ED Nurses Vent and Haemodynamics Workshop

This post captures some of the resources discussed in the ED Nurses Vent and Haemodynamic Monitoring workshop at Redcliffe Hospital. These resources are high quality FOAM and can help with expanding upon the learning and piqued curiosity from the workshop. Happy self-directed learning.

Pro-tip on organising and capturing your CPD activities: Keep a portfolio. Quite simply, document your intended personal learning objective; identify a high quality resource that addresses this (article, workshop, conference); document a reflection on your achieved personal learning outcome. For a comprehensive overview of a Nursing Professional Portfolio head to this guide from the ACN. My newly discovered resource for keeping track of CPD portfolio is this great app from Ausmed Education.

Arterial lines, central lines and haemodynamic monitoring

Quick snapshot on Arterial lines – http://lifeinthefastlane.com/ccc/arterial-line/

Literally the whole chapter on Haemodynamic Monitoring, an amazing resource – http://www.derangedphysiology.com/main/core-topics-intensive-care/haemodynamic-monitoring

arterial pressure waveform

Image from Deranged Physiology

Acute Respiratory Failure

Medscape emedicine overview of Respiratory Failure – http://emedicine.medscape.com/article/167981-overview

British Thoracic Society Guidelines for a host of diseases, diagnoses and therapies in ARF – https://www.brit-thoracic.org.uk/standards-of-care/guidelines/

Non-Invasive Ventilation

NIV Clinical Practice Guidelines – http://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0007/239740/ACI14_Man_NIV_1-2.pdf

Q&A format NIV for the criitcally ill patient from LITFL – http://lifeinthefastlane.com/non-invasive-ventilation/

LIFTL Critical Care Compendium NIV – http://lifeinthefastlane.com/ccc/non-invasive-ventilation-niv/

Great 5 minute overview of NIV

Rapid Sequence Induction/Intubation

RSI Checklist Podcast and host of resources – https://emcrit.org/podcasts/intubation-checklist-2-0/

The Vortex Approach : a unique and systematic approach to safe emergency airway management – http://vortexapproach.org/

Nice overview of indications for RSI

RSI Dump Sheet adapted from KI Docs

Post-Intubation Care

The go-to package for post-intubation, EMCrit – https://emcrit.org/podcasts/post-intubation-package/

Mechanical Ventilation

For those that want EVERYTHING, here is the chapter from Deranged Physiology – http://www.derangedphysiology.com/main/core-topics-intensive-care/mechanical-ventilation-0

Don’t forget the importance of alarm settings – CritIQ video

A huge suite of brilliant videos from Respiratory Review – The Principles of Mechanical Ventilation

A short lecture on basic ventilator settings using the Hamilton T1 – https://www.youtube.com/watch?v=XOt4nMrJgww

Hamilton T1 online settings simulator – https://www.hamilton-medical.com/.static/HAMILTON-T1/start.html

The Crashing Ventilated Patient

This is a brilliant lecture with some good mental models and mnemonics for assessing and treating the patient who crashes post-intubation

Respiratory Review – Principles of Mechanical Ventilation

resp reviewRespiratory Review and the Principles of Mechanical Ventilation Videos

Complex areas of clinical practice, such as developing an understanding of Mechanical Ventilation are challenging to grasp for those new to critical care. Be you a Doctor, a Nurse, or a Respiratory Therapist, skill, knowledge, and mastery of Mechanical Ventilation are developed and acquired over time. We grasp the principles, revisit theory in clinical practice and develop tacit experience, all on our own learning trajectory. I know I have often had to revisit the foundation principles of Mechanical Ventilation throughout my career, re-integrating the core theory and have often found I’ve been left to leaf through textbooks and search broadly for unfiltered content online.

Enteoli pooler Oli Poole @RespReview, Respiratory Therapist practicing in Canada and provider of some of the best FOAMed, FOANed and FOAMcc content around on mechanical ventilation and associated clinical topics. If you like what you see below, please go and visit the Respiratory Review YouTube Channel https://www.youtube.com/channel/UCtaRF58UDVthvH36YYCttng This channel is a repository to an expanding library of top notch, Khan Academy style videos on Ventilation and related topics.

