The CRNA Club Podcast

The oxygen hemoglobin dissociation curve shows how full hemoglobin is with oxygen at each oxygen pressure. We read the normal S-shaped curve, then see how heat, acid, CO2 and DPG slide it right, and how cold, alkalosis, low CO2, low DPG, fetal hemoglobin and carbon monoxide slide it left. From there we move to oxygen content and delivery, and finish with what a pulse ox reads and what it misses, including carbon monoxide and methemoglobin. RESOURCES FOR THIS EPISODE: Grab the free Oxygen Hemoglobin Dissociation Curve Study Guide KEY POINTS: Why the curve is an S: each hemoglobin carries up to four oxygen molecules, and binding the first makes the next easier The flat top and steep middle: a PaO2 of 100 gives a sat near 97 or 98 percent, 60 gives about 90, and 40 gives about 75 Anchor points: a sat of 90 is about a PaO2 of 60, 75 is about 40, and 50 is about 27, the P50 Right shift causes: heat, acid, more CO2 and more 2,3 DPG, and the Bohr effect Left shift causes: cold, alkalosis, low CO2, low DPG, fetal hemoglobin and carbon monoxide Why the same sat of 90 sits on a different PaO2 in a hot, acidotic patient and a cold, alkalotic patient Oxygen content: 1.34 times hemoglobin times the sat, plus 0.003 times the PaO2 A hemoglobin of 15 versus 7.5 at the same sat of 97 percent, and why delivery is cardiac output times content times 10 What the pulse ox measures, and why a sat of 100 on oxygen could be a PaO2 of 150 or 400 Hypoventilation on oxygen: the sat holds while the CO2 climbs Carbon monoxide, co-oximetry and treatment with 100 percent oxygen Methemoglobin, benzocaine, nitroglycerin and nitroprusside, and the pulse ox reading near 85 percent FREE RESOURCES TO HELP YOU ON YOUR CRNA JOURNEY: Transcript Analyzer - See your cumulative, science, and last-60-credit GPAs 9-Step Application Checklist - Work through the CRNA school application process in order CRNA School Database - Search and compare CRNA programs Certification Planner - Build a CCRN, CSC, or CMC study schedule around your shifts Timeline Generator - Build a personalized CRNA application timeline Try The CRNA Club free for seven days - Explore the all-in-one CRNA school application platform. Follow The CRNA Club: Instagram: @thecrnaclub YouTube: The CRNA Club Website: thecrnaclub.com Share this episode with an ICU nurse preparing for CRNA school.

Sepsis and septic shock start with an infection and the body's dysregulated response to it. Sepsis is life-threatening organ dysfunction, a SOFA rise of 2 points or more from the patient's baseline. Septic shock is sepsis where the pressure and the cells both fail. Recognizing it early starts the one-hour bundle early. We follow sepsis down to the cellular level, then match each bundle step to the part of the blood pressure equation it treats. RESOURCES FOR THIS EPISODE: Grab the free Sepsis Study Cheat Sheet KEY POINTS: How sepsis is defined and how the SOFA score counts organ dysfunction Septic shock: a pressor to hold a MAP of 65 or higher and a lactate above 2 millimoles per liter The one-hour sepsis bundle, step by step Why MAP equals cardiac output times SVR, and the three places sepsis lowers it PAMPs, DAMPs, TLR4, nitric oxide, cyclic GMP and the glycocalyx Venous pooling, capillary leak and septic cardiomyopathy Microcirculation, mitochondria and why lactate rises Cultures, antibiotics, source control and fluid resuscitation at 30 mL/kg Norepinephrine, vasopressin, epinephrine, dobutamine and hydrocortisone FREE RESOURCES TO HELP YOU ON YOUR CRNA JOURNEY: Transcript Analyzer - See your cumulative, science, and last-60-credit GPAs 9-Step Application Checklist - Work through the CRNA school application process in order CRNA School Database - Search and compare CRNA programs Certification Planner - Build a CCRN, CSC, or CMC study schedule around your shifts Timeline Generator - Build a personalized CRNA application timeline Try The CRNA Club free for seven days - Explore the all-in-one CRNA school application platform. Follow The CRNA Club: Instagram: @thecrnaclub YouTube: The CRNA Club Website: thecrnaclub.com Share this episode with an ICU nurse preparing for CRNA school.

