medically induced comas, what it was like to not be able to balance their check book, read a book, read a clock, like they were barely able to text. These are people thinking ‘How long is this going to last? my brain is not the same'. So that is what got me into looking into the research. I was shocked to find decades of research, exposing the harm of our normal practices. Yet we continue to do those things and I was back in that awake and walk ICU. Seeing a completely different way and I've seen this contrast from what I experienced for years as a travel nurse. Then where I was currently at as a doctorate student, nurse, and then I started working as a nurse practitioner, in that same ICU. That's when I started this podcast ‘Walking home from the ICU' to show what they were doing in the ICU and now it's turned into ‘how do we revolutionize our normal practices in the ICU?'KK: I got so much here, first. I never even would have comprehended or would have thought that your initial experience, I didn't realize that your initial experience was people were able to ambulate and get out of bed and reduce the amount of sedation. KD: People are gonna say ‘Oh, well, that must have been, you know, long term mentors or not that high acuity' They were the first ICU to publish the study back in 2007, showing that it was safe and feasible to walk patients on ventilators and in that study, they had PF ratios less than 100.KK: What that means in nonmedical folk is that your lungs were extremely damaged and require a lot of supplemental oxygen to make sure your saturations are high enough that your oxygen levels are high enough. So, this is the sickest of the sick. From a breathing perspective, getting up and hustling and movement answered. So that is amazing. From a personal side, it must have been an absolute mind F that you couldn't, that you went from one extreme to the other. I'm doing tell you from my I've worked in several ICUs in my country, and the latter is the norm, people aren't getting up on a ventilator, you know, they're not getting, they're barely getting up into a chair on a ventilator. KD: They aren't even getting sedation vacations, they're snowed. KK: One of my main jobs in the ICU when I walk in is minimize the sedation and even often I've seen in practice, they're getting Dilaudid or opioid infusions for no real reason to be honest with you. They're not post op. They have no pain syndrome and we're given pain medication in infusion, which accumulates and what you're describing to amongst patients, my other job is in palliative care when they get toxic or delirium. Delirium from medication. Yeah, that can be traumatic, these memories, these images. That must have been an absolute frustrating experience to go from one version to the other.KD: I was just really confused. I mean, I was still I feel like I'm still new in my career and impressionable. No one taught me the why that's the unfortunate thing about a lot of our medical education is we're taught how we're taught task lists, but we're not taught the why that allow us to critically think and see a bigger picture. I feel like looking back I was really victim to that. I but I would still ask every ICU ‘So, shouldn't this patient get up? Can I get them up?' because it I knew that was beneficial. I wanted that and a lot of it for me was, I wanted to see my patients get better. When you're walking a patient moments later, you know that they're progressing, you get to connect with them, you get to know who your patients are, I had no idea who my patients were, they were just bodies in the bed. That's not why I got into medicine. So even just selfishly, I wanted them to be off sedation, had I known that by taking off sedation, we could decrease their seven-day mortality by 68%. Oh, I would have been all over that, but I didn't know. I did work in one ICU, where they had some level of ABCDEF bundle, which is a protocol to help guide teams to minimize sedation and get patients up. There's such a spectrum of compliance and different approaches to it. So, I was taught to do an awakening trial, which means you turned on sedation. The purpose really should be to get them off sedation, it should be sedation cessation, but I was taught. So, you know, at five o'clock in the morning, we must turn down sedation, it's super annoying, I know but just turn it down. Wait to see them thrash - that's how you know, when you see all their limbs move that they haven't had a stroke. When you can tell they can't tolerate the ventilator, then you turn the sedation back on and call it a failed trial, just chart it. I was confused. I didn't know what the objective was, I didn't know what we were doing. I didn't know why they were agitated. For her to say it's because I can't tolerate the ventilator. That was confusing to me because I'd seen so many patients tolerate the ventilator. I didn't understand delirium, and I hated awake new trials. They were laborious, they were stressful, they felt unsafe. It's hard to see patients between delirium, it's hard to see them be so uncomfortable, and you can see the terror in their eyes. But again, when in Rome, I just did what I was told, unfortunately. So, this is my journey now is almost my penance for the harm that I caused my patients during those years. KK: Well, Let's be honest, Kali, you can't be looking at it that way, man. We all remember sedation is the norm. What we're doing now is trying to advocate for change. I can't emphasize enough the change can be dramatic for people like it really comes down to function. If you in the ICU and you're paralyzed into intubated on sedation and analgesia, you're not moving, like you're not using your muscle. Then when you're trying to go back to what you want it to where you want it to be. I think a lot about our COVID patients. They were in the 40s/50s/60s, that are trying to get back to working, trying to get back to doing the activities that they love to do. When you think about this not only are you impacting their ability, like they're not getting to their functional level, but what's it doing for their family. Now you got a loved one that's got to take care of them, that might have to take off time off work too. It just is an absolute amplifier when people can't be functional.KD: For those that maybe don't work in the medical field, or even especially those that do, here's what we're not talking about the bedside, here's what we're not telling patients and families. When we go into surgery, they give us informed consent, they tell us here are the remote risk that things that could happen, right. What we don't do before intubation for patients and our families is tell them the actual risks of sedation. We don't understand ourselves that sedation is not sleep, it disrupts the brain activity so severely that they don't get real REM cycle. So, my perspective is that it's a form of torture, really, I mean, that's what we do, and war in the military, we deprive people of sleep, and that's what we're doing to our patients when we give medications that make it so they cannot get restorative sleep. Many of our study, sedatives are myotoxic, meaning that they're toxic to the muscles, so it causes more muscle breakdown. Then on top of that, if there's absolute disuse when you're stopped sleeping deeply sedated, you're not even contracting a muscle usually. So that disuse makes it so that our muscles break down more. That disruption of sleep often caught is one of the mechanisms that causes delirium, which is acute brain failure. It's an organ dysfunction. That can turn into long term post ICU, dementia, cognitive impairments. So, they cannot return to their normal lives can't take care of their families can't go back to their jobs because they can't. Cognitively their brains can't function the same way anymore. They have this post ICU PTSD because of those vivid scenarios that they live. I'm not going to call them hallucinations, because that's, that's not accurate. Those were real to them. We just don't see that big picture of sedation, and we just don't even question and I do that a lot in my life too. They're things that I'm just taught that I don't question, but we don't question whether or not sedation is necessary. Sometimes it is. When we understand how risky it is, then we can do a true risk versus benefit analysis for each patient to say, ‘they're intubated for this reason, does that necessitate sedation?' If not, let's get it off and see what they need. Let them communicate. Let's prevent delirium. Your platform is all about preventative medicine. In the ICU you come in with one acute critical illness and we sign them up for chronic conditions?KK: Absolutely, as you said, like it really is about what can we do to prevent this from becoming a chronic condition. Honestly, it's a culture change, from what I could see. What's sad about medicine, is that we have data to support how bad things are or how good things are. The amount of time we invest in create that change is limited. If you look at the data for sedation vacation, so that same principle of, turn off someone's sedation, periodically, that we know that has positive outcomes, like we know that, but you could go through an ICU, throughout any country in North America and the odds are that they're not getting it routinely. Why doesn't that happen? That's why I'm proud of Kali. Number one, being a champion of this, ICU care sucks, but a lot of us that will end up in there. So, we want to be able to optimize care, but also like just doing some about it. It's one thing to want to bring attention to it but also, being an activist. I think it helps. So, you've got the podcast, Kali, you've done some other work, how else have you been able to increase awareness? You could even get into like, what the podcast also has done for you or in the people around you?KD: So with a podcast, I started that right before COVID hit. I don't know if your god person but I, God told me to start a podcast in December 2019. I barely even listened to podcast didn't know how to start one, but I couldn't. I couldn't rest. I knew exactly that I had to start, I had to put out 32 somewhat episodes by the beginning of March of 2020. I didn't know why it had to be so fast and so furious, and survivors came out of nowhere. I interviewed my colleagues, researchers, it was just this miraculous setup that just came together, put out all these episodes, and then COVID hit. I thought ‘well now it's all gonna be all about COVID, and no one's gonna care about this'. God back handed me and said, ‘This is for COVID They're gonna be millions of people on ventilators, how is this not relevant to COVID'. So, I continue to throw out COVID Even though I recognize that the ICU community was not really in a place to revolutionize. The hard thing is that this could have been so beneficial to COVID we created more work for ourselves with the sedation practices, you talked about awakening and breathing trials. Once I just looked at only wake & breathing trial started sedation, turn it off once a day and then turn it back on. Decrease ventilator days, by 2.4 days, days in the ICU decreased by three days in that hospital decreased by 6.3 days, when we're in a staffing crisis, we need to have a process of care that's efficient actually gets patients out of the ICU. Instead, we created this bottleneck where patients are now stuck on the ventilator because they're too weak to breathe on their own. Even if their lungs are better. Now they need tracheostomies. They're stuck in a ventilator. We can't at least in the States, we couldn't get them to LTACH because LTACH's were too full of all the other COVID long term patients. So, then the ICU wasn't rehabilitating these patients, and so then they develop more hospital complications, and then they ended up needing more care. It's just we created so much more work for ourselves. It just was a hard time to really take on a new endeavor and totally change your practices. But during COVID, everyone ran back to the 90s. Not everyone but a lot of people ran back to the 90s. As far as using benzodiazepines, higher doses of sedation, deeper sedation longer times, there was so much fear. We did a lot of fear-based medicine. So, I just kept chugging along with my podcast, knowing that the community was going to need healing after all of this. We were going to need a lot of rehabilitation within our own clinicians, but also within our practices. So now, teams are coming to me saying what we're doing now. We're still doing COVID care even these are not COVID patients, we're still we're back to deeply sedated patients. Where are we lost so many seasoned clinicians, new clinicians came in during COVID. They've been trained to deep deep, deeply sedate, they don't know how to move patients they're scared to. But one team said I look on my ICU It's not an ICU, these aren't ICU patients. These are LTACH patients. These are rehab patients that we're not rehabilitating. We're bottlenecked. We can't get these patient outpatients out, we can't get new patients, we're stuck. We're creating that kind of scenario. So now, I work as a consultant and I do training with the teams, I teach them the why the reality of delirium, giving them a picture of an awake & walking ICU using real case studies, pictures, videos, so that we have a vision of what could be I feel like the ABCDEF bundle when it was rolled out in the mid 2000's good change happened, a lot of things moved forward. I do feel like we didn't explain fully the why behind it. Until every ICU clinician hears the voice of survivors, they won't be afraid of sedation, they'll still be inclined. We started, we continued this start sedation automatically, then at some subjective point down the road, start to take it off, when they come out, agitated, turn it back on, we just didn't, we didn't give them this perspective of ‘Hey, most patients should be awakened walking. Here's how to treat delirium and here's how the team works together' we put a lot of it on nurses, which is not fair, feasible or sustainable. So, as I work with teams, I tried to really give them a foundation of why, and then how, how to treat patients without automatically sedating them. When the sedation necessary. How do we navigate appropriate and safe sedation practices? When do we use it? How do we mobilize patients, I go on site with teams and I do simulation training, we do real case studies and practice and the whole team practices together. Because it's a skill set, we think about pronation, when we