Posted: 12/26/2015 2:15:28 PM EDT
Hello fellow RNs! So Im starting a little nursing project via a Youtube channel called "The Critical Care Nurse" which will be a resource for nurses getting into critical care or who have been in critical care. All I have done so far was make the channel and that's it  . I plan on making videos specifically to help nurses in the ICU setting but would like to show case good information for any nurse to have. So far my game plan is to go over the following:
- ABGs - Liver failure - Adrenergic Agonists and pressor like meds (vaso/milrinone etc.) - Cardiac Devices i.e. ECMO, Balloon Pump, Impella, Tandem, VAD - Opioid analgesics, sedative hypnotics - Vent settings - Intubation/Extubation - Codes - Cardiac Arrest - ARDS - TOF and Cisatracurium - Spontaneous Bacterial Peritonitis I have pounded out like 60+ CEUs via the AACN website in the last month for my CCRN renewal and plan to incorporate a lot of the latest evidenced based practice into the videos. I precept newer RN's on my home unit (Cardiac/Transplant) and hold them to very high standards and make sure they have all the tools they need to succeed wherever they go. I do a pretty damn good job  . But what worries me is the knowledge and skill discrepancy from the nurses that I take under my wing in comparison to the nurses from other ICUs (MICU, CCU, SICU, NICU) when I float there. I feel that IF the information that I teach and share with my nurses is readily available to everyone, I can help step up the Critical Care games of a lot of fellow RNs, and in turn enhance the profession in that manner. If it helps even one RN make a good call that helps save even 1 patient's life, it will be absolutely worth it.
So what I wanted to ask is what are other areas (other than the ones covered above) or topics that would have helped you as a new RN? What are some difficult critical care concepts to go over that would help a newer RN or even a seasoned RN? Thanks for stopping in! 
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I think what you are doing is awesome. I also think your list covers very good subjects. ABG's were my pet peeve when I was precepting student nurses and new RN's. The local Colleges and Universities(3) it seemed, spent very little time on this. Vents are solely operated and attended by RT at my Hospital but when seconds count, they are a few minutes away. Knowing how to read a 12 lead is a topic of concern as well. Being able to recognize 1st degree heart block in a cardiac pt. can save a life. I could go on and on because knowledge is key and the Educational system is now about grad rates and money. When I graduated, 80% was required to get a passing grade, now it is 74.8 and you keep taking the class until you pass. Kinda scary. In Indiana, after you fail the NCLEX 3X, you must appear before the State Nursing Board to get permission to take it again. A good friend says that every month they have between 150 and 300 requesting that authorization. Real Scary! Good on you! |
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How about how to try pawning off all your patients on other floors 5 seconds after they've been extubated and saying everyone who's not got 1 foot in the grave is 'medically stable?' That's what my hospital ICU nurses do.
But seriously, it's a cool idea and I wish you luck. I can't really help since I'm a psych nurse, other than to suggest: - beware of alcohol & benzo withdrawal and medicate aggressively - give agitated psychotic patients not just benzodiazepines but some Haldol, Thorazine, Zyprexa, Geodon or some sort of other antipsychotic Posted Via AR15.Com Mobile |
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Awww, we're being serious?
I agree with getting at least basic knowledge of cardiac rhythms, recognizing an arrhythmia can save a life. Don't always trust what the machine says or what the monitor tech thinks, they are not always correct. (I was a monitor tech for awhile.) Good luck, OP. Pretty cool thing you're doing. |
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Quoted: How about how to try pawning off all your patients on other floors 5 seconds after they've been extubated and saying everyone who's not got 1 foot in the grave is 'medically stable?' That's what my hospital ICU nurses do. But seriously, it's a cool idea and I wish you luck. I can't really help since I'm a psych nurse, other than to suggest: - beware of alcohol & benzo withdrawal and medicate aggressively - give agitated psychotic patients not just benzodiazepines but some Haldol, Thorazine, Zyprexa, Geodon or some sort of other antipsychotic Posted Via AR15.Com Mobile 2mg ativan/5mg Haldol q4 IM/PO |
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Therapeutic hypothermia and the associated electrolyte shifting.
DKA.....and the associated electrolyte shifting as you fix the pH and move glucose intracellularly Potassium shifting using dextrose, insulin, calcium, and albuterol. 12-lead interpretation. oxygen hemoglobin association curve....and why we care so much about pH |
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Hemodynamics is a big one. It's a lost art.
There's also an astonishing lack of ECG/electrophysiology knowledge out there. Everything from measuring heart rates (no, the computers do not always count correctly), to rhythm interpretation to managing external pacemakers. There seems to be a lot of slackers making it out of orientation... |
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The art of doing all of your assessments and med passes without leaving your chair at the nurse's station. #truth. I'm a charge nurse in the ER and I busted one of my nurses doing that. Her assessment was already documented by the time I got back to my desk after walking the of to their room. Posted Via AR15.Com Mobile |
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Quoted: How about how to try pawning off all your patients on other floors 5 seconds after they've been extubated and saying everyone who's not got 1 foot in the grave is 'medically stable?' That's what my hospital ICU nurses do. But seriously, it's a cool idea and I wish you luck. I can't really help since I'm a psych nurse, other than to suggest: - beware of alcohol & benzo withdrawal and medicate aggressively - give agitated psychotic patients not just benzodiazepines but some Haldol, Thorazine, Zyprexa, Geodon or some sort of other antipsychotic Posted Via AR15.Com Mobile Pawning off your patient 5 seconds after they've been extubated? Sounds like the PACU sometimes at my facility. I've gotten patients that are nowhere near recovered get wheeled up to my floor (med/surg). RR 12 and essentially unresponsive? That's awesome. Thanks PACU nurse! |
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Pawning off your patient 5 seconds after they've been extubated? Sounds like the PACU sometimes at my facility. I've gotten patients that are nowhere near recovered get wheeled up to my floor (med/surg). RR 12 and essentially unresponsive? That's awesome. Thanks PACU nurse! Quoted:
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How about how to try pawning off all your patients on other floors 5 seconds after they've been extubated and saying everyone who's not got 1 foot in the grave is 'medically stable?' That's what my hospital ICU nurses do. But seriously, it's a cool idea and I wish you luck. I can't really help since I'm a psych nurse, other than to suggest: - beware of alcohol & benzo withdrawal and medicate aggressively - give agitated psychotic patients not just benzodiazepines but some Haldol, Thorazine, Zyprexa, Geodon or some sort of other antipsychotic Posted Via AR15.Com Mobile Pawning off your patient 5 seconds after they've been extubated? Sounds like the PACU sometimes at my facility. I've gotten patients that are nowhere near recovered get wheeled up to my floor (med/surg). RR 12 and essentially unresponsive? That's awesome. Thanks PACU nurse! "But, but, they weren't like that in PACU 3 minutes ago!" Riiiight. (Same for the ED... )
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Can't wait to subscribe!
ABG and EKG interpretation for sure. External pacing settings and indications. Swan-Ganz and/or Flo-trac monitoring with in depth interpretation of CO/CI, SVR, CVP, SVV, etc. Ventilator settings and modes. Chest tube management. Drips, drips, drips! Pressors/inotropes: alpha vs. beta, comparison and specific indications of levo, neo, epi, vasopressin, dopamine, dobutamine. Antiarrythmic gtts: cardizem, amiodarone, lidocaine. IABP and Impella. ECMO/cardio saver. |
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I think what you are doing is awesome. I also think your list covers very good subjects. ABG's were my pet peeve when I was precepting student nurses and new RN's. The local Colleges and Universities(3) it seemed, spent very little time on this. Vents are solely operated and attended by RT at my Hospital but when seconds count, they are a few minutes away. Knowing how to read a 12 lead is a topic of concern as well. Being able to recognize 1st degree heart block in a cardiac pt. can save a life. I could go on and on because knowledge is key and the Educational system is now about grad rates and money. When I graduated, 80% was required to get a passing grade, now it is 74.8 and you keep taking the class until you pass. Kinda scary. In Indiana, after you fail the NCLEX 3X, you must appear before the State Nursing Board to get permission to take it again. A good friend says that every month they have between 150 and 300 requesting that authorization. Real Scary! Good on you! ABG's is a must! I think I will also cover causes of metabolic/respiratory acidosis/alkalosis, ways they manifest, and considerations when choosing treatment options. Yikes, that's a little scary about the NCLEX failure in Indiana  , I believe 78% was minimum passing for me when I graduated, although I was never close to failing 
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ABG's is a must! I think I will also cover causes of metabolic/respiratory acidosis/alkalosis, ways they manifest, and considerations when choosing treatment options. Yikes, that's a little scary about the NCLEX failure in Indiana , I believe 78% was minimum passing for me when I graduated, although I was never close to failing Quoted:
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I think what you are doing is awesome. I also think your list covers very good subjects. ABG's were my pet peeve when I was precepting student nurses and new RN's. The local Colleges and Universities(3) it seemed, spent very little time on this. Vents are solely operated and attended by RT at my Hospital but when seconds count, they are a few minutes away. Knowing how to read a 12 lead is a topic of concern as well. Being able to recognize 1st degree heart block in a cardiac pt. can save a life. I could go on and on because knowledge is key and the Educational system is now about grad rates and money. When I graduated, 80% was required to get a passing grade, now it is 74.8 and you keep taking the class until you pass. Kinda scary. In Indiana, after you fail the NCLEX 3X, you must appear before the State Nursing Board to get permission to take it again. A good friend says that every month they have between 150 and 300 requesting that authorization. Real Scary! Good on you! ABG's is a must! I think I will also cover causes of metabolic/respiratory acidosis/alkalosis, ways they manifest, and considerations when choosing treatment options. Yikes, that's a little scary about the NCLEX failure in Indiana , I believe 78% was minimum passing for me when I graduated, although I was never close to failing For some years now the NCLEX has been administered with Computerized Adaptive Testing which uses an algorithm to determine within 95% certainty that the candidate has achieved a 0.00 logit standard. Fancy way of saying the test is adaptive and the questions are weighted. Miss an important question and you get more like it that go into greater depth. Unfortunately there isn't an easy passing percentage anymore. OP, I am a chapter president of the Infusion Nurses Society and a clinical consultant for a major medical device manufacturer. I am board certified in vascular access (VA-BC) and have my (CRNI) certified registered nurse infusion, let me know if you need anything, this is a great project! |
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12 lead interpretation is lacking even at the physician level on our surgery service, and they staff the SICU after a year or two so that continues to be a must. You can see an arrhythmia just as easily in one or two leads on the monitor and do a static grab at one of the stations but a 12 lead will show you foci and ischemia/infarct. I don't know a single nurse who knows S1Q3T3, sgarbossa's criteria (or really when to apply it), and very few who know when they should be looking at the right side or posterior of the heart. And I agree that a little primer on DKA management or a K shift is always good. Sometimes nurses get hung up on the Na of 120 when the glucose is 1000. It's also the things that you can't read about on UpToDate like priming out enough insulin in standard-sorbing tubing (20ml sayeth the research) so that you're not just infusing NS at 1ml/hr with a D10 driver, meanwhile cranking it up hour after hour. |
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How about how to try pawning off all your patients on other floors 5 seconds after they've been extubated and saying everyone who's not got 1 foot in the grave is 'medically stable?' That's what my hospital ICU nurses do. But seriously, it's a cool idea and I wish you luck. I can't really help since I'm a psych nurse, other than to suggest: - beware of alcohol & benzo withdrawal and medicate aggressively - give agitated psychotic patients not just benzodiazepines but some Haldol, Thorazine, Zyprexa, Geodon or some sort of other antipsychotic Posted Via AR15.Com Mobile I see these a crazy amount when I flow to MICU and usually blast them with a fentanyl and lorazepam drip. Haldol does work wonders on the wild ones 
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Diabetic Nursing Considerations are always good to review. Steroid use, Peripheral Neuropathy, and particularly Stasis Dermatitis to Cellulitis -- all things that RNs have to be on their toes in dealing with. As for diabetes I think incorporating DKA, HHNKS, electrolyte shifts, and even things as simple as cutting the IV insulin dose when tube feeds are turned off for a procedure or extubation is very important. In terms of steroids I will also include sudden hypotension that can sometimes occur with adrenal insufficiency post operatively since that is one we see in a blue moon on the units. |
| Toxicology, as in overdoses, exposure to toxic chemicals, all the crazy stuff people try and kill themselves with. The Cert to have is AHLS, Advanced hazardous life support. the headquarters company is in Arizona. Very good course for anyone taking care of patients who have been exposed whether by design or not to all the drugs and chemicals in our world. |
| For starters, your logo is incorrect. You should use rod of Asclepius, not Caduceus. You got to many snakes. One snake is deity of healing and medicine. Two is another thing completely with the closest coming to meaning of alchemy or commerce. But I like your idea hopefully it can help people. |
Your project sounds pretty awesome, but as a manager and executive in a different industry, I have to wonder why it's necessary. If I ever did anything remotely like they do it in healthcare, I wouldn't have a job very long. Health care seems like a complete fucking disaster. After hearing how my wife's day was for the last two years, I can tell you that I don't EVER want to wind up in a hospital, EVER. Fuckin' A. It sounds like when people make it out of there, it's more by fucking accident! 
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(just guessing)
| Some overall basics like what information to have when calling a Dr. "My patients sats are low" "low urine output" and "my patients BP is low". The nurse asking those questions wouldn't have looked at xrays, labs, know accurate weight, i&o's for the last 24hrs and hx of pt. 14 years ICU exp, 10 years as charge rn, and last 2 years as a rapid response rn. It seems alot of times nurses get report from a cardex, but truly don't know their patients. Also SLED/CVVHD , icp/ventric's |
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My wife is an RRT, VABC, and soon to have her ACCS......she's not using them though, she's passing duonebs on the floors every day. Her department is a fucking disaster from the Director on down. Zero leadership, no accountability for the management, at least one patient death and two CLABSIs in the last 90 days due to shitty care from her department. She quit the Lines Team and went to said floors to escape the stupidity. The Director did implement LEAN on their supply chain though, so the VPs love him I guess.......
Your project sounds pretty awesome, but as a manager and executive in a different industry, I have to wonder why it's necessary. If I ever did anything remotely like they do it in healthcare, I wouldn't have a job very long. Health care seems like a complete fucking disaster. After hearing how my wife's day was for the last two years, I can tell you that I don't EVER want to wind up in a hospital, EVER. Fuckin' A. It sounds like when people make it out of there, it's more by fucking accident! And this is why after 18 years as a RRT I'm an exterminator now. Don't miss it a bit |
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Awww, we're being serious?
I agree with getting at least basic knowledge of cardiac rhythms, recognizing an arrhythmia can save a life. Don't always trust what the machine says or what the monitor tech thinks, they are not always correct. (I was a monitor tech for awhile.) Good luck, OP. Pretty cool thing you're doing. I think going over the lethal ones that we see on The Units is a must. |
Alright so filming and light editing is complete. I should have the first video up by Sunday Noc or Monday AM at some point  . It's going to be Pressors and pressor like medications! Unfortunately it is kind of long for a youtube video, I might even have to do a part I and part II, but I feel the content is important and needs that much time. Since this video is highly specialized and highly specific to the ICU RNs, I think I am just going to keep it at the length that it is
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Alright guys I finally finished my first video! It is titled:
ICU Nursing: Vasopressors and Vasopressor like Medications If you have the time, please let me know what you think! And also if you have any suggestions to make it better, please let me know. I am always open for constructive criticism!
