• Case Study

• Favorite adjunctive resources

• Brief physiology review

• S/S of high and low sodium levels and assigning severity

• Diagnosing the type of derangement

• Narrowing the etiology differentials

• When to treat and when to leave them alone

• How to treat

• Pitfalls to avoid in management

• When to consult nephrology

• The limitations of a typical non-cardiac ICU nurse practitioner

• Case Study

• Rhythm review including diagnosis, handling emergencies, when to get a 12 lead and what to do with it, cardioversion, anti-coagulation, other medical/device management, and when to phone a friend.

  • ST

  • SVT

  • AVNRT

  • AVRT

  • AT

  • Afib

  • Aflutter

  • Bradycardia / Sick Sinus Syndrome

  • VT & VT storm

  • PVCs and other intermittent irregular beats

• Best resources

• How To Choose The Right Fluid Type, Rate, & Site of Administration By Diagnosis

  • Resuscitation ≠ Maintenance

• Case Study

• How Fluids Move

  • ECF vs ICF

  • Oncotic/Hydrostatic Pressures

  • Electrolyte Impact

• Crystalloid vs Colloid

• Each Fluid Type & Their Effect On ECF/ICF Electrolytes & Volume Shifts

  • Indications v Contraindications

• A Bit About Access

• Case study

• Understanding the mechanism of action with CPAP and Bipap devices

• Breakdown of the interface variables and what they mean

• Discussion of indications for and limitations of use

• Absolute and relative contraindications

• Delineation of modes, deciding what mode to use for initial set up

• How to perform the follow up evaluation

• When hypercarbia is expected and how to handle it

• Evaluating pt response and knowing when to intubate

• The progression of pathophysiology in acute alcohol ingestion -> alcohol dependency -> alcohol withdrawal

• Case Study

• Guidelines

• How to diagnose ETOH w/d and assign severity

• Disposition - where your pt. will be best served/safest

• Management

  • Neurotransmitter targeted approach

  • Adjuncts

  • Supportive Care

  • Why CIWA protocols suck

  • Airway concerns

• Identifying The Source (Upper v Lower)

• Quality of bleeding and degree of concern

• Hematologic considerations

  • Limitations of H/H results - how to interpret with clinical context

  • Coagulopathy reversal

  • TEG guided resuscitation

• Diagnosing etiology

• Risk Stratification: Ok for floor admission | ICU admit | All hands on deck emergency

• Pillars of Mgt

  • Emergent Steps

  • Medical Management

  • Interventions for source control and who does what

This lecture will discuss THE MOST COMMON problem we treat in any ICU: The dreaded sepsis. Antibiotics are complicated and rely heavily on an individualized approach. For me, understanding proper coverage became easier once I took a reverse engineering approach. Starting with identifying the common problems we treat (PNA, UTI…), what organisms tend to cause these infections, the resistance profiles we need to be cognizant of covering, and pt co-morbidites that impact drug selection.

• How to identify when de-compensated HF has progressed to cardiogenic shock

• Why cardiogenic shock is a self-perpetuating cycle of badness (brief pathophys review)

• Hemodynamics

• Delineation of the two(-ish) categories of cardiogenic shock

• How it differs from other forms of shock

• Management Steps 1-5

• Inotropes / Mechanical support

• Types of HF: Left v Right, Systolic v Diastolic

• Common causes

• When to hold goal directed medical therapy

• How to evaluate severity from an organ system approach

• Management pillars

• Cardiogenic shock and mechanical support will be covered in the lecture following this

• Brief review of pathophysiology and causes

• ARDS discussion

• Step1-3: Assessment of patient, medications, recent events, or changes in plan of care that have impacted this decline

• Step 4: Assessment of imaging (POCUS, XR, CT)

• Step 5: Assessment of ventilator and other equipment, what the data on the vent can elucidate. Alarms, peak/plateau pressures

• Step 6: Chart review/further narrowing of differentials

• Step 7-8: Developing an action plan and reevaluating

• What constitutes a pressor, an inotrope, and other medical agents used to treat hypotension

• Shock vs hypotension with basic physiology review

• Breakdown of adrenergic receptors

• Classification, MOA, indications, dose, pros, cons, and tips for each of these drugs:

  • Levophed, Epinephrine, Vasopressin, Neosynephrine, Milrinone, Dobutamine, Dopamine, Isuprel, Angiotensin II

• This lecture includes a visual aid download under the PDF archives section.

• Discussion of the 5 phases of post cardiac arrest syndrome to help you anticipate the “what comes next when” plan.

• Focusing on etiology of the arrest, which tests still need to be ordered, and what you should do about common causes.

• Post-stabilization fall out: which organs are going to fail when and how do you handle this.

• TTM discussion: current evidence and pros/cons of cooling.

• When and how to prognosticate.

• Tips for handling the family/POA.

As a provider you have many roles to fill in a cardiac arrest situation, which when you are new, can feel overwhelming in the heat of the moment. This lecture will walk you through the step-wise approach to organizing your thoughts, interventions, and management of the coding patient.

• How your role as the provider is different

• Pros/Cons and timing of procedures you may need to perform

• How to command the room and limit the chaos

• How to determine etiology

• Immediate management

The key to teasing out what to do or not do is to understand the difference between the normal-abnormal state and the abnormal-normal state. In this lecture we will talk about the following conditions in regards to establishing etiology, steps to take for treatment, when to leave them alone, when to worry, and when to panic:

• Tachycardia

• Tachypnea

• Hemoglobin

• Hypercarbia

• Sodium Derangements

• Learn the proper way to set up your room/equipment.

• Define the steps involved with establishing multiple plans and creating a team approach.

• Discuss drug selection.

• Identify the common high risk intubation situations, and what you can do to mitigate complications/prevent cardiac arrest.

  • GIB

  • Hypoxemia

  • Hypotension

  • Metabolic Acidosis

  • Asthma/COPD
    
    

• Determining the diagnostic class of respiratory failure.

• Disease states and a brief review of which phase of ventilation and impaired gas exchange is affected.

• Review of the pertinent data/exam used. Do you need an ABG? What invalidates a VBG?

• Determining etiology and why this is the cornerstone to developing a plan.

• Options which could defer intubation.

• CPAP/Bipap

• Global perspective on diagnosis + prognosis in conjunction with pt GOC to establish what actions need to happen and in what order.

• A brief review of the types of agitation.

• Emotional vs physical causes, common etiologies andhow to differentiate your problem.

• Step 1: Identifying and managing emergencies.

• System based exam, review of recent events, labs, diagnostics, and vital signs data and how these narrow the differential.

• Focused/ideal management for your specific patient.

• The goal: evidence based; focused selection of the most appropriate plan of care for what you are combating.

• A discussion on the nature of agitation.

• Analysis of the neurotransmitters/receptors involved in agitation.

• Drugs presented: Precedex, Propofol, Versed, Phenobarbital, Ketamine, Typical and Atypical Anti-psychotic options, PRN options.

• Indications, mechanism of action, dosage, adverse reactions, considerations for use, benefits.

• The goal: Evidence based; focused selection of the most appropriate medication regimen for what you are combating.

• Brief ABG review.

• Case studies involving HPI, vitals, labs, imaging, ventilator interfaces, and other info.

• ID primary disturbance

• Discuss expected compensation

• What is the diagnosis driving the ABG derangement

• What is your plan

• The goal here is illustrating application of ABG mastery. Ultimately an ABG is just a tool to point us in the right direction.

ABG Mastery AND Application

• Interpretation overview - made super fast.

• Why the data you’re looking at may not be accurate.

• Focus on compensatory mechanisms, how to determine if the pt is doing so on their own; if they need support and how urgently.

• Differential diagnosis development and how ABG’s assist.

• What to do about the acid base disturbance. APPLICATION is the key.

• Case studies including lots of ABG print outs. Our goal is to speed up the assessment and plan process related to ABG’s.

• Deep overview of how to relate similar modes regardless of what manufacturer your institution uses.

• Suggested resources for those who want to go a little deeper in understanding mechanisms, asynchrony and pt complications while on vent.

• Mode Taxonomy

• Control Variable

• Breath Sequence

• Target Scheme

  • Do we want the machine to adapt to pt feedback?

• Pros/Cons to each mode.

• The four main classifications of modes: PCV vs VCV, IMV, Pressure Support/CPAP, and adaptive modes.

• Why is it so confusing?

• Best way to learn - step by step approach

• Suggested resources

• Vent scavenger hunt

• Breaking down the components you see - machine (set/independent variables) and pt (dependent variables) + numerical vs graphic display

• Intro to waveforms and what they represent

• Intro to pressures

• Our own vent scavenger hunt

• Review of chest anatomy and physiology

• When your film is trash and how to shift your interpretation

• ABCDEF approach…

• Common pathology and what to do about it

• Case Studies presentation

• Pathophysiology Review

• Suggested Resources / Recommended Pocket Guides

• Hemodynamics Overview of Shock States

• Case Studies