Prone positioning is likely to be one of the most intimidating things you’ll encounter in the ICU…the beds are big, they don’t provide instant access to your patient and the risk for complications is higher than in a standard bed. But, with excellent nursing care you can keep your patient safe without biting your fingernails down to the quick!
In this episode we talk about the basics of ARDS – Acute Respiratory Distress Syndrome. It is the most severe form of acute lung injury and is something we see pretty regularly in the MICU. Learn about the different stages that occur as ARDS develops, what you’re going to assess and how the patient is going to be treated in this episode of the Straight A Nursing Podcast.
ECMO (otherwise known as extracorporeal membraneous oxygenation) is essentially a life support measure used when the lungs or both heart and lungs cannot function adequately with traditional mechanical ventilation support. In ECMO, blood is drained from the body, diverted to an oxygenator where gas exchange takes place, then returned to the patient. There! Now you know everything you need to know about ECMO. Just kidding! Let’s start at the very beginning.
It’s your first shift of four-in-a-row and little do you know that you are in for a tough stretch! Your shift starts out calmly enough, but at 0200 you take report on a 23-yr old post-surgical trauma patient who came in through the ED due to a pedestrian vs auto incident. The patient was crossing the road on a dark, rainy night when she was struck by a vehicle at approximately 30 mph. Her injuries are:
Taking care of patients with neurological injury means managing their intracranial pressure, or as it’s commonly called, ICP. And when we say neurological injury, keep in mind that we’re not just talking about people getting bonked on the head with a 2 x 4. We’re talking about space-occupying lesions, hydrocephalus, intracranial hemorrhage, subdural/epidural hematoma, even severe hyponatremia…basically anything that’s a key player in (drum roll please….) the Monro-Kellie doctrine.
Knowing when you need to intubate a patient in respiratory distress is a key skill you will use regularly as a nurse. This skill applies across the board…not just ED or ICU. Nurses in all settings come into contact with patients who decompensate, and knowing when you need to intubate can mean the difference between life and death.
When you do your critical care clinical rotation, you will most likely be monitoring your patient’s CVP (central venous pressure). We’ll get into the what’s and why’s of CVPs in another post…for this post we’re going to talk about the basics of setting up the CVP line. With any luck you’ll get an opportunity to practice, so this should give you a wee bit of a head start. Note that I always say there is more than one way to skin a cat….if your preceptor sets up the lines differently, that is great…you’ll learn multiple ways and ultimately figure out the one that works best for you. Ok, let’s get going!
If you are in a critical care clinical rotation, or new to the ICU, you may hear the term “mixed gas” thrown around here and there. What is a mixed gas, why do you measure it, and what does it tell us about your patient?
“Mixed gas” is shorthand for an SVO2 measurement or “mixed venous gas,” which looks at the oxygen saturation levels of blood obtained from the pulmonary artery. However, not every ICU uses PA catheters regularly, but never fear…you can still get some usable data by using blood from the superior vena cava. Note that when the blood is drawn from a central line placed in the superior vena cava vs the PA catheter, the measurement is referred to as an ScVO2. In the ICU where I work, we don’t use PA catheters much , so our mixed gasses are typically taken from the superior vena cava and are used to obtain information related to severe sepsis and septic shock. Unless you are working in a cardiac-surgery ICU, your mixed gas measurements will most likely be done as ScVO2 and related to sepsis and/or shock, so that’s what we’ll focus on here.