started printing patients, everyone was terrified. And it took so many people and it took so long, you know watching every little line and now teams flip them like pancakes, right? It becomes a skill set. So, I tried to get them opportunity to practice that on a pretend patient. So, they can think through critically think through the scenario, think through delirium, thanks for ICU acquired weakness, then practice mobilizing patients with different levels of mobility.KK: My brain is going like, the whole time, it's like you need to come see our group.KD: Let's do it. I'll hope on a plane tomorrow – I can't actually. I'm going to Kentucky tomorrow, but let me know I'll be there!KK: We would absolutely love to have you. Just knowing where a lot of clinicians lack is hearing the voice of the people that have gone through it. Clearly, that's been a motivator for you in terms of why we need to pivot and provide less sedation to our patients and mobilize our patients and avoid them from having all these secondary complications as a result of being immobile. The means are there. KD: The data is strong; the data is really powerful. I mean, decreased mortality by 68%. Who doesn't want to do that, right? So, but almost even more powerful are the voices survivors, when you hear their voices in your head when you're sitting in a patient. It's haunting COVID, there were times when patients could not oxygenate the movement. I had to sedate them. I hated it. I just felt sick because I, I just didn't know what they were experiencing. I didn't know if they were in pain. I didn't know what was going on underneath that they were going to live with us the rest of our lives, it's because of the survivors that have interviewed on my podcast, they are the educators.KK: Yeah, I have so many ideas going through my head. I would love after when we jump off, links to the some of the episodes from the survivors that we can pass along to our group, to our show in general, but our group to give a sense of what it really is like to go through this. Yeah, our patients don't come I mean, every once in a while we get a patient come back and say how they're doing but they don't give us the they don't give us the negative side, they really focus on showing some gratitude. KD: Which is good, but if they came back, it's probably because they weren't too traumatized to come back. The ones that don't come back. I mean, why would you go back to the place that you are sexually assaulted?KK: Yeah, no, yeahKD: It's like to trigger and some people can't even go the same street as that hospital. On my website under the resources tab, the clinician podcast, at the bottom, the page is organized by topics. One of those topics is survivors of sedation and mobility, as well as survivors of an awake & walk ICU. So, you can hear their different perspectives and testimonies, it's organized by different topics. KK: You're an organized cat, I'm looking at it right now. I can tell you, you're very structured and organized just by the way your website is set up. It's on point.KD: It's curriculum. This is education, this is not just a hobby. I mean, this is we've got to make sure we get the right information to the right people.KK: You're so boss. You're gonna be running an organization one day, and ICU, I don't know. I see big things for you.KD: We'll see. I mean, I have a lot of optimism for the future of critical care, going to conferences, meeting with people at the bedside podcast listeners reaching out. It's not just me that cares about this. That's why I continue is that there are so many people that I call revolutionists, sometimes as the lone voice in their ICUs. But they're bringing big changes, they're making waves there so my motivation with podcasts is to provide the ammo, the quiver the arrows in their quiver, so that they can share that with their colleagues get more buy in, so that they don't have to reinvent the wheel. It's a lot to change a perspective and change a culture. It's hard.KK: Yeah, and maybe just seeking some advice, we had Dr. Wes Ely on the show and how to create some culture change around this issue. I want to hear your perspective. Kali, how do you think you do create that culture change? Because you bring this up to many staff, and they'll be like, ‘Oh, they're gonna extubate themselves? Oh, we're short staffed. This is not gonna be able to work.' What are your thoughts?KD: Yeah, this has been a lot of my journey is figuring out what are the barriers? and how do we address them? I think we're over the checklists. I think it is important to systemize and protocolized our practices. When we implement these kinds of changes, we this can't just be “Hey, Nurse, take off the sedation' that is not going to work. They have some valid fears at all I had ever seen. With a patient coming off sedation. After days, two weeks of sedation, I would have a lot of inhibitions. When I'm busy. I don't have time to wrangle that patient. I don't have time to make sure they don't self extubate. I have a Thank you for reading Solving Healthcare Media with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.whole episode on unplanned extubations, but delirium increases the chances of unplanned extubations by 11 times. So, it's just changing the perspective understanding what is delirium? why should we be panicked about it? What causes it? We are practices are some of the biggest risk factors and culprits of delirium in the ICU, and to learn doubles that are in hours required for care. So, when we're short staffed, why would we create a delirium factory? When it doubles our workload? It doesn't make sense, but when that's all we know, we don't understand that there's a better way to do it. So, my approach when I go to help a team have culture change is to, again explain the ‘why' give a perspective of what could be, here's what patients can be like, when we don't sedate them. If they when they wake up after intubation, it's like coming out of a colonoscopy. Endotracheal tubes not comfortable. Here are some tools to help make it more comfortable. Here's how we can talk to them. Give them a pen and paper, I would get agitated and panicked. I couldn't communicate. Here's how you involve the family, here's the toolbox to help you succeed and have that patient be calm & compliant. And they will protect their tubes. I've had patients write ‘please be careful my tube' That's what I need to experience. So, when you find a couple of case that isn't so easy hits, easy wins. Allow your team to see a patient awake, communicative, calm in even more while on the ventilator, the perspective starts to shift. Then they start to ask, okay, that was easy. That was fun. That changed outcomes. They walked up the ICU. Who else can we do this on and it starts to have a domino effect. So suddenly, we expect him to just shut up and do it. That's, that's not going to cut it. I don't think that I think that's partially why the ABCDEF bundle rollout, years ago was not has kind of gone away, because we didn't provide the why. We also, again, I think starting sedation, and then taking off later, is a lot of work. We should only do that if it's absolutely necessary. Otherwise, I mean, I have an episode with a hospital in Denmark, they do the same thing and that allow patients to wake up right after intubation. They are so much easier, more compliant, because they don't have delirium, we have to understand that that agitation is usually rooted in delirium, we have to come to really be terrified of delirium.KK: I'm really enjoying this, I'm really liking this because it's even at that added perspective of saying, ‘Hey, your workload is going to be worse if people are delirious, so let's avoid going delirious in the first place' Let's just get a grip on this bad boy, out of the gate.KD: You're all about preventative and it's like, Let's prevent one of the biggest culprits of mortality. Delirium doubles the risk of dying in the hospital. So, people say we don't have time to mess with all sedation practices, like let's just sedate them and like, save their lives and figure it out later. No. By doing that, by increasing the risk of delirium, we could double their chances of dying. So, if we care about mortality, then we will care about our sedation practices. We also know that ICU acquired weakness is really laborious. When people imagine mobilizing patients on ventilators. What they're imagining is taking off sedation days to weeks later when they're delirious. They can barely lift a finger and now we're trying to mobilize these, you know, 200 plus pound adults to the side of the bed. That's dangerous, laborious, it takes so many people. If a patient walks into the ICU or into the hospital, hypoxic hypotensive, whatever. We have moments later, we haven't stabilized. Why can't they walk? Did we cut their legs off? Right? So, once we have oxygenated, perfused, what's the harm in sitting outside of the bed and seeing how they do when they're not delirious, they can tell us how they're feeling. We can provide more support on the ventilator; they can probably walk better than they did come in and hypoxic. Once they're stabilized hours later, or even 24 hours later. So that is so much easier when they maintain their ability to walk. So, in the COVID ICU, many patients were standby assists to the chair with a nurse while they were on a ventilator, because they're alone in the room, right? Physical therapy could go in and work with a patient, just scoot the ventilator wall to wall as they're stuck in their rooms, help them stand or sit, step on steps, they were alone in that room with these patients, because they were strong enough to do it, because we didn't allow them to be under myotoxic sedation and I would say rot in the bed. So, all of that plays into an ease of workload. Then obviously the get off the ventilator sooner, get out of the ICU sooner. It makes the workload easier. So, it's a little bit of an exchange and efforts in some ways. Yes, you must talk to a patient. Yes, you must assess them a little bit more. But also, could during COVID, I was hearing about swapping out propofol bottles every hour, picking up to go in and out to titrate vasopressors that we were getting just because of the sedative and hypotensive effects. All of that is effort but wasn't necessary and wasn't beneficial.KK: I'm telling you, you are changing the boogie. Yeah, changing the conversation and perspective. This is something that can dramatically impact patient care. If we could get the buy in, in the culture. Wow.KD: You know, people will say ‘Well, we don't have we're trying to save $25 million this year. We can't afford to pay our payer clinician some extra time for education or whatnot' The ABCDEF bundle, even in their spectrum of compliance, decreased healthcare costs by 24 to 30%. KK: Oh, yeah. KD: ICU acquired weakness increases healthcare costs by I want to say 30-40%. Delirium increases healthcare costs by 40%. ICU acquired weakness increases healthcare costs by 30.5%. So, by having a process of care that prevent those complications with decreased healthcare costs. So why wouldn't we, right? KK: 100%. We even we had a paper out last year showing the financial impacts of ICU delirium. We always think to have the opportunity cost, that money could be diverted into more staffing, more resources for physio, optimizing nutrition, all these things can be enhanced. If we, if we make it a priority. KD: I think it's one of our one of our strongest cards to play for staff, safe staffing ratios. To say staff is better, we'll get better care in this using this protocol. We will save you so much money so it's investing thousands to save millions or billions.KK: I love it. You're speaking my language. We are definitely going to have you back in some capacity. I don't know that for some reason. It's not just gonna be the show. I really want to get you talking to our group. Maybe regional rounds, or something. I don't know what it's gonna be. It's something that we need to hear more of talked about the patient experience, your own experience and the drive like what's pushing this. Knowing my people a lot of intensivists and an ICU nurses and allied health professionals, we want to achieve this, get our patients to a point where they are better. Really better, not just alive, but thriving. This starts here. I really do believe it starts here. So I just want to give number one, Kali some mad love on what you're doing and continue to hustle, it's paying off. Second. How do people get to know you a little bit more? and about the show and the consulting and so forth?KD: So, have a website www.daytonicuconsulting.com. There's more information about consulting services available, the podcast is on there, the podcast has transcriptions and citations organized by topics. KK: So organized folks. KD: 116 episodes, and I really didn't even know how much of a what's called a rabbit hole that this would become. There's so much to learn about the science behind what we're doing as well as the patient and clinician perspective. So, check that out, find the topics. If nothing else start at the beginning. I think the beginning lays a foundation, I was very intentional about how I organized it at the beginning to lay a foundation of ‘why' and ‘how' comes later. I'm on Instagram @daytonicuconsulting, Twitter, Tik Tok. Go ahead and set up a consultation with me send me an email and we can chat about your team, your barriers, even your family members what's going on? I'm obviously obsessed. So, I'm here for you! let me know.KK: So good. So good. Thank you so much for joining us. Those on the chat group or that are watching live. You want a piece of this episode just tap NL into the chatbox will give you a copy the video and the end the podcast when it's released. Awesome work. Congratulations.KD: Thanks for caring about this.KK: 100% KK: Kwadcast nation that's exactly what I'm talking about changing the boogie right here in ICU care. Follow us on Instagram, YouTube Tiktok Facebook @Kwadcast Leave any comments at kwadcast99@gmail.com, subscribe to our newsletter. Essentially, it's like a membership you want to know more about Kwadcast nation. Go to Kwadcast.substack.com Check it out. Leave that five-star rating and continue to allow us to change boogie in unison. Take care, peace. We love you.Solving Healthcare Media with Dr. Kwadwo Kyeremanteng is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to Solving Healthcare Media with Dr. Kwadwo Kyeremanteng at kwadcast.substack.com/subscribe

In this 247th episode I welcome Kali Dayton back to the show to discuss her work helping ICUs around the country learn how to get their intubated patients awake and up and walking and implement the ABCDEF bundle.Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

The ICU can be a traumatizing place for patients, who are frequently heavily sedated, rendered unable to speak by breathing tubes, isolated by family visit limitations, and sometimes even physically restrained. In fact, a significant proportion of patients discharged from the ICU later develop persistent cognitive impairments and physical disabilities. Over the past two decades, Dr. Wes Ely has worked to improve the care of patients in the ICU, leading landmark studies resulting in the development of delirium prevention protocols that are now adopted in ICUs everywhere. Today, Dr. Ely co-directs the Critical Illness, Bran Dysfunction, and Survivorship (CIBS) Center at Vanderbilt University Medical Center. In this episode, Dr. Ely joins us to share his career-long fight to reform ICU medicine and to recount poignant stories that illuminate and elevate the humanity of patients amid the chaos of the ICU — and in the process discusses themes that seldom appear in contemporary medical discourse, such as love, beauty, and mercy.In this episode, you will hear about:How Dr. Ely discovered medicine as a calling while growing up in rural Louisiana - 2:33How a fascination with cardiopulmonary physiology, combined with an interest in patient relationships, led Dr. Ely to critical care medicine - 4:27A discussion of how patients in ICUs can often be “de-humanized” - 6:31A story from early in Dr. Ely's career that illustrates “malignant normality” — when treatment norms led to patient harm - 10:40A discussion of physician burnout and how the dehumanization of patients contributes to it - 13:27What Dr. Ely and his colleagues have learned through years of research about the harmful standard practices of ICU care - 18:53An explanation of the ABCDEF treatment bundle designed by Dr. Ely and his collaborators to improve outcomes of patients in the ICU patients - 24:04How Dr. Ely processes the guilt and shame he feels from the harm he inadvertently caused to patients early in his career - 29:37Reflections on how eye contact, physical touch, and openness of the heart are essential to good medicine - 36:03A discussion on how Dr. Ely's spirituality has influenced his approach to patient care - 44:51What it means to provide healing when patients are facing serious illness, even at the end of life - 50:45Dr. Wes Ely is the author of Every Deep-Drawn Breath, a chronicle of his experiences caring for ICU patients.You can find out more about his work at ICUDelirium.orgFollow Dr. Ely on Twitter @WesElyMDVisit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to info@thedoctorsart.com.Copyright The Doctor's Art Podcast 2022

What was it like as a travel COVID ICU nurse to jump into an “Awake and Walking COVID ICU”? How does true mastery of the ABCDEF bundle impact RN workload, burnout, safety, and career fulfillment? Travel RN, Laurelai, shares with us her experiences and insights. Www.DaytonICUConsulting.com --- Support this podcast: https://anchor.fm/restoringlife/support

In deze aflevering heb ik Andrea Esmeijer te gast. Andrea is IC-verpleegkundige en heeft voor haar master critical care opleiding haar thesis geschreven over pijnstilling en -meting op de IC. Ze komt hier uitgebreid vertellen over alles omtrent deze belangrijke aspecten van de zorg en nog meer!We bespreken de volgende onderwerpen:Wat zijn de gevolgen van pijn voor de IC-patiënt?Hoe beoordeel je pijn bij een IC-patiënt?Waarom zijn veranderingen in vitale functies een slechte indicatie voor pijn bij de IC-patiënt?Wat is multi-modale pijnstilling?Welke vormen van pijnstilling zijn er?Is esketamine een wondermiddel?Wat zijn de verschillen tussen alle opiaten?Wat is een context-sensitieve halfwaarde tijd?Wat zijn de nadelen van opiaat toediening?Waarom kan je meer pijn krijgen door opiaten?Is continue opiaat toediening nodig op de IC?Wat zijn de tips en tricks van Andrea omtrent pijnbehandeling?Bronnen:https://pubmed.ncbi.nlm.nih.gov/31046402/ (paracetamol i.v. --> hypotensie)https://aacnjournals.org/aacnacconline/article/29/2/101/11/Ketamine-Use-in-the-Intensive-Care-Unit (Ketamine op de IC)https://pubmed.ncbi.nlm.nih.gov/30268528/ (Ketamine verlaagd delier?)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7723435/ (fentanyl induced cough)https://pubmed.ncbi.nlm.nih.gov/21412369/ (opiaat induced hyperalgesia)https://pubmed.ncbi.nlm.nih.gov/15983467/ (Ketamine verminderd opiaat geinduceerde hyperalgesie)https://pubmed.ncbi.nlm.nih.gov/26095487/ (fentanyl induced hyperalgesia)https://jtd.amegroups.com/article/view/64596/pdf (opiaatafhankelijkheid op de IC)https://pubmed.ncbi.nlm.nih.gov/21074739/ (PCA pomp + continue infusie)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3681375/ (switch van fentanyl i.v. naar methadon oraal)https://emcrit.org/pulmcrit/analgesic-ladder/https://emcrit.org/ibcc/pain/#opioidshttps://www.sccm.org/Clinical-Resources/ICULiberation-Home/ABCDEF-Bundles (ICU richtlijnen omtrent pijn/sedatie/delier)https://icconnect.nl/op-de-ic/wat-kun-je-verwachten/de-abcdefgh-bundel/ (ABCDEF bundel in NL)Bedankt voor het luisteren!Volg @intensiefdepodcast op InstagramVragen? intensiefdepodcast@gmail.com

ABCDEF...Gayle joins Smallzy at the MTV EMA's in Germany and spills on joining Taylor Swift on tour next year.See omnystudio.com/listener for privacy information.

For this podcast, we don't just have one but two guests. Returning to the show is Dr. Tara McMichael, an Internal Medicine Physician with Lakeview Clinic and Internist for Ridgeview, and Stacy Jepsen, a clinical nurse specialist with Ridgeview. During this podcast, Dr. McMichael and Stacy will be discussing Post Intensive Care Syndrome, also known as PICS. They will both bring unique perspectives from the initial critical illness and care in the ICU to the patient's outpatient visits and long term prognosis. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Define post intensive care syndrome (PICS) and post intensive care syndrome-family (PICS-F). Identify risk factors for devcelopment of PICS and PICS-F. Summarize prevention and treatment strategies for PICS and PICS-F Interpret the prevalence of PICS within the community. Utilize available resources to support patients/families with PICS symptoms. Describe how patients and their families can be supported who are struggling with PICS. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at  Education@ridgeviewmedical.org. To receive continuing education credit for this activity - click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker's outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES:  *See the attachment for additional information.  CLINICAL NURSE EDUCATOR- Advance practice RN who operates as an expert clinician, educator, researcher or consultant. - Masters or doctorate degree - Role had been around the US for over 60 years. POST INTENSIVE CARE SYNDROME (PICS)- New or worsening cognitive, psychological, physical limitation, post survival of critical illness and stay in ICU. - Post intensive care syndrome - family (PICS): family memvers who have mental limiations from the experience of having a loved on eiwth a critical illness. - First defined by Society of Critical Crea Medicine in 2010. - Remains difficult to diagnose for coding and reimbursement. ICD-10 code does not exsist. RISK FACTORS - critical illness with stay in ICU- Delirium- Sedataion during hostpital stay- Diagnosis of sepsis, ARDS, etc. DIAGNOSIS - Cognitive: short term memory loss, slow cognition, mental disorganization - Physical: changes in balance and gait - Psychological: anxiety, depression, insomnia, PTSD TESTING - no specific tests available for PICS          - MoCa           - Mini mental status           - PHQ9 (in setting of depression)           - GAD7 (in setting of anxiety) - two or more symptoms in any category - cognitive, physical and psychological 4-6 weeks post hspitalization. PREVALENCE - Of 5.8 ICU admissions, 4.8 million survive - Of the 4.8 million survivors, 50-80% will beet diagnostic criteria - COVID has brought PICS to forefront. PREVENTION- Prevention tips (multidisciplinary rounds, ABCDEF bundle, checklists for goals, support groups)- ABCDEF Bundle    A - Assess, precent and manage pain     B - Sedation reduction and vent weaning     C - Choice of analgesic and sedation      D - delirium prevention, recognition and treatment     E - Early mobility     F - Family BARRIERS - Communication, not true barrier, but requires effort PICS RESOURCES & TREATMENT - PICS clinics (pros & cons) - For primary care physician (it exists, dont; have to solve it one go; there are online resources available) - Addition PICS resources (listed in show notes). Thanks for listening.Please check out the additonal show notes for additional resources.

Traumatic brain injuries can have distinct exceptions that necessitate deep sedation and immobility. How then can we apply the ABCDEF bundle to protect injured brains and restore lives? Charlotte Davis, BSN, RN, CCRN and Richard Rivera, BSN, RN-BC share their expertise and their team's incredible success with the ABCDEF bundle in the settings of TBI. www.DaytonICUConsulting.com --- Support this podcast: https://anchor.fm/restoringlife/support

The trauma ICU has a variety of high-acuity and difficult conditions that can cause obstacles and hesitation to change sedation and mobility practices. How does the ABCDEF bundle apply to the trauma ICU? Dr. Gregory Schaefer joins us now to discuss his expertise and team's success in practicing the ABCDEF bundle in the trauma ICU. www.daytonicuconsulting.com --- Support this podcast: https://anchor.fm/restoringlife/support

A summary of the ABCDEF bundle - what are the components, how is it implemented and what are the impacts? Learning objectives for this talk: Introduction of SCCM's ICU liberation bundle Understanding of post intensive care syndrome (PICS) Review of the benefits of ICU liberation bundle implementation To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com

No episódio de hoje, Vinicius Zofoli, intensivista e editor do portal PEBMED, traz uma atualização sobre os principais paradigmas do delirium. São discitidas formas de realizar o diagnóstico, com o CAM-ICU; além de prevenir e tratar essa condição, com destaque para o bundle ABCDEF. Clique e confira o episódio!

Episode 105: The ABCDEF Bundle in the CVICU How does the ABCDEF bundle apply to the CVICU with a variety of diagnoses, acuities, and devices? Anna Dalton, DNP, ACANP, in an "Awake and Walking CVICU" shares with us the evolution their team has experienced in improving their mastery of the ABCDEF bundle. www.daytonICUConsulting.com --- Support this podcast: https://anchor.fm/restoringlife/support

FB粉專 影片 https://bit.ly/3aDJrbp YouTube 影片 https://bit.ly/3cdzy4A 本集主題：「華碩智慧醫療」新運用 訪問：賴政宇 Greg 經理 台灣其實是製造血糖機的大本營，國際大廠亞培（Abbott）、羅氏（Roche）、嬌生（Johnson & Johnson）等出品的血糖機其實超過半數都是台灣製造。同時別忘了台灣傲人的雙A電腦，台灣既是製造傳統硬體醫療器材的王國，也是推動全球ICT產業的寶島。當醫材遇上科技會有什麼火花，由經歷過各種醫療形態變化的智慧醫療經理人Greg來道出他的切身經驗。 1.科技防疫、遠距看診、行動醫療、智慧監測…，這些智慧醫療的專有名詞到底在說什麼呢？ 2. AI(人工智慧)、BigData(大數據)、Cloud(雲端)、Date(數據)、Edge Cmputing(邊緣運算)、5G(Fifth Generation)，這幾個科技領域中不斷出現的熱門ABCDEF關鍵字，又能替醫療帶出什麼新風貌？ 3. 自身從醫療器材製造到開發設計智慧醫療產品，最大且難以習慣的地方在哪？有什麼差異處 4. 台灣的智慧醫療的優勢及藍海在哪？我們有什麼不是全球都一樣的me too？華碩在智慧醫療上有什麼成果 5. 無論時代怎麼變化，醫療革命的目標永遠往同個方向前進：以使用者為中心，尊重個體化差異來提供最合適且獨特的醫療解決方案，未來的醫療正往精準醫療邁進 粉絲頁： ASUS #李基銘 #fb新鮮事#生活有意思#快樂玩童軍 #漢聲廣播電台 YouTube頻道，可以收看 https://goo.gl/IQXvzd podcast平台，可以收聽 SoundOn　https://bit.ly/3oXSlmF Spotify　https://spoti.fi/2TXxH7V Apple　https://apple.co/2I7NYVc Google　https://bit.ly/2GykvmH KKBOX　https://bit.ly/2JlI3wC Firstory　https://bit.ly/3lCHDPi 請支持六個粉絲頁 李基銘主持人粉絲頁：https://www.facebook.com/voh.lee 李基銘的影音頻道粉絲頁：https://www.facebook.com/voh.video Fb新鮮事新聞報粉絲頁：https://www.facebook.com/voh.fbnews LIVE直播-fb新鮮事：https://www.facebook.com/live.fbshow 漢聲廣播電台「fb新鮮事」節目粉絲頁：https://www.facebook.com/voh.vhbn 漢聲廣播電台「快樂玩童軍」節目粉絲頁：https://www.facebook.com/voh.scout

Episode 104: ICU Rehabilitation When ICU-acquired weakness is not preventable, or we encounter a patient that has not received the ABCDEF bundle, how can we start the rehabilitation process? What approach can one lone clinician use for initiating recovery or preventing ICU-acquired weakness? Physiotherapist, Lucy Sutton, shares with us incredible insight into ICU rehabilitation. www.daytonicuconsulting.com --- Support this podcast: https://anchor.fm/restoringlife/support

There are a series of common unrealistic expectations that lead to the ABCDEF's of negativity: Anger, Aggression, Blame, Betrayal, Criticism, Challenge, Despair, Depression, Exit, Escape, Frustration, Futility. Join Dr John Demartini for a deeper look into what these unrealistic expectations are. He'll show you how to identify unrealistic expectations, how to reveal the valuable feedback they provide for your life and the steps you can take to be sure your life expectations are balanced and realistic and lead you to a state of fulfilment, inspiration and appreciation. Turn the volatility of an ungoverned mind into the poise and presence of a governed mind so that you can experience true appreciation for the magnificence of life as it is. USEFUL LINKS: Free Masterclass | Balancing Emotions: https://demartini.fm/emotions (https://demartini.fm/emotions) Learn More About The Demartini Method: demartini.fm/demartinimethod Learn More About The Breakthrough Experience: demartini.fm/experience Determine Your Values: demartini.fm/knowyourvalues Claim Your Free Gift: demartini.fm/astro Join our Facebook community: demartini.ink/inspired

What does the ABCDEF bundle look like in neurocritical care? When patients suffer conditions such as intracranial hypertension that necessitate sedation and immobility, how does the ABCDEF bundle apply? Neurointensivist, Dr. Neha Dangayach, shares with us her team's strong ABCDEF culture and practices in the neuro ICU. @Drdangayach www.daytonicuconsulting.com --- Support this podcast: https://anchor.fm/restoringlife/support

Die Initianten gegen die Beschaffung des F-35 stellen sich grundsätzlich gegen neue Kampfjets. Aber vor allem während der aktuell herrschenden Diskussion sei angemerkt: Eine Initiative im Sammelstadium hat keine aufschiebende Wirkung. Bei einem bestehenden, positiven Volksentscheid erst recht nicht. Man stelle sich einmal vor, welchen Einfluss eine solche Androhung auf unser politisches Tun hätte.

How does ventilator-associated pneumonia occur? How does the failure to practice the ABCDEF bundle increase the risks of prolonged time on the ventilator and mortality? What do we know about the impact of early mobility on VAPs? Let's dive deep into what we know about VAPs and how to drive down the rates in our ICUs. www.daytonicuconsulting.com @Walkinghomefromtheicu --- Support this podcast: https://anchor.fm/restoringlife/support

What is the proven method to get patients off of the ventilator the quickest with the best short and long-term outcomes? Families should understand the ABCDEF bundle as the gold standard of care to prevent delirium and muscular atrophy in the ICU. Www.daytonicuconsulting.com @walkinghomefromtheicu

First episode of 2022 G4 talk, Celebrities who passed, MTG, Zoned out hosts.    Beacons.ai/angrywargamer

#70: Cher and Skeery dress up for Christmas and Skeery has a wardrobe malfunction; Cher has a problem with gift wrapping and Skeery takes the lazy way out; Cher & Skeery discuss the latest trends and cycles in popular music and how teen angst, sad songs, ballads, revenge, sorrow and negativity are ruling the charts

Fauci is looking for a definition change for "fully vaccinated." The BioNTech CEO himself has even said the upcoming Omicron variant vaccine “should be a 3-dose vaccine.” Just how many boosters will we have to get? Fauci has made the rounds on news outlets, as he loves to do, saying that the communal good supersedes individual choice. Jussie Smollett gets heated over the prosecutor not censoring what Smollett wrote in an Instagram message. Hillary Clinton cries as she reads her presidential acceptance speech that she could never give. Kamala Harris wants us to have healthy babies ... the babies we don't abort, at least. A new song is at the top of the charts. Hilary Kennedy drops in to talk about the Ghislaine Maxwell trial. Twitter has shut down one of the primary accounts for information on the trial. What is your favorite Christmas movie? There's more info on the civil asset forfeiture at Dallas Love Field. Joe Biden has always supported civil asset forfeitures. Mayor Lori Lightfoot wants to know why shop owners are not policing crime in their stores. Learn more about your ad choices. Visit megaphone.fm/adchoices

Η μηνιαία μας ανασκόπηση για τον Οκτώβριο του 2021 είναι πραγματικότητα. Απολαύστε την υπεύθυνα. _ Το SimplerMinds είναι ένα ελληνικό podcast με συζητήσεις εμβρυακού επιπέδου που όμως εκμαιεύουν μεγάλες αλήθειες... simplerminds.gr _ ΑΚΟΛΟΥΘΗΣΤΕ στα Social Media: Facebook Instagram _ ΔΕΙΤΕ μας στο youtube: SimplerMinds Youtube Channel _ ΑΚΟΥΣΕ το Podcast εδω: Spotify Apple Podcasts Google Podcasts Anchor Pocket Casts Radio Public Stitcher   Contact: thesimplerminds@gmail.com

Si te llamas ABCDEF, escucha esta noticia loca. --- Send in a voice message: https://anchor.fm/exa-fm-ecuador/message

Think about it: what good is your computer without the keyboard? Just an overpriced hunk of plastics and metals? Let's look at that oh-so-important keyboard a little closer. When and how was it invented? Why do you get doubles of some of the keys and not others? And, by the way, why does the keyboard layout start with QWERTY and not with ABCDEF? Well, at the very beginning of the computer era, you wouldn't recognize the early models since computers back then used punched cards to input and output data. An early computer programmer needed so many punch cards, it ended up looking like a deck of playing cards! But as computers got more sophisticated, the keyboard needed a lot more keys than just numbers and letters. In the 1980s, IBM took a scientific approach to come up with the perfect keyboard – they arranged a focus group! Learn more about your ad choices. Visit megaphone.fm/adchoices

A few spontaneous tunes

Quote: “If you believe it will work out, you'll see opportunities. If you believe it won't, you will see obstacles.” – Wayne Dyer was an American self-help and spiritual author and a motivational speaker.

今日【平評理】 ABCDEF等著輪流限電，戳破民進黨從2016喊到2021的不缺電笑話，幾天內累計確診數超過之前一年半的死亡交叉，3+11的破口長驅直入從沒廣篩的社區，唯一的救命稻草只剩充足的疫苗！

ICU Liberation (ABCDEF) Bundle Special Guest: Joanna Stollings, PharmD, FCCM, BCPS, BCCCP   Show Notes: https://pharmacytodose.files.wordpress.com/2021/04/icu-liberation-bundle-show-notes.pdf   Reference List: https://pharmacytodose.files.wordpress.com/2021/04/icu-liberation-bundle-references.pdf   03:48 – What is the ABCDEF bundle?; 08:35 – Barriers to bundle implementation; 12:14 – Excluding patients; 14:18 – A: Assessing/preventing/treating pain; 20:27 – B: Spontaneous awakening/breathing trials; 26:27 – C: Choice of sedation; 38:40 – D: Assessing/prevention/treating delirium; 42:09 – E: Early mobility/exercise; 45:40 – F: Family engagement and involvement; 49:16 – Importance of multidisciplinary involvement; 52:58 – Bundle implementation with COVID-19; 60:21 – Advice for those looking to implement the ICU Liberation Bundle; 64:30 – Pharmacist’s role in successful bundle implementation   PharmacyToDose.Com @PharmacyToDose on Twitter PharmacyToDose@Gmail.com  

Vous voyez les ordis ? Certains sont pas mal, je sais. Mais vous voyez les premières touches là… ? A.Z.E.R.T.Y.U.I.O.P… Que s'est il passé dans la tête de celui qui a créé cette norme de clavier. Pourquoi il n'a pas fait ABCDEF ? Un truc normal quoi ? En gros, pourquoi nous avons des claviers AZERTY ?Cet épisode de Mourir Moins Con vous est proposé par les ordinateurs Dell XPS.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Quer me contratar para ser seu treinador? Acesse: http://www.leandrotwin.com.br/​ Baixe meu E-book gratuíto: "Abdomen Definido: Como Chegar lá" = http://bit.ly/abdomendefinidoebook​ Instagram: @leandrotwin Youtube: https://www.youtube.com/c/LeandroTwin Growth Supplements: http://www.gsuplementos.com.br/​ Atenção: As mensagens contidas em todos os vídeos de LeandroTwin não possuem o objetivo de substituir orientação de um profissional (independente da sua área de atuação). O vídeo é informativo. Qualquer rotina iniciada por conta própria é de responsabilidade do próprio.

Quer me contratar para ser seu treinador? Acesse: http://www.leandrotwin.com.br/​ Baixe meu E-book gratuíto: "Abdomen Definido: Como Chegar lá" = http://bit.ly/abdomendefinidoebook​ Instagram: @leandrotwin Youtube: https://www.youtube.com/c/LeandroTwin Growth Supplements: http://www.gsuplementos.com.br/​ Atenção: As mensagens contidas em todos os vídeos de LeandroTwin não possuem o objetivo de substituir orientação de um profissional (independente da sua área de atuação). O vídeo é informativo. Qualquer rotina iniciada por conta própria é de responsabilidade do próprio.

Kerry McDonald shares her optimistic view of education and education innovation along with her insights about the remote learning situation many parents currently face during the pandemic. Kerry defines “Unschooling” - the idea taught in her book “Unschooled: Raising Curious, Well-Educated Children Outside the Conventional Classroom” and gives evidence based advice and hope to parents seeking a better way to educate their children. This episode is a great reflection on what education really is and how it should be approached.  Highlighted Quotes “Opportunity in Education Entrepreneurship”   We're seeing tremendous growth in all aspects of the economy in terms of entrepreneurship, of course that's not offsetting the vast number of businesses that have been shut down due to government orders, but it is a hopeful sign that entrepreneurship is alive and well and I think, again, education entrepreneurship is ripe for more opportunities and more innovators to create some really wonderful options for families. “Defining Unschooling” “Unschooling” is really disentangling education from schooling and seeing schooling as one method to being educated sort of top down, course of type learning where you know here are your daily assignments here are your tests and quizzes here's your ABCDEF grade, and yet learning is so much broader and again more enriching than that experience. Also unschooling doesn't mean that you're not taking classes, it doesn't mean that you're not doing what we would consider school like activities. It just means that it's a less coercive experience and it's more driven by the child's interest. “Parents” Parents are the ones, ultimately responsible for making sure their children are highly literate and numerous highly educated, and I argue that that's true whether your children are homeschooled or in a conventional school that it's up to the parents to make sure your children are getting a high quality education that it's your responsibility as a parent to do that. Resources/Mentions: Book Unschooled: Raising Curious, Well-Educated Children Outside the Conventional Classroom Why I Love Homeschooling  Company Expanse Learning   Expanse(Linkedin)  Organization FEE.org Guest Links: Kerry - Linkedin Kerry Mcdonald Website (Fee.Org) Kerry's Forbes Articles  Kerry - Facebook Kerry - Instagram  Kerry - Twitter  Podcast Links: Instagram: @Hopestrategy  Facebook: @hopestrategy  Twitter: @thehopestrategy Youtube The Hope Strategy   

La mobilisation précoce fait partie des recommandations ABCDEF. Mais, mobilisez-vous précocement dans vos soins intensifs ? Mathieu discute avec Grégoire Marois sur la mobilisation précoce aux soins intensifs dans ce 16e épisode de FrancoFOAM ! Les notes de l'épisodes sont disponibles à https://francofoam.com/balado/episode-16-mobilisation-soins-intensifs/ Suivez-nous sur Twitter https://twitter.com/Francofoam1 Suivez-nous sur Facebook https://fr-fr.facebook.com/francofoam/ Écrivez-nous @ info@francofoam.com Visitez-nous sur https://francofoam.com/

In this episode, we discuss the ABCDEF bundle, a tool used to promote evidence-based care that promotes healing and liberation from critical illness for patients in the ICU. Our guest is Dr. Julia Barr who is currently the Associate Professor of Anesthesia in the Medical Center Line at Stanford Medical School and a staff anesthesiologist and intensivist at the VA Palo Alto Medical Center. Dr. Barr has served as a national faculty member for the SCCM ICU Liberation Campaign ABCDEF Bundle Collaborative and is a member of the SCCM’s ICU Liberation Committee. Additional Resources: Society of Critical Care Medicine’s guidelines on management of pain, agitation and delirium: http://www.sccm.org/Research/Guidelines/Guidelines/Pain,-Agitation,-and-Delirium-in-Adult-Patients-in Society of Critical Care Medicine’s guidelines for Family-Centered Care in the ICU: http://www.sccm.org/Research/Guidelines/Guidelines/Family-Centered-Care-in-the-ICU Books Mentioned in This Episode: The Power of Habit: Why We Do What We Do in Life and Business: https://www.amazon.com/Power-Habit-What-Life-Business-ebook/dp/B0055PGUYU/ref=sr_1_2?ie=UTF8&qid=1530020419&sr=8-2&keywords=the+power+of+habit

There is no magic bullet that will reduce the mortality rate of the ARDS patients. It is the early and consistent applications of evidence-based supportive therapies that results in improve short and long-term outcomes. Understanding the ARDS Berlin definition that differentiates the syndrome based on severity of hypoxemia to be mild, moderate or severe, helps the experienced nurse target the correct supportive care. Our knowledge of the diffuse injury to the alveoli and capillary membranes caused by inflammatory mediators and ventilator-induced injury helps for greater understanding of the clinical signs/symptoms and why certain therapies support the ARDS patient better. Due to the complexity of the patient, it is critical that the skilled frontline nurse have a user-friendly structure (8 P’s) to trigger implementation of evidence based care practices. The goal is to PREVENT further injury of the lung, reduce ventilator-associated events and physical and cognitive decline. The team must utilize evidence-based ventilator strategies (PEEP) while ensuring adequate volume for the heart to work at maximum efficiency (PUMPS & PIPES) to help deliver oxygen to the tissue. The critical care nurse plays a key role in minimizing oxygen demand and balancing brain recovery through appropriate use of sedation and paralytic agents (PARALYSIS). The timing and implementation of the prone position (POSITIONING) can determine its effectiveness on oxygenation and prevention of lung injury.  Once prone position is no longer useful, early progressive is critical to improve long-term cognitive and functional ability. Appropriate nutrition (PROTIEN) to promote healing and reduce inflammation is an essential component of the care plan. Incorporating evidence based (Protocols) such as the ABCDEF can impact overall outcomes in the ICU patient.  It takes all our knowledge and skill to ensure the ARDS patient not only survives but is able to return to a meaningful life as soon as possible.  

In this episode, Dr. Vincent DeLeo talks to Dr. Shari Lipner about nail education gaps in the American Academy of Dermatology Basic Dermatology Curriculum. Although the curriculum is designed to introduce medical students to essential concepts in dermatology, nail-related topics such as diagnostic techniques, biopsy procedures, and skin cancers of the nail unit are inadequately covered. Dr. Lipner discusses strategies to close these gaps and improve nail education for medical students and dermatology residents. She also breaks down the mnemonic for identifying nail melanomas. We also bring you the latest in dermatology news and research: 1. Gentamicin restores wound healing in hereditary epidermolysis bullosa. 2. Measles complications in the U.S. unchanged in posteradication era. 3. Dr. Adam Friedman outlines oral treatment options for hyperhidrosis. Things you will learn in this episode:  A thorough full-body skin examination should include the skin, hair, and scalp, as well as the nails. Even while the patient is initially speaking, pay attention to the nails. Many dermatology residents and attendings are not familiar with the ABCDEF nail melanoma mnemonic, which is more complex than the mnemonic for cutaneous melanoma. There is a gap in educating dermatology residents on nail biopsies and surgical procedures. Nail education can be improved by encouraging medical students and residents to be aware of the nails, get comfortable with the nails, and incorporate nails into the didactics during medical school and training. More lectures at national and local conferences and hands-on learning also are helpful. “By understanding nails, both diagnosis and management, potentially we can improve patients' quality of life, and it can also be lifesaving in the case of malignancies.” Hosts: Elizabeth Mechcatie; Terry Rudd; Vincent A. DeLeo, MD (Keck School of Medicine of University of Southern California, Los Angeles)  Guest: Shari R. Lipner, MD, PhD (Weill Cornell Medicine, New York, New York)  Show notes by Alicia Sonners, Melissa Sears, and Elizabeth Mechcatie. Contact us: podcasts@mdedge.com Twitter: @MDedgeDerm Rate us on iTunes!

You can never really start over too many times, though it's pretty important to do it right. So let's go through my self made ABCDEF's to resetting, together and hopefully we can do better.

ICU delirium is a state of agitation or confusion that can affect as many as 80 percent of patients who are admitted to the intensive care unit. Dr. Matthew Schreiber explains this condition and how we reduce the risk for our patients.   TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine. Host: Thanks for joining us today. We’re talking to Dr. Matthew Schreiber, associate director of the Medical ICU and an attending physician in Pulmonary Disease/Critical Care Medicine at MedStar Washington Hospital Center.  Welcome, Dr. Schreiber. Dr. Matthew Schreiber: Thank you for having me. Host: Today we’re talking about ICU delirium, a sudden and intense confusion that can include hallucinations, delusions, and paranoia. So, Dr. Schreiber, what can cause ICU delirium? Dr. Schreiber: What can cause it is really the focus of a lot of research right now and the list of things is very, very long. We know that medications have an association with delirium.  Some of the things that historically have been used in the ICU to help treat a patient also have risks that are now being identified, like delirium.  Additionally, the ICU as an environment itself can lend to having delirium because imagine in your normal job, or your normal life, with a newborn child or something else, if you become sleep deprived, the next day you’re a little bit foggy and a little bit less focused, and imagine dealing with night after night of a twenty-four-hour lights on, beeping environment where things are happening because they need to happen to treat somebody. After days of that, it also impacts a patient’s mental status and can lead to delirium.  On top of that, delirium is really a very specific disease.  It’s not dementia, it’s not pain, it’s not agitation -- those things might look really similar, but what delirium is, is it’s an end organ failure, meaning the brain, in response to other things going on.  And we don’t have a model to say A causes B, but we know delirium happens based on a diagnostic criteria—a series of questions and kind of a test, if you will, to say if someone’s delirious or not. But we can’t necessarily chalk it up to ‘if we could just do this one thing we’d be able to get rid of it.’  It’s a…it’s a sign of a disease, but it is its own condition and its own disease and its own thing on its own. Host: That’s fascinating. So, the brain can actually die from overstimulation? Dr. Schreiber: It’s interesting that you put it that way, ‘cause that’s somewhat of what’s being shown in some research.  If you parallel this to something like sepsis. Sepsis is the whole body responding to an infection in one place.  So, lots of people get urinary tract infections, but some people, their body’s inflammation and that’s the body’s response to it, they end up septic from that same urinary tract infection.  The brain sees all the same blood as everywhere else in the body, so even though somebody might have low blood pressure or troubles breathing because of an infection down in their lower extremities or again, that urine, the lungs were an innocent victim. Here the brain is an innocent victim to whatever the illness is because of all the things circulating around in the body causing end organ damage.  To come back to what you said about the brain dying, there actually are some studies coming out of Vanderbilt where they’ve done MRIs on people who were diagnosed as having delirium during an ICU stay. Six months later the brain actually looks different when compared to people who were just as sick but for whatever reason their body didn’t end up having delirium, so something physical is happening there. Host: So, we’re talking visual, and auditory and physiological symptoms. What would be some of the indications that a person has delirium as opposed to another condition? Dr. Schreiber: So, it’s important to point out that those kinds of things you brought up are what a lot of people think of when they think of delirium, but delirium really is more nuanced than that.  It’s got a couple of clinical tests that can be done at the bed side to help make the diagnosis, but they’re all consistent in what they are.  Delirium is a condition that waxes and wanes, meaning it comes and goes.  Dementia is something that comes on and gradually happens over years and doesn’t necessarily just get better.  Delirium is something that can be there at 6 AM, and gone at noon and back again at 7 PM and gone at 2 AM and so the ongoing fluctuations like that are a key component. The second part is inattention.  The patient just can’t maintain focus.  And so, we test that by seeing if they can just do something that we’re asking them to do, uh, ten times.  You know, some of them being in the affirmative, meaning do it, and some of them not, meaning we say something and they’re not supposed to do it, but if they can’t maintain focus for those, that’s inattention, and that’s the second component. And the last part is disorganized thinking.  You might just call it confusion.  But the way that we test for this when it comes to disorganized thinking is we ask questions to a patient that really should have no question of what’s right and wrong. Things like, is ice cream cold? Is a mouse bigger than a giraffe?  Can you hit a nail with a hammer?  And when somebody has delirium, questions like that still become difficult for them to answer even though they sound like something anyone should be able to get right. Really, it’s hard to tell without actually doing the test.  There are people who can be completely oriented, can tell you the date, where they are, their name and be delirious.  And there are people who can be disoriented or have dementia or have changes in their ability to respond because of a stroke and not be delirious.  So, it really does come back to those key things of waxing and waning mental status, so it’s changing throughout the day, inattention, and disorganized thinking. Host: So, it sounds like different populations of people, different conditions for which they’re hospitalized in the ICU, can cause varying levels of delirium symptoms.  Is there a particular risk factor an individual might have that would make, say me as opposed to you, more susceptible? Dr. Schreiber: That has been shown. So, the older a person gets, the more likely they are to have delirium. The more ill the person is when they first come into the hospital, the more likely they are to have delirium. People that have a history of dependencies on different chemical substances, whether it’s things like alcohol or illicit drugs or even prescription medications, are more likely to have delirium. Whether if any one of those things is the absolute risk or not, hard to say. But it’s something we really should be looking for in every patient.  It’s also important to say this is not just an ICU thing.  It’s where a lot of it happens, in fact eight out of 10 people who end up on a breathing machine will have delirium at some point in their hospital stay. But half the people who never end up on a breathing machine can still be that way, and even just regular admissions to the hospital, what we call the medical/surgical floors or wards—up to a quarter of those people will have delirium during their stay, at some point. Host: So, this is a fairly common thing.  How many cases would you estimate that you see at MedStar Washington Hospital Center in a year? Dr. Schreiber: Hundreds. I think the better way to put it is how many people every day do we see having delirium?  We…we make it part of our rounds.  It’s something that the nurses do every single shift, is do a test - we call it a Cam ICU, confusion and agitation method in the ICU, to look at that series of questions. Has their mental status changed? We ask people, to basically squeeze my hand or blink your eyes or stick out your tongue.  Whatever they can do when I say the letter A, and then I spell out ‘save a heart,’ and heart is spelled wrong, it’s s a v e  a  h a a r t, and if they get more than two of those wrong, then we move on to disorganized thinking and ask them those simple yes, no questions, and can they follow a command. And if they can’t follow two separate commands and answer questions without more than two errors altogether, that’s delirium.  We check every patient in the ICU every single day, and when we find it, then that can actually change our plan of care.  Do we need to be more aggressive getting rid of a sedative?  Do we need to change that to something else, even if it, you know, we’re not sure it’s going to be as effective to help maintain a level of comfort. Or, is it a sign that something’s going wrong?  You know, when a patient’s in the hospital and has a fever, everyone says “oh, we need to figure out why that patient has a fever.”  If someone was normal yesterday and delirious today, that’s another sign that the brain is raising a red flag maybe something’s going on and that might be the first sign of an infection or a complication. Host: Is this something that patients have ever brought up in themselves and say, you know, “doctor, I just don’t feel right?” Or is this something that family members can also watch out for? Or caregivers? What’s their role? Dr. Schreiber: The patient’s usually not aware because it’s affecting their brain and so that level of noticing ‘hey, I’m different’ is one of the risk factors of the condition.  Family see it, they just not necessarily know what to call it. Why is my loved one not themselves?  Why did they act like they didn’t know who I was?  And the worry is, is this dementia? Is this permanent? Is—have they had a stroke? Is there something going on?  Is it any number of things?  They don’t necessarily come up and say, ‘I think my loved one’s delirious.’  But when we get those kind of questions, like ‘she was talking out of her mind this morning’ or ‘she couldn’t remember something I said to her fifteen minutes ago’ or something like that, those are red flags to that disorganized thinking. Host: Is there anything that a patient or a family member can do to decrease the risk for delirium? Dr. Schreiber: Absolutely. Being a familiar face, being able to redirect, being able to anchor that patient in what’s going on and help them stay focused, has been shown to help.  Having things like the whiteboards in our rooms that have today’s date and today’s nurse and today’s information, help reorient the patient.  Having things on the television in the room that have current, redirecting kind of issues.  Not necessarily dramatic things you might see on the news, but things that let people know of what’s going on now have been shown to help. And also, letting people get the rest they need.  You know, we do have an open ICU that allows visiting hours around the clock. But our goal is to let patients sleep at night and stay awake during the day. During the day, we try to be aggressive with pushing things forward as much as the patient can do and so family members can help by being encouraging for that. Helping keep the patient’s spirits up and when the patient’s saying things like “I just don’t know if I can do physical therapy today,” to ask them, “Are you sure?  How about a little, but can we help you?  Can we cheer you on?” You know, this is really gonna help you out by staying purposeful and active and moving forward because early mobilization and activity’s also been shown to reduce delirium. Host: Interesting. So, walking or getting up and participating in PT? Dr. Schreiber: Absolutely, and not just with the physical therapist. One of the things that we’ve been doing here for almost two years now in the medical ICUs is rolling out a bundle of things to help control, manage, and prevent delirium. This is called the ABCDEF bundle. It stands for assessing and addressing pain, because that’s important. When a patient is ‘quote un quote’ agitated, maybe it’s because they’re hurting, and if we can control that pain syndrome instead of just using something like a sedative, or an antipsychotic or something to calm them down, you might actually get two birds with that one stone, and reduce their risk, and help that issue. The B is for both the spontaneous awakening and breathing trial. So, people that are on a vent—mechanical ventilation, a breathing machine for life support - to every single day see, can they breathe on their own?  And, if they’re really sick, they’re going to declare that they can’t because they’ll breathe fast, and you can tell within a minute. But maybe they can, because if they can breathe on their own on that machine with some settings being changed, maybe they’re ready for that to come off and you get rid of another risk factor for delirium. The awakening trial is not just saying, let’s turn down any pain or sedative medications to see where we can get the patient awake and comfortable, but literally every single day to push stop on those machines and see if the patient needs it.  That’s been studied, and by always trying to adjust to just enough for the patient what they need was considered standard of care. By doing that but also once a day pushing pause on the machines, cut the number of days of continuous medications like that, cut the number of days on the vent, shortened the ICU stay, and did nothing to raise mortality or patient harm, and so the fear of ‘Well, I can’t push stop on this medicines that going through this IV pump, the patient will hurt themselves,’ never has actually been shown. In fact, continuing it longer seems to be what hurts people. The C is the choice in those medications.  Things called benzodiazepines.  At home, people might know this as Xanax, is one of those examples. Ativan is another example. That family of medicines has the most research behind it to lead to delirium than anything else we know. In fact, one study showed a direct relationship of the dose that you get of medicines in this family to having delirium within a day, and it doesn’t seem like much but relatively low doses ended up having a hundred percent of people having delirium that day, so we try to avoid those whenever we can.  Sometimes they’re needed. We use benzodiazepines when someone is seizing. We use them when someone’s in alcohol withdrawal.  But, a lot of times you can find something else.  The D is for delirium. To check it, because if you don’t look for it, you’re not going to find it. And that’s that test we call a Cam ICU.  The E is early mobilization activity, which might be physical therapy, but our nurses are fantastic. You know, we can sit somebody on the edge of the bed, let them use those core muscles to dangle their feet. We can move people to a chair because the sitting position uses different muscles than laying in bed, and we walk people. And we walk people.  You know, we get a physical therapist, a nurse, another nurse to help, if needed, and even if someone is still on a ventilator, still on a breathing machine, still on life support, we can walk them in the unit if they’re able, but we won’t know if we don’t check to see what they can do. And the F is family engagement and involvement.  Because it is important for family members to help us help that patient in a way that we can’t. As much as I might like my patients, I will never be that familiar face that they’ve known for years and years and years, at least I hope that I’m never that face. And that’s something we can’t reproduce. And so, we do try to invite families to rounds every day. If they can’t be there, we try to call them every day, and we really do try to encourage that engagement with the patient to help them move along. Host: Is there a risk for untreated delirium, or if somebody has it, can it resolve on its own? Dr. Schreiber: Most of the time patients, as they get better clinically, as whatever got them sick in the first place gets better, they’ll start to improve.  There are long term risks here though.  Being delirious on its own, even when you, what we call, adjust for other things, meaning you’re doing statistics to say how much does this cause that or associate with that, and you say ‘well, I’m going to take two people who are just as sick and one’s delirious and one’s not, how does, how does this outcome change,’ delirium’s been shown to increase mortality at six months. If it’s its own process being on its own, it’s more likely to kill you, which is why it’s so important to try to prevent it with those other things like getting out of bed, and less days on the vent and less sedation.  I mentioned the MRI studies a little bit earlier, that there’s something physically different happening in the brain and so, long term, patients that have had delirium tend to have more cognitive issues and functional issues and it can be something simple like more often saying ‘I was going to tell you something. I just can’t remember what that was’, but it can be life changing if now they can’t go back to work.  And icudelirium.org is a fantastic website for both patients and practicing clinicians and family members and everyone else to see testimonials from patients and caregivers and hospital professionals all talking about the long-term outcomes of this condition. It can be life altering and the worst part is, if no one was ever able to say ‘hey, you had this while you’re in the hospital’ because there are plenty of places that don’t check for it every day. Even in our institution, I can’t tell you that every single unit, every single nurse, every single day, checks for this. Then they go home and wonder ‘why am I different?’  And we have a long way to go to help support people at the back end of their illness, at the back end of the ICU after they’ve left, to try to give them every opportunity to get back to being themselves. Host: That’s really a lovely statement, I think, because yeah, I mean it’s traumatic enough being in the hospital, let alone being in the ICU after a traumatic event.  Is there a certain subset, say accident victims or surgery, you know, people that had complications with surgery, that you see delirium in more often or a certain age group? Dr. Schreiber: The older you are, the more likely you are to become delirious.  As far as the disease itself, I think the literature is just not there yet from the research.  It has been shown in burn ICUs, cardiac ICUs, surgical ICUs, medical ICUs, it doesn’t discriminate.  What we do know is it happens far more often if you are on a breathing machine, and that’s probably a mix of both - that means you’re sicker because if you’re on a form of life support to help you breathe, that’s pretty bad.  But also, what does oxygen do to you and your brain?  If you’ve ever been unfortunate enough to have a family member in a neonatal ICU or if you’ve ever worked near one of those, you know that they, as…as early and aggressively as possible, try to have that baby off of oxygen because of how it can affect your eyes and other things.  We always try to use it as little as possible but it has things that cause inflammation, it’s one of the effects, so could the vent itself do some of this?  We don’t know. The research isn’t there yet.  People who are septic -  there’s some studies that say there might be more delirium in that because of the way the whole body can become inflamed, including the brain, when the body is dealing with an infection and becoming septic.  But if there is one disease to do it, I don’t think we have that answer yet. Host: Have you ever seen a very severe case of delirium turn around and what was that process like? Dr. Schreiber: I have. I, I can distinctly remember a patient who, you’d walk past the room and looked like a normal guy.  Sitting in the chair awake, watching tv, and then you’d talk to him, and you’d hear from the nurse, ‘Well, overnight we had to, you know, give him something because he was agitated, or we had to calm him down,’ you know, even if it wasn’t with the medicines. So, right there you have waxing and waning mental status. And then you’d ask questions and he would give answers that just seemed a little off, and so you’d take the next step and ask him to squeeze your fingers when you say the letter a for all those letters, and get that wrong, and then ask him these disorganized think questions and get that wrong. And then something would come out and he, he was scared because that’s what he saw and that’s what he believed was going on, and you would never know this if you didn’t ask the right questions because he would talk to you like everything’s fine, until you got into what he was perceiving and seeing. And, you know, he acted like he was actually handling it ok, and it’s not a big deal but then you realize he’s delirious and that visual hallucination was one of the things his delirium was manifesting. He ended up doing well.  He left the hospital. I saw him in the clinic months later and he was trying to go back to work.  He ran his own business and said he was having some trouble doing the books, so to speak, but for as close as he came to death with what brought him in, it was a remarkable improvement, just not all the way to as good as you wish you could get if you survived a life-threatening illness. Host: Thank you for joining us today, Dr. Schreiber. Dr. Schreiber: Oh, it’s been my pleasure! Thank you. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