On this Injectable Orange page, with Oli’s permission, I am providing a second home/portal and a mini curriculum of sorts, around the foundational content. These videos run sequentially alongside the common induction knowledge pathways for those new to Intensive Care, and Critical Care in the ED or Respiratory Wards. This Page has a permanent home on the site at http://injectableorange.com/principles-of-mechanical-ventilation/


Principles of Mechanical Ventilation 1: Goals and Indications for MV

Content: This video provides an introduction into the goals of mechanical ventilation, as well as categorising the indications for mechanical ventilation into 3 major categories.

Learning Outcomes: At the end of this video the learner should be able to:
1) Describe the goals of mechanical ventilation
2) Understand the major indications for mechanical ventilation
3) Describe the primary ABG disturbance for Type I and Type II respiratory failure


Principles of Mechanical Ventilation 2: Phases of a breath

Content: This video briefly outlines the 4 major phases of a mechanically ventilated breath:

  1. Start of Inspiration;
  2. Inspiration;
  3. End-Inspiration;
  4. Baseline.

Learning Outcomes: At the end of this video learners should be able to demonstrate knowledge of the 4 phases of a mechanically ventilated breath.


Principles of Mechanical Ventilation 3: Total Cycle Time and I:E ratio

Content: This video builds upon the video on phases of a breath, introducing the topics of total cycle time, and I:E ratio.
Learning Outcomes: By the end of this video learners should be able to:
1) Define Total Cycle Time and I:E ratio.
2) Calculate the I:E ratio using varying respiratory rates and inspiratory times.


Principlies of Mechanical Ventilation 4: Modes – Assist Control (AC)

Content: This video introduces the topic of modes of ventilation. Identifying the different breath types that can be delivered by a ventilator the video explores the ‘Assist/Control’ mode.

Learning Outcomes: After watching this video the learner should be able to:
1) Identify the 3 types of ventilator breath
2) Differentiate between a control breath and an assisted breath
3) Explain what happens when the patient triggers an additional breath in an assist control mode.


Principle of Mechanical Ventilation 5: Assist Control Volume Control

Content: This video specifically explores the features of Volume targeted breath delivery, including ventilator waveforms in Assist Control Mode.


Principles of Mechanical Ventilation 6: Phase variables

Content: A video on the 3 key phase variables: Trigger Variable, Limit Variable, and Cycle Variable.


Principles of Mechanical Ventilation 7: Calculating I:E ratio in Volume Control (VC)

Content: This video demonstrates how to calculate IE ratio, Ti, Te, and TCT in volume control.
It should be noted that some modern Ventilators allow Ti to be selected in “Volume Control”. Such modes are not truly volume control, but Pressure Regulated Volume Control (PRVC), or a version of it. We will cover PRVC in later videos.


Principles of Mechanical Ventilation 8: I:E ratio example 2 in VC constant flow

Content: This video builds, with another case upon Video 7. Second example of how to calculate I:E ratio in volume control with constant flow.


Principles of Mechanical Ventilation 9: Pressure Volume relationship in VC

Content: A video on the relationship between pressure and volume in volume control ventilation. A really important concept!
Key points:
1) Pressure is variable in volume control, the pressure generated will depend on the lung mechanics of the patient, the size of the breathing tube etc.. think of anything that changes COMPLIANCE or RESISTANCE
2) A high pressure alarm can be set to cycle high pressure breaths, this protects the lungs from the deleterious effects of high pressures
Compliance is key! Watch the video on compliance, up next.


Principles of Mechanical Ventilation 10: Compliance

Content: A video on lung compliance. Hopefully this will give you a good intuitive idea of what compliance is, and how it relates to mechanical ventilation.


Principles of Mechanical Ventilation 11: Modes – Pressure control

Content: This videos aims to provide and intuitive look at pressure control. This is simple an introduction to the pressure controlled breath delivery. We will be delving much deeper into the details later on.

Related homework: Inspiratory Time in Pressure Control: How to use the Flow Waveform! https://www.youtube.com/watch?v=8WzOqLg2j3E

resp review

I hope this serves as a gateway to Oli’s brilliant work. Please check out his other videos covering physiology topics related to ventilation. Oli has a talent for distilling the complex, into simplicity.

Hat Tip: I was first directed to Respiratory Review via the Critical Care Practitioner Podcast. Check out Jonathan Downham’s two interviews with Oli: