Access complete lectures plus interviews with our speakers.
GGR25 - Hannah Wunsch
The treatment of pain is an essential component of the care of critically ill patients. Opioids are a mainstay of this care in the ICU, used for both analgesia and sedation. However, recent trends in the overall use of opioids in the population have raised concerns regarding the potential for acute exposure to lead to long-term dependence or abuse. This talk will review the current evidence for best use of opioids in the ICU and address the concern as to whether exposure during critical illness may impact long-term prescribing.
CCN 41 - Susan Dirkes
In this presentation, Acute kidney injury will be defined and discussed with regards to causes, mortality and how to detect it. Conventional biomarkers have been used to detect acute renal failure, such as urea and creatinine. New biomarkers will be discussed for detection of injury, as well as current treatment options.
CCN 40 - Tom Ahrens - Sepsis
In this programme, recent improvements in the understanding and treatment of sepsis will be presented, including how SARS-COV2 induces sepsis. A review of past therapies and the recent introduction of newer treatments for sepsis will be discussed. Updates from the Surviving Sepsis Campaign will be presented, as will recent studies that address the management of sepsis. Controversies in the treatment and identification of sepsis will be reviewed, as well as case studies using novel treatments in the care of the patient with sepsis. The emphasis on early identification and how to implement protocols in hospitals, from the ED and floor to the ICU will be highlighted. The program emphasises innovative learning strategies in an attempt to help the learner retain more information as well as make the program a more enjoyable event.
GGR - Dustin Anderson - EGG
A talk summarising the important aspects of EEG for the acute care physician.
CCN 39 - Kathleen Vollman 3
In the year of the nurse, it is important to remember a famous quote by Florence Nightingale; “It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm”. In our current work cultures, some basic nursing care activities designed to prevent harm, are frequently seen as just tasks to be completed before the end of the shift or just one more project. With health care infections a worldwide problem we can make a difference in preventing the invasion or halting the spread of microorganisms by implementing basic care strategies to reduce the source of the infection. This session provides an in-depth examination of the science of bathing critically ill patients and the impact it has on infection. This session will seek to dispel any myths and address the evidence-based practice and provide suggestions for successful implementation leading to a change in care.
GGR - John Myburgh 2
Physiological facts: Haemodynamics are complex and represent a teleological neurohormonal response to stress. Defence of MAP represents the balance between the afferent and efferent circulations and the compliance of the system. Monitoring is an aid to an overall assessment that must be considered within the clinical context and patient’s trajectory of illness. Pharmacological facts: Catecholamines are hormones that are administered to augment inadequate endogenous responses. Synthetic catecholamines have no established role in clinical practice. Neurohormonal supplementation strategies have limited roles and should be confined to indications established from RCTs. Non-catecholamine inodilators have not been demonstrated to improve patient-centred outcomes in critically ill patients.
ISNCC 7 - Patsy Yates
The aim of this lecture is to examine the important role of palliative care in cancer control efforts and explore the essential role of nurses in providing that care. Key principles and strategies for delivering quality palliative care will be discussed.
CCN 38 - Eugene Mondor
On any given day, Critical Care Nurses may be called upon to assist with or admit complex, critically injured polytrauma patients into the adult Critical Care Unit. It is essential that nurses possess a solid and accurate understanding of best practice trauma resuscitation principles. This session identifies current, evidence-based practice guidelines for Critical Care Nurses for the restoration of hemodynamic stability and avoidance of complications, following the admission of the adult polytrauma patient to Critical Care. The “ABCDE” approach to trauma patients, shock, oxygenation, ventilation, fluid resuscitation, coagulopathies, and damage-control surgery, is described and discussed.
GGR - Paul Young 2
Stress ulcer prophylaxis is given commonly to patients in the ICU. However, the choice of which type or drug to use for this purpose or whether widespread use of ulcer prophylaxis is justified is debated. This talk will review current evidence in relation to stress ulcer prophylaxis in the ICU focusing on the recently published PEPTIC trial.
CCN37: Gavin Leslie
Determining body fluid balance in critically ill patients is a major challenge, particularly where patients have required extensive resuscitation and/or have renal impairment. Fluid imbalance and overload, key consequences of severe acute kidney injury, can lead to an increase in patient morbidity and mortality. Nurses play a critical role in the assessment of fluid balance and the management of patient care interventions such as renal replacement therapy which allow significant manipulation of body fluid status and require diligent management to ensure effective fluid balance maintenance.
GGR - Simon Finfer 2
The practice of medicine and healthcare in general is a fusion of art and science. The art of medicine relies of often intangible and unquantifiable components such as common sense and experience. The science of medicine arises from the conduct and interpretation of research which should be scientifically valid, quantifiable and applicable to the patient in front of you. Unfortunately, much research is poorly conducted, poorly analysed, poorly presented, and often interpreted by researchers who have a vested interest in the results. Understanding the ever-expanding methods used in clinical research in general, and particularly in critical care is essential to providing your patients the best and most appropriate care. Fortunately, a structured approach to evaluating research evidence is possible and forms the basis of this talk. Adopting such an approach will allow you to provide better care and outcomes to your patients.
ISNCC 6 - Isabel White
This talk outlines the most common male and female sexual difficulties that arise as a direct or indirect consequence of cancer diagnosis and treatment. Factors affecting clinical assessment and health professional / patient communication about treatment-induced sexual difficulties will then be explored. The biomedical, behavioral and other therapeutic strategies available to improve sexual rehabilitation after cancer treatment will also be addressed in detail. Finally, theoretical, practical and evidence-based approaches are combined, thus offering an integrated approach to comprehensively address this often neglected yet important aspect of cancer survivorship.
CCN36: Lisa Chen
In this lecture, Dr. Chen will talk about how we can implement research evidence into clinical practice. This will include several concepts including implementing change, theoretical domains framework, and process evaluation. An exemplar will be given about implementing same-day discharge following percutaneous coronary intervention from Dr. Chen's doctoral study, together with current evidence for the practice.
GGR - Phil Dellinger2
A case based presentation of things not to forget when managing critically ill patients. Each brief case presentation is paused at a critical diagnostic or management decision point to allow the audience to think. Then the important diagnostic or management point is revealed in the form of a commandment with explanation and supporting information that follows.
CCN 35 - Andrea Marshall
Critical care practice is underpinned by policy and research which acknowledges the benefits of patient and family engagement in the intensive care unit. Engagement occurs across a continuum from low to high levels of engagement. In this session we will discuss how patient and family involvement in care delivery can be promoted, ways in which families might be engaged while their family member is in the ICU, the potential benefits to the patient, family and health professionals, and managing potential challenges. We will also discuss some novel approaches for more active family engagement and partnerships in the ICU.
Global Grand Rounds: Dustin Anderson
A discussion regarding the diagnosis, treatment, and outcomes of patients with autoimmune encephalitis. Particular emphasis will be placed on critically injured patients.
ISNCC - session 5 - Meera Achrekar
Nurses practice in many settings and are at front line, delivering care which is safe, effective and holistic. With the influx of emerging therapies, it is important for oncology nurses to adapt themselves to this increased demand for care and therefore nursing leadership is paramount. This session discusses current nursing scenario in developed and developing countries, challenges faced by oncology nurses, new leadership styles, nursing empowerment and few strategies to improve nursing leadership in cancer care.
CCN 34 - Yogesh Apte
We demonstrate the feasibility of introducing a non-ventilatory intervention of prone positioning in the management of patients with moderate to severe ARDS, which has been applied and demonstrated in the Regional Intensive Care in South East Queensland. This strategy could be replicated and adopted in other similar ICU's who do not have the ability to provide Tertiary services, such as extra-corporeal life support. The advantage of this process is its easy applicability and rapid implementation, especially in this era of the COVID-19 Pandemic.
Global Grand Rounds Mervyn Singer
Sepsis is certainly a major cause of mortality and morbidity worldwide, but how common is it? Do we have any idea of true incidence and mortality? This talk will critically examine current epidemiology and ask the questions as to how many deaths are directly attributable, and how many are avoidable.
ISNCC - 4- Julie Challinor
Childhood cancer is rare, although increasing, and generally distinct from adult cancers. In high-income countries, survival rates can reach >85% for some cancers; yet, in low- and middle-income countries (LMIC), successful treatments are challenged by local realities. This lecture addresses the nursing care of a developmentally diverse patient population, with complex needs and varying family needs and resources. Challenges and strengths of the nursing role across the world to provide effective care whether the goal is cure or palliative care until the end of life will also be considered.
CCN 33 - Kathleen Vollman 2
Is the spread of multi-drug resistant (MDRO) organisms a major problem in your patient care environment? Then consider designing a plan of attack using the latest evidence and implementation strategies to win the bug war. MDRO’s contribute to serious infections and higher mortality in acute and critically ill patients. This session will explore modes of transmission to outline a strategy for source control. Habitual care practices including bathing, oral hygiene, and handwashing will be examined closely as potential sources. An in-depth focus on the development of evidence-based care practices and protocols and the examination of resources and systems that support source control and reduce transmission will be discussed. Let’s eradicate the bugs together.
Global Grand Rounds: John Marshall
Events occurring within the gastrointestinal tract are largely hidden from the clinician, yet they play an important role in the pathogenesis of critical illness. This talk will trace the origins of the concept of the gut as the motor of critical illness from the time of the ancient Egyptians to the 21st century.
CCN 32: Elizabeth Manias
This talk examines key definitions relating to medication safety, including medication errors, adverse drug events, and adverse drug reactions. The talk also identifies the prevalence of medication errors, the outcomes and risk factors associated with medication errors in intensive care. After providing the context in which medication errors occur in intensive care, consideration is given to various interventions that have been shown to impact on reducing medication errors.
Global Grand Rounds: Paul Young
Provision of invasive mechanical ventilation is required for most critically ill patients admitted to an intensive care unit (ICU). Delivery of supplemental oxygen to ICU patients receiving mechanical ventilation often exposes them to a high fraction of inspired oxygen (FIO2) and higher than normal arterial oxygen partial pressure (PaO2). Humans are adapted to breathe air and it is plausible exposure to higher amounts of oxygen, either PaO2, FIO2, or both, might be harmful. Despite this, the optimal oxygen regimen in critically ill patients remains uncertain. This talk will focus on existing evidence around oxygen therapy mechanically ventilated ICU patients and on the design of the Mega-ROX trial, 40000 patient RCT comparing conservative oxygen therapy and liberal oxygen therapy, which has recently begun enrolling patients.
CCN 31 - Debbie Massey
Patients continue to deteriorate. In this presentation, we will identify the context, the challenges, the solutions, and the future in relation to the nurse’s role in recognising and responding to patient deterioration.