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I was originally planning to do 1 video/week. Finally, 4 weeks later, I finished my second video .
ICU Nurse's Guide to Endotracheal Intubation! |
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I'm not a nurse and have no medical experience. I watched part of your 2nd video and have some feedback. When you start writing on the tablet it is very hard to hear you. Try using a microphone of some sort to pick up your speech. Also, instead of writing on a tablet, maybe use a whiteboard mounted to a wall. That way, you can keep the camera fixed on the entire whiteboard instead of panning around to certain areas of the tablet. People can see the entire contents of the whiteboard and also see you while you're explaining things.
Keep up the good work! |
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I'm not a nurse and have no medical experience. I watched part of your 2nd video and have some feedback. When you start writing on the tablet it is very hard to hear you. Try using a microphone of some sort to pick up your speech. Also, instead of writing on a tablet, maybe use a whiteboard mounted to a wall. That way, you can keep the camera fixed on the entire whiteboard instead of panning around to certain areas of the tablet. People can see the entire contents of the whiteboard and also see you while you're explaining things. Keep up the good work! Crap! I am using a Yeti Blue and I guess I haven't figured out the ins and outs of it yet . Thank you for your input, I will definitely look into the whiteboard idea as it might be easier to write things down on it and explain concepts instead of panning around like a moron . Cheers! 
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Yikes, what classes? Quoted:
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I will definitely be subscribing...I'm in my second semester of nursing school (and it fucking sucks). Midterms this week 
Yikes, what classes? medsurge, pharm 2, sociology I bombed my last medsurge quize so I need to do good on it. The stuff I got wrong I think I got it straightened out. |
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medsurge, pharm 2, sociology I bombed my last medsurge quize so I need to do good on it. The stuff I got wrong I think I got it straightened out. Quoted:
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I will definitely be subscribing...I'm in my second semester of nursing school (and it fucking sucks). Midterms this week
Yikes, what classes? medsurge, pharm 2, sociology I bombed my last medsurge quize so I need to do good on it. The stuff I got wrong I think I got it straightened out. Posted Via AR15.Com Mobile |
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Hemodynamics is a big one. It's a lost art. There's also an astonishing lack of ECG/electrophysiology knowledge out there. Everything from measuring heart rates (no, the computers do not always count correctly), to rhythm interpretation to managing external pacemakers. There seems to be a lot of slackers making it out of orientation... I work on a cardiology floor and this is a big problem. It's not that hard just attention to detail. |
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hang in there. School is not like work. I didn't even want to do it anymore when I graduated. Posted Via AR15.Com Mobile Quoted:
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I will definitely be subscribing...I'm in my second semester of nursing school (and it fucking sucks). Midterms this week
Yikes, what classes? medsurge, pharm 2, sociology I bombed my last medsurge quize so I need to do good on it. The stuff I got wrong I think I got it straightened out. Posted Via AR15.Com Mobile Thanks. that helps. Ive been wondering wtf im doing lately 
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Retired RN here. Came to it later in life after I retired from PD.
Are you getting any help from your staff development people? Dont forget something on post op strokes and fat embolisms. And the RRT is right, dont screw with the vent. Oh, and keep the damn PT's away from my patients. |
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medsurge, pharm 2, sociology I bombed my last medsurge quize so I need to do good on it. The stuff I got wrong I think I got it straightened out. Quoted:
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I will definitely be subscribing...I'm in my second semester of nursing school (and it fucking sucks). Midterms this week
Yikes, what classes? medsurge, pharm 2, sociology I bombed my last medsurge quize so I need to do good on it. The stuff I got wrong I think I got it straightened out. Pharm? My favorite! Hang in there, brother.
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