Do you spend time finding out what the “why” is for your patient? Have you considered it’s not what is the matter with the patient but what matters to the patient? What the patient thinks their purpose is? Or at the very least, what they wish for during the next part of life, however short that may be? In this episode American intensivist, Dr Wes Ely, tells us how he deeply cares about the whole patient – the body, the mind and the spirit. He is passionate about really getting to know his patients. And to do that he thinks we need to be heavily focused on both ICU liberation and good listening. The ICU liberation bit sounds easy. It's removing the patient from the sedatives, the ventilator and whatever other harmful interventions are no longer needed when their situation is improving. But it's harder than we think. And to help with this, he has led the development of the ABCDEF bundle. With the assistance of many colleagues, and based on high quality science, he has progressively developed a simple 6 factor approach that has been shown to speed up ICU liberation and improve patient outcomes. And in this podcast he describes how he uses it, and how you can too. Listening to our patients also sounds easy. But how many of us spend the time required, and really be there for that person with grace and humility, so we can truly find out what matters to them, and respect their spiritual faith. Wes will be well known to many of you. He is a Pulmonary and Critical Care specialist who conducts patient-oriented, health services research as a Professor of Medicine in the Division of Allergy, Pulmonary, and Critical Care Medicine at Vanderbilt University School of Medicine, in Tennessee, USA. He is also a practicing intensivist with a focus on Geriatric ICU Care, as the Associate Director for Research for the VA Tennessee Valley Geriatric Research and Education Clinical Center. His research has focused on improving the care and outcomes of critically ill patients with ICU-acquired brain disease. Wes has built the ICU Delirium and Cognitive Impairment Study Group and his team have developed the primary tool by which delirium and health-related quality of life outcomes are measured, the CAM-ICU. He has over 350 peer-reviewed publications and over 50 published book chapters and editorials. In this conversation, Wes and I cover many other topics including: How he chose medicine after observing family illness as he grew up The enjoyment he receives from holding the hands of and looking into the eyes of patients How good doctors are not distracted by technology A Wall St journal and a CNN.com article he has penned which display his ability to find out what really mattered to 2 of his patients The importance of reading - and the 3 types of reading we should do How his ICU ward round is patient-centric and heavily nurse-focused The need to understand our unconscious biases and to have humility The concept of becoming the best version of our selves That life balance requires exercise, sleep and healthy eating His passion for triathlons, including the ironman How he balances family and work How his spiritual faith helps him to minimize stress His understanding that there is something bigger than us happening around us How burnout is simply an imbalance in the fundamentals of life The Nietzsche quote “He who has a why to live can bear any how” His appreciation of the work of the 3 Wishes Project (links below) What happened when he read the Jabberwocky poem (link below) to one of his patients His advice that young clinicians should be patient and truthful What the mnemonic DR-DRE means to him My genuine hope with the Mastering Intensive Care podcast is to inspire and empower you to bring your best self to the ICU by listening to the perspectives of such thought-provoking guests as Wes Ely. I passionately believe we can all get better, both as carers and as people, so we can do our absolute best for those patients whose lives are truly in our hands. Please help me to spread the message by simply emailing your colleagues, posting on social media or subscribing, rating and reviewing the podcast. If you wish to connect, leave a comment on the Facebook “mastering intensive care” page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at andrew@masteringintensivecare.com. Wes Ely is a genuine leader of our specialty and is a wise, philosophical and compassionate doctor with a refreshing spiritual perspective. Please enjoy listening to the podcast. Andrew Davies   -------------------- Show notes (people, organisations, resources and links mentioned in the episode): Wall St journal article about bringing a swimming pool to the ICU: https://www.wsj.com/articles/a-swimming-pool-in-the-icu-1466117000 This article was published in the medical literature too: https://link.springer.com/article/10.1007/s00134-016-4434-0 CNN.com article about patient Paul: https://edition.cnn.com/2018/03/20/opinions/caregiving-what-its-like-to-be-me-wes-ely-opinion/index.html The ABCDEF bundle: http://www.iculiberation.org/Bundles/Pages/default.aspx Lancet article on an RCT of no sedation: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)62072-9/abstract New England Journal of Medicine article on RCT of daily interruption of sedative infusions: https://www.ncbi.nlm.nih.gov/pubmed/10816184 New England Journal of Medicine article on RCT of spontaneous breathing: https://www.ncbi.nlm.nih.gov/pubmed/8948561 Lancet article on Awakening and Breathing Controlled RCT: https://www.ncbi.nlm.nih.gov/pubmed/18191684 Lancet article on RCT of early physical and occupational therapy: https://www.ncbi.nlm.nih.gov/pubmed/19446324 Critical Care Medicine article about the ABCDEF bundle: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5830123/ Critical Care Medicine article about a single-centre ABCDE bundle trial: https://www.ncbi.nlm.nih.gov/pubmed/24394627 Critical Care Medicine article about a multi-centre ABCDEF bundle trial: https://www.ncbi.nlm.nih.gov/pubmed/27861180 William Osler: https://en.wikipedia.org/wiki/William_Osler Dalai Lama: https://www.dalailama.com/ Matthew Kelly: http://www.matthewkelly.com/ Fulton Sheen: https://www.fultonsheen.com/ David Bennett: https://www.rushu.rush.edu/faculty/david-bennett-md The Merton prayer: https://reflections.yale.edu/article/seize-day-vocation-calling-work/merton-prayer Friedrich Nietzsche: https://en.wikipedia.org/wiki/Friedrich_Nietzsche Viktor Frankl: https://en.wikipedia.org/wiki/Viktor_Frankl Annals of Internal Medicine article on the 3 Wishes Project: https://www.ncbi.nlm.nih.gov/pubmed/26167721 Another article on the 3 Wishes Project: https://www.ncbi.nlm.nih.gov/pubmed/27525361 Poem “Jabberwocky” by Lewis Carroll: https://www.poets.org/poetsorg/poem/jabberwocky Mother Teresa: http://www.motherteresa.org/index.html Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com Mastering Intensive Care page on Facebook: https://www.facebook.com/masteringintensivecare Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care Twitter handle for Andrew Davies: @andrewdavies66 Instagram handle for Andrew Davies: @andrewdavies66 Email Andrew Davies: andrew@masteringintensivecare.com

Entrada I. ABCDEF Relectura del fotógrafo David Hornback David Hornback (Los Angeles, 1962) es ganador del Pulitzer en 1990 con sus compañeros de redacción del San Jose Mercury News por el reportaje del terremoto “Loma Prieta”, San Francisco. Como reportero gráfico ha trabajado para National Geographic, GEO, Time, New York Times y Stern entre otros medios gráficos. Sus trabajos le han llevado por cuatro continentes cubriendo la caída del muro de Berlín, la Exposición Universal de Sevilla de 1992 y el 60 aniversario del Desembarco de Normandía. Bajo el título de "Ficción, crítica cultural y feminismo" abordaremos desde diferentes perspectivas la crítica cultural y los feminismos a través de la novela experimental "Yo veo / Tú significas” (consonni, 2016) de la reconocida escritora, crítica cultural y activista feminista Lucy R. Lippard que estará presente a través de una entrevista en video. Será una oportunidad para disfrutar de nuevas piezas musicales, escénicas y sonoras creadas para la ocasión reintrepretando capítulos del libro. Una lectura colectiva de la novela desde distintas miradas. Para ello contaremos con la música Mursego, las artistas Mabi Revuelta (con la colaboración de Matxalen de Pedro y Otto Castro), Elena Aitzkoa y Macarena Recuerda Shepherd junto con la bailarina y coreógrafa Idurre Azkue, el performer y crítico de danza Jaime Conde Salazar, el crítico de arte Peio Aguirre, el DJ Oleaktiff, las escritoras Silvia Nanclares y Kattalin Miner, la arquitecta Oihane Ruíz (con la colaboración de Maria Arnal y Marcel Bagés), el fotógrafo David Hornback, la crítica de arte e investigadora Paloma Checa-Gismero (en audio) y la musicóloga e investigadora Agnès Pe.

This week on A Civil Assessment we meet the award-winning election journalist Lulu Friesdat. T.J. and Lulu discuss her history reporting on elections, her documentary “Holler Back” about voters who were not voting in 2005, the annual tech conference DEF CON where hackers broke into election machines in under 2 hours, bi-partisan election security, the Wisconsin, Georgia and Florida recounts, and more. Lulu walks us through how hackers easily hacked a number of different election machines, a lot of which was made easier due to simple passwords (such as “ABCDEF”) and lack of encryption. She recommends voting via paper, in order to secure your vote! Lulu Friesdat is an Emmy award-winning journalist whose many news assignments include producing election coverage for MSNBC, editing with the CBS Evening News and Good Morning America, and writing for Salon, and Alternet. She’s been reporting on problems with U.S. elections since 2008, when she received a Best Documentary award for directing her first feature-length documentary, Holler Back: [not]Voting in an American Town. A two-time recipient of the Edward R. Murrow award, she has been interviewed on radio and television shows including Writer’s Voice and Connect the Dots. Follow her on twitter @LuluFriesdat.

1. What do you mean by sound, nada or Dhwani? 2. How do we generate voice? 3. What do you mean by correct and incorrect breathing? 4. How can you control voice with help of breathing? 5. Who defined phonetics in devanagari script? 6. What is the significance of vowels and consonants in music, breathing and practical life?

Ludwig Lin, MD, speaks with Brenda Pun, DNP, RN, ACNP, about the ICU Liberation ABCDEF Bundle Improvement Collaborative. Dr. Pun reflects upon Collaborative work, including origins and logistics of the project, team training and resource-sharing, and the importance of the interprofessional care model, as well as successes, challenges, and barriers to bundle implementation.

Ludwig Lin, MD, speaks with Brenda Pun, DNP, RN, ACNP, about the ICU Liberation ABCDEF Bundle Improvement Collaborative. Dr. Pun reflects upon Collaborative work, including origins and logistics of the project, team training and resource-sharing, and the importance of the interprofessional care model, as well as successes, challenges, and barriers to bundle implementation.

ABCDEF guy! That'll make sense later as you listen to our new episode of Losing Lives where we work our way through Final Fantasy:The Spirits Within! We get into the history of Final Fantasy the video game series, and then dive into the movie. This movie is not at all as it was advertised, and the box office showed it. Join us as we pick this movie apart!

Michael Weinstein, MD, FACS, FCCP, speaks with E. Wesley Ely, MD, FCCM, at the 44th Critical Care Congress in Phoenix, Arizona.

Michael Weinstein, MD, FACS, FCCP, speaks with E. Wesley Ely, MD, FCCM, at the 44th Critical Care Congress in Phoenix, Arizona.

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