Global Grand Rounds 14: Didier Payen
Inflammation is the cornerstone of almost all life-threatening conditions motivating ICU admission. This lecture will try to give a picture of inflammatory response putting on scene the major actors of the play. Integrating their interactions, the sepsis will be used as an example to demonstrate the kinetic of inflammation and the potential to intervene with drugs to modulate the host response facing pathogens. The recent SARS-Cov-2 pandemic is a perfect example of the role of the host response to the virus as a key determinant of the clinical presentation, acquired specific immunity, and strategy for vaccine development.
ISNCC Session 3 - Lize Maree
Cervical cancer is the fourth most common cancer in the world and the most common cancer in various parts of the developing world. Despite being preventable, cervical cancer is responsible for severe suffering as women lack knowledge, suffer the symptoms of the disease and treatment, are failed health care systems, are subject to traditional beliefs and medicines, suffer emotionally and financially, and are failed by their support systems. This lecture will highlight cervical cancer and tell the story of Africa’s women suffering from this disease.
CCN Lecture 30 - Tom Ahrens
Capnography has the unique ability to aid clinicians in assessing both ventilation and blood flow. In this program, a review of the physiology that allows exhaled CO2 to monitor ventilation and perfusion is presented. The emphasis in this program is using capnography to prevent over-sedation and monitoring of blood flow. Due to the ability to assess both ventilation and perfusion, capnography has been called the “15-second vital sign”. The use of capnography is likely to quickly grow throughout the hospital and even into pre-hospital settings.
Global Grand Rounds Lecture 13 Francesca Rubulotta
In addition to the learning objectives below, additional concepts that will be covered include: (1)Team training is a well-established approach for preventing errors in high-risk industries such as the military and the airline industry and is now being applied to the medical industry. (2) Simulation is a promising new strategy for improving patient safety. Similar to flight simulators used by the airline industry, health care simulators allow providers to learn a procedure or protocol using high-tech mannequins instead of living patients. (3)Pay-for-performance is a new approach for driving improvement in medical care by using financial incentives to reward hospitals that perform well on preestablished safety and quality measures. (4) Those who want to lead in patient safety should innovate new approaches for preventing errors and study these approaches using rigorous research methodology.
Critical Care Nursing: Lecture 29
A tour through common and not-so-common infections of the nervous system, with a focus on clinical presentation, treatment, and outcomes.
Global Grand Rounds Lecture 12
The optimal treatment of vulnerable, critically ill patients depends primarily on two factors: the patient's innate response to the insult (host response) and minimising secondary insults (iatrogenesis). The host response is primarily genetically determined, but the adequacy of this response is influenced by associated co-morbidities and environmental factors such as access to effective health care. In this context, the greatest impact on human survival has evolved from advances in preventive medicine, public health initiatives, universal health access, and medical technology. While Intensive Care Medicine has resulted in major improvements in the care of critically ill patients, many of the fundamental interventions have evolved through physiologically-based paradigms, often predicated on normalising short-term variables, clinical measurements, or surrogate clinical endpoints. When many of these strategies are tested in comparative effectiveness studies, evidence of adverse impacts on patient-centered outcomes has emerged that is often attributed to iatrogenic injury. While some technological advances have delivered substantial benefits, the safety and efficacy of these technologies have not been evaluated by high-quality studies. This technological imperative is associated with inexorable indication creep, overuse, and misapplication of related strategies that are applied with little consideration of adverse down-stream consequences that independently affect patient-centered outcomes. Coupled with non-validated management bundles and clinical practice guidelines, the art and science of medicine is lost, so that effective treatment directed at augmenting the innate host response over the course and trajectory of critical illness becomes obscured.
ISNCC Global Classroom: Session 2
Psychosocial support is a fundamental part of cancer care and should be provided to all cancer patients and their families. It includes social & financial, psychological, emotional, spiritual, and functional aspects over the different phases of the cancer trajectory. During the last decades, a growing body of evidence supports a stepped care approach to allow the provision of tailored and targeted interventions to patients and their relatives. This includes screening, assessment and intervention provision. In her talk, Manuela Eicher will discuss the development and implementation of psychosocial interventions in cancer care in the light of person-centred care approaches.
Critical Care Nursing: Lecture 28
Contemporary approaches in healthcare simulation facilitate development or enhancement of clinical judgement, interprofessional practice, and safe patient care. During this session, a range of simulation-based education initiatives and applied pedagogy will be showcased. Reference to readily available, seminal resources will be provided. Opportunity for dialogue amongst participants and with the presenter may expand networks and lead to future collaborations.
Global Grand Rounds: Lecture 11
This energetic talk starts with discussing the importance of Human Factors in Acute Care Medicine, and then pivots to how these ideas can be applied to understanding burnout, resilience, coping and practical aspects of culture change in medicine. These ideas are all presented within the context of the COVID pandemic.
ISNCC Global Classroom: Session 1
Learning Objectives: By the end of this lecture, the attendee will be able to: 1. Recognise some of the challenges faced by cancer nurses due to the COVID-19 pandemic 2. Describe ways taken to overcome some of the challenges in China and the UK 3. Critically reflect on the lessons learned within cancer nursing from the COVID-19 pandemic and how these can be applied to one's own practice.
Critical Care Nursing: Lecture 27
This talk is focussed on abdominal-pelvic, or more specifically, junctional haemorrhage. It is all about bleeding that is too proximal for an extremity tourniquet but below the diaphragm. Pre-hospital (civilian), battlefield, and iatrogenic causes will be presented and discussed. Haemorrhage control strategies will be taught.
Global Grand rounds: Lecture 10
By the end of this lecture, the attendee will be able to: 1. Describe the evidence for inherited susceptibility to critical illness in infection. 2. Define key terms including phenotype and genotype. 3. Understand the scale of the human genome and variation within it. 4. Describe the analogous nature of new terms describing sub-syndromes and diseases.
Critical Care Nursing: Lecture 26
Prone positioning has been utilised to recruit alveoli to improve oxygenation while preventing complications of ventilator-induced lung injury in patients with ARDS for over 30 years. Recently with new studies, the use of prone positioning is now considered front line therapy and utilisation of the technique has increased significantly since COVID 19. With the mortality rate of the ARDS patient remaining at 40%, we need to implement evidence-based practices that work. This session discusses the physiological mechanisms of the prone position for reducing lung trauma and improving oxygenation. How a team can successfully build and implement a proning protocol is outlines. An exploration of the evidence used to define the patient likely to respond to prone positioning, identify the appropriate time to initiate therapy, and time spent in the prone position are discussed. Evidence-based strategies for turning and sustaining the patient in a prone position are outlined to ensure safety for the patient and healthcare worker. As practitioners, we have the potential to influence patient outcomes through a safe non-invasive positioning technique.
Global Grand Rounds Lecture 9
This talk will provide a background to quality improvement with key tools and techniques that can be used in intensive care. There will be a focus on how to make change happen, and discussion of the rapid innovation that has had to happen in the face of COVID-19. The application of plan, do, study, act (PDSA) cycles to the COVID 19 pandemic will be mentioned. Measurement for improvement will be covered.
Critical Care Nursing: Lecture 25
Practical evaluation and evidence-based management techniques for increased intracranial hypertension will be the focus of this lecture. Whether the neurologic system strikes fear in your heart or if you would describe yourself as a "neuro nerd", this lecture will have something for you! Pathophysiology of cerebral edema will lay the foundation for why increased intracranial pressure might occur. Building upon that groundwork, herniation syndromes, and exam findings will be reviewed, along with noninvasive exam techniques/technology which will enable early, bedside identification of increased intracranial pressure (IICP). Moving beyond a basic neurologic exam, advanced brain pressure, perfusion, and oxygenation technology will be described along with a review of guidelines to indicate the application of device implementation. With examination strategies reviewed, evidence-based practice guidelines will be utilized to support tier 1-5 intervention/management strategies. This information-filled lecture will leave the learner with the knowledge that can be applied at the bedside or support protocol development to enhance care outcomes in the malignant intracranial hypertensive patient.
Global Grand Rounds Lecture 8
This engaging, provocative, and practical talk uses examples from the COVID-19 outbreak but is relevant in all those who practice Emergency Medicine, Anaesthesia, or Critical Care Medicine before, during, or after pandemics. It starts by discussing the importance of how AMOTOR differs from AMITOR (airway management in the operating room) and how and why it is more perilous and nuanced. It discusses what it means to have a difficult airway and further divide this difficulty into anatomic, physiologic, and situational. We then focus on situational difficulty and the importance of mastering Human Factors and Team factors. We offer novel airway insights and common misconceptions regarding airway management including cricothyroidotomy and glottic impersonation. The goal is simple but profound: to keep airway teams strong and patients alive.
Global Grand Rounds Lecture 7
Post Intensive Care Syndrome, popularly known as PICS, is a condition that affects large numbers of intensive care unit (ICU) survivors. PICS is defined as a syndrome in which individuals experience new or worsening difficulties in cognitive, mental health, or physical functioning domains and, as a result, display difficulties in functioning. While always a concern, the likelihood of individuals developing PICS during the COVID-19 pandemic is very high and thus an issue that medical providers, patients, and families should pay close attention to. In this presentation, we will discuss wide-ranging aspects of PICS, with a focus on prevention and treatment strategies, both in the ICU and beyond.
Critical Care Nursing: Lecture 24
The evidence on which we base decisions about nurse staffing in critical care units is sometimes not clear. The use of ratios (for example, nurse to patient ratio) is based on the assumption that patients with more organs failing require greater nursing resources. In the current climate, with increased demand on all health services, it is important to understand what impact any change in critical care nurse staffing might have on patients, family members, nurses, and the health service.
Critical Care Nursing: Lecture 23
This talk will highlight current advances in the pathophysiology of ICU delirium, including neuroinflammation, oxidative stress, and dysregulation of circadian rhythms and HPA axis. Key pathophysiological mechanisms will be linked with current evidence-based recommendations for the assessment, prevention and treatment of ICU delirium, with emphasis on evidence on non-pharmacologic interventions. Data on epidemiology and approaches to improve long-term outcomes will be presented, and gaps in the literature and practice implications will be discussed.
Global Grand Rounds Lecture 6
The current Covid-19 pandemic has challenged not only entire hospital systems but also thousands of healthcare providers who are increasingly grappling with mental health difficulties such as anxiety and distress. This webinar aims to describe psychological challenges faced by health care providers, to provide a framework to understand these challenges and to provide practical insights and guidance to help optimize coping and enhance emotional functioning.
Global Grand Rounds Lecture 5
ARDS is a life-threatening illness that results in complex management within the Intensive Care. In this talk, we will explore the developments surrounding ARDS and how to best treat our patients suffering from ARDS. Strategies for optimal ventilation and appropriate fluid management are vital in ARDS patients to aid a better outcome. We will also discuss supplementary therapies and the effects of pharmacological treatments. The lecture will include discussion around COVID-19.
Critical Care Nursing: Lecture 21
Evidence supports that we are in the midst of a significant nursing shortage and it is expected to worsen in the next ten years. One of the noteworthy factors contributing to nurses exiting the profession is burnout and job dissatisfaction. This session will focus on outlining the ingredients necessary for nurturing the person and the nurse. Skills regarding the ability to become an influencer to affect change within the workplace will be outlined. Each participant at the conclusion of the session will start creating a vitamin recipe for personal and professional success. It is only when the caregiver’s needs are adequately addressed will they most effectively be able to help the patient and their families and feel good about being a nurse. Create your own vitamin recipe for personal and professional success.
Global Grand Rounds Lecture 4
Severe anaemia is common and life-threatening cause of admission in children in sub-Saharan Africa(sSA) ~ 10% will die in hospital, and ~ 12% die 6 month post-discharge l. Whilst blood transfusions are an important treatment for severe anaemia, scientific evidence to guide doctors on how much blood to give children, or which children require it is poor. The TRACT trial showed that children with complicated severe anaemia (Hb <4g/dl or 4-6g/dl with severity signs) who do not have a fever require a larger volume of blood transfusion (30mls/kg whole blood) than current WHO guidelines recommend- halving mortality. Conversely, children with a high temperature guideline-recommendations (20mls./kg) are correct. The TRACT trial also showed that children with uncomplicated severe anaemia (no severity signs, haemoglobin 4-6g/dl) do not require an immediate transfusion, as long as they are closely monitored for signs of complications, or their haemoglobin levels dropping, and receive a transfusion at that point.
Critical Care Nursing: Lecture 20
In this talk, we will explore why sedation in ICU patients is important, what the links are to outcomes and the challenges of optimising sedation. We will then discuss the different strategies that have been used to optimise sedation practice and the evidence of the effectiveness of each of these strategies. This discussion will enable you to develop ideas of how you might lead change in sedation practice in your own ICU.
Global Grand Rounds: Lecture 3
Survivors of critical illness are left with myriad morbidities including neuromuscular and neurocognitive dysfunction, serious mood disorders and diverse medical problems. Morbidities contribute to functional disability, significant healthcare use, inability to live independently or return to work, and compromised quality of life. Family caregivers of ICU survivors also experience a traumatic life event, suffering the burden of complex care that may precipitate their own severe mood disorders and also compromise their health and well-being. An understanding of these outcomes is essential to optimize care during the critical illness and beyond to mitigate these consequences for patients and families.
Critical Care Nursing: Lecture 19
End-of-life care in critical care is a challenging topic that can cause distress to both families and staff. During this lecture, we will aim to discuss the role of end-of-life care in the critical care environment and common challenges and possible strategies for solutions for nursing staff. We will also spend time discussing a detailed systemic approach for implementing the withdrawal of life-sustaining therapies to better prepare nurses to feel more comfortable and confident in providing this vital care.
Global Grand Rounds: Lecture 2
We will unpack the real-life implementation of bedside patient management concepts derived from over 40 NEJM, JAMA, and LANCET papers that went into the ABCDEF Bundle that has now been shown to save lives, reduce LOS, reduce bounce backs, and ICUs globally revamp their service to the world's sickest patients. You will leave able to make a difference in your own ICU.
Critical Care Nursing: Lecture 18
Critical Care Nurses are assuming greater responsibility in management and care of patients receiving mechanical ventilation. This session focuses on the foundational aspects of mechanical ventilation that is essential for every Critical Care Nurse to know and understand. How the mechanical ventilator delivers breaths (volume vs. pressure), compliance and resistance, ventilator settings, peak and plateau pressures, and initiating mechanical ventilation, are highlighted. Current best practice strategies for ventilating the adult patient with Acute Respiratory Distress Syndrome (ARDS), will also be reviewed. This session aims to assist Critical Care Nurses to become more familiar with mechanical ventilation, thereby enhancing patient outcomes.
Global Grand Rounds: Lecture 1
Acute focal and generalized peripheral ischemia are seen in a wide array of acute illnesses. The term symmetric peripheral gangrene (SPG) is most often used to describe generalized peripheral ischemia that is associated with disseminated intravascular coagulation (DIC) induced microvascular thrombosis leading to gangrene with symmetric acral(peripheral body parts) distribution. SPG is usually caused by infection-induced DIC and when present often co-exists with sepsis-induced multi-organ dysfunction/failure as well as septic shock. Since many of these patients are receiving vasopressors SPG is often misdiagnosed as vasopressor induced peripheral ischemia. Since cases are rare, there is no evidence-based medicine that supports any particular treatment. We will discuss the pathophysiology and differential diagnosis of SPG as well as potential treatments based on chalkboard logic and case report anecdotal experience.
Critical Care Nursing: Lecture 17
Using electrical therapy for defibrillation, cardioversion and pacing can be intimidating at the bedside. This webinar will provide practical tips and strategies for the successful use of energy for all these situations. In addition, newer evidence for vagal manoeuvres for SVT will also be discussed.
Critical Care Nursing: Lecture 16
Despite limited evidence, chlorhexidine oral care is used worldwide in the prevention of intubation-related pneumonia as it is recommended by leading health institutions. Recent research, however, questions the safety of this practice with a trend towards increased mortality in meta-analyses and a solid association with mortality in a large hospital-wide cohort study.
Critical Care Nursing: Lecture 15
This session disruptively addresses burnout and resiliency in healthcare workers. An evidence-based evaluation of the causes of stress and burnout and strategies for resilience are discussed, including the role of emotional intelligence. Emotional intelligence can be learned and emotional intelligence assessment tools highlight many of the skills required to minimize burnout and reduce the need for resilience. Gumby serves as an example of how we can bend and always return to our true form.
Continulus Uncovered Ep7: Leanne Aitken
Professor Leanne Aitken is Professor of Critical Care at City, University of London. In this role, she is responsible for leading research and scholarship in acute and critical care nursing as well as implementing her own programme of research that focuses on recovery after critical illness and injury and a range of clinical practice issues within critical care. Other responsibilities include teaching, supervision of research students and leadership of new developments within the discipline of nursing at City, University of London. Professor Aitken holds a visiting appointment with Griffith University in Australia and is an Ambassador for the World Federation of Critical Care Nurses. She is a Fellow of both the American Academy of Nursing and the Australian College of Nursing as well as a Life Member and Fellow of the Australian College of Critical Care Nurses. She is also a Fulbright Alumnus after receiving a Fulbright Senior Scholarship to undertake research examining recovery after trauma at the University of Pennsylvania, Philadelphia. Professor Aitken has published more than 120 original publications in peer-reviewed journals and edits the textbook, Critical Care Nursing.
Critical Care Nursing: Lecture 14
Intravenous fluid therapy is one of the most common interventions in acutely ill patients. Each day, over 20% of patients in intensive care units (ICUs) receive intravenous fluid resuscitation and more than 30% receive fluid resuscitation during their first day in the ICU. Virtually all hospitalized patients receive intravenous fluid to maintain hydration and as diluents for drug administration. Until recently, the amount and type of fluids administered was based on a theory described over 100 years ago, much of which is inconsistent with current physiological data and emerging knowledge. Despite their widespread use, various fluids for intravenous administration entered clinical practice without a robust evaluation of their safety and efficacy. High-quality, investigator-initiated studies have revealed that some of these fluids, notably hydroxyethyl starch and other synthetic colloids, have unacceptable toxicity; as a result, several have been withdrawn from the market whereas others, controversially, are still in use. The belief that dehydration and hypovolaemia can cause or worsen kidney and other vital organ injury has resulted in liberal approaches to fluid therapy and the view that fluid overload and tissue oedema are ‘normal’ during critical illness; this is quite possibly harming patients. Increasing evidence indicates that restrictive fluid strategies might improve outcomes. For generic use a buffered salt solution such as Plasmalyte or Hartmanns (Lactated Ringers) is a safe first choice. In patients with septic shock not responding to crystalloid resuscitation, albumin is a rationale second choice. Although the evidence is less clear, normal saline should be first choice for patient with acute brain injuries; albumin in a hypotonic carrier fluid is contra-indicated for such patients. There is no role for hydroxyethyl starch solutions is acutely or critically ill patients and their continued use harms patients.
Critical Care Nursing: Lecture 13
Pressure injuries are one of the most frequently occurring, painful, costly yet preventable adverse events in hospitals. Intensive care patients have major risk factors in developing pressure injuries including immobility, poor perfusion, and vasopressor medication infusions. Multi-faceted interventions, also known as programs or care bundles, are recommended to prevent pressure injuries. However, clinicians often face the challenge of not knowing how to implement these programs or care bundles. In this lecture, we discuss current research evidence on the interventions and implementation strategies on pressure injury prevention in intensive care patients.
Critical Care Nursing: Lecture 12
We have our differences, but clinicians, administrators, policy-makers, and health care funders share a common core goal: to provide the best possible care to patients and to improve that care continuously. The tools they use differ, and may even appear to be in conflict. Clinical research seeks to determine in as rigorous a manner as possible, which of several options yields better patient-centered clinical results and to disseminate these findings to clinicians. Administrators use quality improvement tools to ensure that accepted best practice approaches are routinely applied in clinical care. Research focuses on a small population of patients, requires their informed consent prior to engagement, is funded from sources outside of the provision of care, and determines whether one of two or more approaches is better. Quality improvement implements conclusions of variable scientific rigour across a broad group of patients, assumes benefit and so does not seek consent, is funded from clinical funds, and focuses on clinician compliance rather than patient benefit. Evolving research designs such as the stepped wedge cluster trial or the platform trial provide a mechanism to bridge the gulf between research and quality improvement and to ensure that new knowledge that benefits patients is incorporated rapidly into clinical care.
Critical Care Nursing: Lecture 11
The use of ECMO therapy is increasing in today’s critical care environment, so this course is designed to be a basic introduction to extracorporeal membrane oxygen support therapy or ECMO. We will discuss the What, How, Why and When of implementing ECMO therapy as well as common complications encountered during ECMO. Case Studies will be incorporated as well as discussion differentiating between ECLS and ECPR. The information provided will be based upon the ExtraCorporeal Life Support Organization (ELSO) recommendations for best practice with ECMO support.
Critical Care Nursing: Lecture 10
Does feeding make a difference to critically ill patients….or not? There remains considerable variability in nutrition support practice for the critically ill despite the availability of numerous guidelines to support our practice. The complexity of the metabolic response to critical illness, coupled with patient heterogeneity, means that a one-size-fits-all approach to nutrition support is unlikely to work and that not all patients will benefit equally from nutrition interventions. We also lack clarity on the best way to determine nutritional requirements and there are insufficient data to specify the amount of protein and/or calories that patients should receive. All of these factors contribute to uncertainty regarding the benefits and best practices in relation to nutrition. Nevertheless, we know that if we don’t feed patients they do poorly. We also know that the practices of critical care nurses who manage the delivery of nutrition can have a significant impact on nutrition adequacy both in ICU and during recovery in the ward. Think about what you can do to make a difference to nutrition intake for patients recovering from critical illness.
Critical Care Nursing: Lecture 9
The aim of this lecture is to enhance knowledge on the use of pain assessment tools in the ICU, and on the clinical significance of systematic pain assessment, and to promote understanding of how the neural circuitry of nociception perpetuates increased pain levels in critically ill patients. The majority of critically ill patients experience moderate to severe pain. Pain may also persist after ICU discharge and shift to chronic pain, and is also implicated in the post-intensive care syndrome. Despite guidelines, implementation and use of validated tools to assess pain in routine ICU practice appears to be inconsistent.
Critical Care Nursing: Lecture 8
Do you feel like you have implemented all the evidence, but you're still not getting the expected results? You are not alone. CLABSI's and CAUTI's remain a significant contribution to patient harm and financial losses. The problem may call for a different approach. Quality implementation science tells us that substantial practice and process variation can lead to lower quality and higher cost. It makes sustainability almost impossible. The first step in this journey is a dissection of both physician and nursing practices and processes, then the application of laser target strategies. This session focuses on key practice areas where significant variation has been identified through a national frontline consultation experience. Innovative assessment techniques and evidence-based approaches are outlined to address both insertion and maintenance related central lines and indwelling urinary catheters. The challenge of incorporating new evidence into practice lies in altering routinized behavior and current culture to support new care practices. Leave with a plan for your organizations breakthrough to achieve zero in CLABSI's and CAUTIs.
Critical Care Nursing: Lecture 7
Susan provides a comprehensive review of traumatic brain injury. Injury identification, with associated evidence-based treatment strategies, will provide learners with practical tools to support patient care. The lecture will begin with a review of the mechanism of injury and primary and secondary trauma assessments. Following this, an overview of primary brain injury will occur where associated CT scan imaging will be utilized to enhance participant learning. Pathophysiology of secondary brain injury will be provided followed by strategies to minimize its sequelae. Brain herniation syndromes, intracranial pressure evaluation, and management techniques will be presented along with miscellaneous items such as deep vein thrombosis, feeding, and temperature management strategies to support optimal TBI patient outcomes. Throughout the course, evidenced-based, nursing treatment strategies will be provided to support rapid identification and practical care management that can be applied in global care settings.
Critical Care Nursing: Lecture 6
Approximately 1/3 of survivors of critical illness experience psychological compromise during recovery. Although the pattern of this compromise varies for individual patients, we can monitor and minimise factors in ICU that might make this worse for patients, and also improve our care to reduce problems during recovery. Interventions to be delivered within ICU that might be of benefit include sedation minimisation, sleep improvement, early mobility and psychological support. Interventions to be considered after ICU include information provision and follow-up support.
Continulus Uncovered Ep6: Kathleen Vollman
A personal interview with Kathleen Vollman, a Critical Care Clinical Nurse Specialist, Educator and Consultant. She has published & lectured nationally and internationally on a variety of topics including critical care, pulmonary medicine, sepsis. From 1989 to 2003 she functioned in the role of Clinical Nurse Specialist for the Medical ICU’s at Henry Ford Hospital in Detroit Michigan. Currently, her company, ADVANCING NURSING LLC, is focused on creating empowered work environments for nurses through the acquisition of greater skills and knowledge. In 2004, Kathleen was inducted into the College of Critical Care Medicine in 2009 she was inducted into the American Academy of Nurses. In 2012, Ms Vollman was appointed to serve as an honorary ambassador to the World Federation of Critical Care Nurses.
Critical Care Nursing: Lecture 5
Outcomes from in-hospital cardiac arrest remain dismal, about 25%. Preventing an arrest is the ultimate goal for hospitalized patients. However, this is not always possible & understanding the components of resuscitation that make a difference should be the focus. This lecture will focus on the top 5 things to focus on in cardiac arrest: high-performance CPR, early & effective defibrillation, feedback to teams & team training and post-arrest temperature control. Incorporating these components will likely increase the patient’s chance of survival.
Critical Care Nursing: Lecture 4
This podcast accompanies the Global Classroom for Critical Care Nurses: fortnightly lectures on core curriculum topics delivered by experts from around the world. Lecture 4 is by David Waters, Associate Professor and Head of Department within the School of Nursing and Midwifery at Birmingham City University, where he leads the Department of Post Qualifying Healthcare Practice. This lecture will explore the critical issues associated with errors occurring within the ICU setting, including the prevalence, nature and contributing factors. In addition, the talk will explore the impact of errors for patients, clinicians and healthcare organisations. The direct consequences for the error maker or 'second victim' will be discussed, with specific focus also on their support needs following an error event.
Critical Care Nursing: Lecture 3
This podcast accompanies the Global Classroom for Critical Care Nurses: fortnightly lectures on core curriculum topics delivered by experts from around the world. Lecture 3 is by Anne Alexandrov, Professor of Nursing and Neurology. This lecture presents evidence-based information about the diagnosis, reperfusion treatment, and prevention of acute ischaemic stroke. The discussion will centre on nursing clinical localization diagnostic skills, the availability and utility of computed tomographic (CT) technology, and nursing’s role in the development of systems of care that support stroke management. Specific topics will include intravenous alteplase and thrombectomy treatments, rapid emergency department management paradigms, the evolution of prehospital treatment on mobile stroke units, and the importance of primary and secondary stroke prevention.
Critical Care Nursing: Lecture 2
This podcast accompanies the Global Classroom for Critical Care Nurses: fortnightly lectures on core curriculum topics delivered by experts from around the world. Lecture 2 is by Stijn Blot, Research Professor at Ghent University, Belgium. Main take-home messages: Administer the first antibiotic dose as soon as possible. In cases requiring a switch in antibiotic therapy, verify whether the reason is de-escalation or inappropriate therapy. Use a controlled infusion, especially for concentration-dependent antibiotics. Respect dosing schedules of time-dependent antibiotics. Start continuous infusion of antibiotics together with the loading dose. Do not interrupt a continuous antibiotic infusion. Consider stability of antibiotic agents in case of continuous infusion. In intermittent antibiotic therapy, deal with dead-space problems.
Critical Care Nursing: Lecture 1
This podcast accompanies the Global Classroom for Critical Care Nurses: fortnightly lectures on core curriculum topics delivered by experts from around the world. Lecture 1 is by Kathleen Vollman, Critical Care Nursing specialist, educator and consultant, USA. Main take-home messages: Incidence of ARDS is higher than we thought Misdiagnosis is more frequent leading to late application of the evidence based supportive care. Frequent assessment of PaO2/FiO2 ratio by nurses can trigger a discussion around earlier diagnosis Keys to therapy to minimize lung injury from the ventilator and biotrauma include; low tidal volume ventilation, PEEP between 10 and 15 cm H2O based on using the FIO2/PEEP table from the ARDS network, prone positioning early in the course if P/F ratios < 150. There is no cure at this time, so the 8 P’s of supportive care can help the patient survive the critical illness and demonstrate improved long-term outcomes. Patient with ARDS are likely to experience the Post Intensive Care Syndrome therefore it is important to educate the patient and family what to expect and while in the ICU focus on consistent delivery of the ABCDEF bundle
Continulus Uncovered Ep5: Ged Williams
Professor Ged Williams Ged is a Professor of Nursing, currently working as a Nursing and Allied Health Consultant in Abu Dhabi. He was Founding Chair & Past President of the World Federation of Critical Care Nurses and Former Director of the World Federation of Societies of Intensive Care & Critical Care Medicine. He has qualifications in midwifery, critical care nursing, Public Sector Management, Company Directorship, a Masters in Health Administration and a Masters in Law. He has published over 80 peer-reviewed journal articles and book chapters and is regularly involved in strategic nursing and health activities at the state, national and international level.
Continulus Uncovered Ep4: Max Valois & Jean-Francois Lanctot
A personal interview with two ED/ICU docs from Montreal, Canada and the brains' behind the EGLS course Max Valois and Jean-François Lanctôt are colleagues in the ED at Charles-LeMoyne Hospital and in the ICU at Verdun Hospital in Montréal, Québec, Canada. Max is Adjunct Professor at McGill University and Université de Montréal, and Associate Professor at Université de Sherbrooke. Jean-François is Adjunct Professor at McGill University, and Professor of Clinical Teaching at Université de Sherbrooke. They are founders and co-directors of the Echo-Guided Life Support course which teaches the use of ultrasound to quickly diagnose and manage the hypotensive patient. They talk life, loves and challenges.
Continulus Uncovered Ep3: Arun Sayal & Matt DiStefano
Arun Sayal is an Emergency Medicine Doctor at North York General Hospital in Toronto and the founder of The Casted Course - a renowned emergency orthopaedic course for doctors and nurses. Eoghan finds out about Arun and in particular why he has such an incredibly positive outlook on life, with some great tips and advice for us all. (Everyone should spend time with him!!) Matt Di Stefano is an Emergency Physician, ski coach, drag racer, and accomplished orthopaedic surgeon from Toronto who delivers a lot of the teaching on the Casted Course. Eoghan and Matt discuss various topics including why Matt ought to be a politician!!
Continulus Uncovered Ep2: Rich Levitan
A personal conversation with Rich Levitan. Rich is an Adjunct Professor of Emergency Medicine at Dartmouth School of Medicine (New Hampshire) and visiting Professor at University of Maryland School of Medicine (Baltimore, Maryland). Professor Levitan is director of the New York City Airway Course, the Yellowstone Airway Course and the worlds largest cadaver airway course, in Baltimore (monthly for 16 years). He has given more than 350 invited international lectures on airway management and authored 42 publications and 3 textbooks on airway management. He is the inventor of the AirwayCam, which captured real-time, advanced airway skills for the first time. These resources have been used in 4000 hospitals in 26 different countries. Rich discusses his early years in medicine and how he got into airway training and research. Eoghan gets to know a little bit more about Rich by discussing his likes, dislikes, passions, annoyances and his hopes for the future.
Continulus Uncovered Ep1: Peter Brindley
A personal conversation with Peter G. Brindley MD, FRCPC, FRCP (Edin) FRCP (Lond). Peter is a full-time Critical Care Physician at the University of Alberta Hospital, Canada and professor of Critical Care Medicine, Anaesthesiology, and Medical Ethics. He has 100 peer-reviewed manuscripts, 30 book chapters, over 70 lesser manuscripts and one textbook focusing on resuscitation; crisis management; human factors; and improving teamwork & communication. He was a founding member of the Canadian Resuscitation Institute; former Medical-Lead for Simulation, and prior Education Lead for Surgery, Anaesthesia and Critical Care at the UofA. He is on the Board for the Canadian Critical Care Society, and the organizing committee for five major conferences. He has delivered over 400 invited presentations in ten countries, and over 50 plenaries. He welcomes disagreements because he doesn’t want to be wrong a moment longer than necessary.