Season 1: Follow the Journey of a Graduate Nurse, starting in the Intensive Care Unit (ICU).
Season 2: Find out what it's really like to work in the Emergency Department (ED).
Season 3: Foundations of Intensive Care Nursing for those 'up-skilling' to enter intensive care during the COVID pandemic.
Physiotherapists in ICU with Samantha Hagan
Physiotherapists play such an essential role in the care of the patient within the Intensive Care Unit.
On today's episode, I speak with Samantha Hagan. Sam was one of the first physio's I worked with as I started as a new grad nurse within ICU. Over those first few months I learnt an incredible amount from Sam. From the specific recruitment manoeuvres; to detailed chest auscultation; Chest X-Ray interpretation; and overall, the role of the physio within ICU.
Sam does a great job in outlining the role of the physiotherapist within ICU; details the rationale of specific manoeuvres including Manual Hyperinflation, and Vibes; details the equipment used; and outlines strategies for how Nurses and Physio's can best work together.
Troubleshooting the Ventilator + Alarms
Now that we've gone over the Modes & Settings, let's start talking about some of the most common alarms, what they mean, and what we could do about them as registered nurses.
There is one alarm in particular, Peak Pressure (High Airway Pressures), that has the potential to lead to an airway emergency. I outline a systematic approach to assess the situation; how to escalate, and how to overcome.
The key messages are:
- If you're ever unsure: Ask
- If the ventilator continues to peak pressuring, the patient is not ventilating during that time
- If in doubt, call for back up, and hand bag the patient using the Bag Valve Mask attached to Oxygen 15L/min.
Mechanical Ventilation - Modes (Pressure Support Ventilation)
Now you might notice, due to turning down the level of sedation, the patient may start to take a few more spontaneous breaths on their own.
This is where Pressure Support Ventilation (PSV), another type of mode, comes into it.
In today's episode, I detail the setting of Pressure Support; and mention at what stage we may switch the patient from a 'Rate' (ie SIMV) to PSV; and highlight a few key things for nurses to keep an eye on when doing so.
Mechanical Ventilation - Modes (AC vs SIMV)
Welcome back to another episode of the New Grad Radio podcast!
Let's continue on with another episode on Mechanical Ventilation.
As I mention in the episode, there are two broad concepts when considering modes - do we have full control and not wanting the patient to breath for themselves; or is that the intention, to allow the patient to take spontaneous breaths, and even take all breaths for themselves?
Today's episode describes the modes used for patients who are not breathing for themselves; whilst the next episode features modes when the goal IS for the patient to take their own breaths.
Mechanical Ventilation - Settings (Foundation)
If you've had a look at the ventilator in action, you'll notice there are numbers that remain fixed, and that there are numbers that seem to change from breath to breath. This is because there are particular settings that we mandatorily 'set' for the ventilator to deliver to the patient; whilst then we monitor the section to see what the actual patient is doing/receiving.
As mentioned I cover the majority of the absolute basics; yet there are some things I haven't covered yet. This will change in the coming episodes.
Today we cover:
- Tidal Volume (Vt)
- Respiratory Rate (RR)
- Positive End Expiratory Pressure (PEEP)
- Fraction of Inspired Oxygen (Fi02)
- Minute Ventilation (MV)
- Peak Inspiratory Pressure (PIP)
Mechanical Ventilation - The Ventilator
Welcome back to another episode of the New Grad Radio podcast.
This episode serves as the first of many to come, highlighting the foundational concepts of Mechanical Ventilation.
As I mention, I am not an expert. But I know what it's like to have started as a grad two years ago, having never seen a ventilator, nor a patient requiring mechanical ventilation. Over the last few years, I've worked in an ICU that has one of the highest percentage of patients requiring mechanical ventilation in Australia - meaning most days I turned up to work, I was directly caring for patients on a ventilator.
I remember what it was like to first stand in front of the ventilator, feeling a little overwhelmed, and learning absolutely everything from scratch.
I remember the questions I had when I first started. It was only a few years ago. And I'll keep those at the forefront of my mind as I create the proceeding episodes.
I'll attempt to keep each episode short, compact, and to the point. If you already have a decent foundation, please feel free to skip to the episodes you're interested in. For those who have never even seen a ventilator, i'll talk through everything I can, step-by-step; commencing with this episode, being the actual machinery of the ventilator; the components; and I highlight specific brands that I have personally worked with, to highlight that ventilators can come in all different shapes and sizes, and be used in different settings.
I don't profess to be an expert on this. I'd just love to pass along some of the knowledge and skills I've developed over the last few years; teach it at a foundational level, for those nurses who may be expected to be using this equipment for the first time in the weeks to come.
I'd love if you could keep me updated on what you think. Need more detail, going too fast, need more clarification, don't hesitate to send a message through to the New Grad Radio Podcast Facebook page.
Exactly what I needed in third year!
Thanks so much for this great podcast Ben! I’m a third year nursing student and was searching for anything that could help me alleviate the stress of the impending grad year. You have really helped me realise it’s more about how you approach it than knowing everything straight away. Awesome job!
A breath of fresh air
All I can say is thank you for this podcast. I’m a new grad in a facility I felt out of my depth in. It’s no where near the complexities of ICU, polar opposites in fact. The underlying theme of this podcast for me has been be resilient and the feelings of being overwhelmed and how to overcome these feelings. Thanks for being raw with your feelings and learning experiences! Awesome listen :)
Laid back though informative!