The autonomic nervous system controls heart rate, blood pressure, airway size and secretions. It has two branches. The sympathetic branch is fight or flight and releases norepinephrine onto alpha and beta receptors at the organ. The parasympathetic branch is rest and digest and releases acetylcholine onto muscarinic receptors. Every ICU drip works at the transmitter, the receptor or the cell. We follow the signal from the brain to the organ, then tie each receptor to the drips you hang. RESOURCES FOR THIS EPISODE: Grab the free Autonomic Nervous System for ICU Pharmacology Study Guide KEY POINTS: How the sympathetic and parasympathetic branches differ Transmitter, receptor, cell: the three steps behind every drip Why one sympathetic signal reaches many organs while a parasympathetic signal stays local Alpha 1, beta 1 and beta 2 in the vessels, heart and airways M2 and M3, atropine, glycopyrrolate, albuterol and ipratropium Phenylephrine, norepinephrine, epinephrine, dobutamine, dopamine, vasopressin and milrinone Why the heart rate often drops on phenylephrine Dexmedetomidine, beta blockers, diltiazem, adenosine and digoxin FREE RESOURCES TO HELP YOU ON YOUR CRNA JOURNEY: Transcript Analyzer - See your cumulative, science, and last-60-credit GPAs 9-Step Application Checklist - Work through the CRNA school application process in order CRNA School Database - Search and compare CRNA programs Certification Planner - Build a CCRN, CSC, or CMC study schedule around your shifts Timeline Generator - Build a personalized CRNA application timeline Try The CRNA Club free for seven days - Explore the all-in-one CRNA school application platform. Follow The CRNA Club: Instagram: @thecrnaclub YouTube: The CRNA Club Website: thecrnaclub.com Share this episode with an ICU nurse preparing for CRNA school.

How to read an EKG comes down to five steps in the same order on every strip: rate, rhythm, intervals, axis, then ST segments and T waves. The first three steps read time. The last two read voltage and need a 12-lead. At 25 millimeters a second, one small box is 0.04 seconds. We finish by applying all five steps to one 12-lead EKG. RESOURCES FOR THIS EPISODE: Grab the free ECG and ICU Waveforms Cheat Sheet KEY POINTS: Rate: 300 divided by the big boxes between R waves, or 1500 divided by the small boxes when the rate is fast Rhythm: find it by looking at the P waves Spotting atrial fibrillation, atrial flutter, junctional rhythm, PACs and PVCs Intervals: measure the PR, QRS and QT, and correct the QT to the QTc Telling first-degree, Wenckebach, Mobitz II and third-degree block apart Axis from lead I, aVF and lead II Reading ST elevation, STEMI versus non-STEMI and T wave changes A normal EKG: sinus rhythm at 60 to 100, PR 0.12 to 0.2 seconds, and an axis between negative 30 and positive 90 degrees FREE RESOURCES TO HELP YOU ON YOUR CRNA JOURNEY: Transcript Analyzer - See your cumulative, science, and last-60-credit GPAs 9-Step Application Checklist - Work through the CRNA school application process in order CRNA School Database - Search and compare CRNA programs Certification Planner - Build a CCRN, CSC, or CMC study schedule around your shifts Timeline Generator - Build a personalized CRNA application timeline Try The CRNA Club free for seven days - Explore the all-in-one CRNA school application platform. Follow The CRNA Club: Instagram: @thecrnaclub YouTube: The CRNA Club Website: thecrnaclub.com Share this episode with an ICU nurse preparing for CRNA school.

The coagulation cascade is the chain of clotting factor steps which ends in thrombin. Thrombin cuts fibrinogen into fibrin, the mesh holding a clot together. The extrinsic and intrinsic pathways both meet at factor 10, and the PT and aPTT time how long fibrin takes to form after each pathway starts. We start with a question: why does a patient on Plavix bleed when the platelet count, PT and aPTT are all normal? Then we follow the cell-based model from injury to fibrin, and read each test and each drug against it. RESOURCES FOR THIS EPISODE: Grab the free Anticoagulation Cheat Sheet KEY POINTS: Extrinsic pathway: tissue factor plus factor 7 activates factor 10, and three plus seven equals ten Intrinsic pathway: the order is 12, 11, 9 and 8, which also reaches factor 10 Common pathway: 10, 5, 2 and 1, with factor 13 cross linking the fibrin Platelet adhesion, activation and aggregation, and how aspirin and clopidogrel block them for the 7 to 10 day life of a platelet The cell-based model: initiation, amplification and propagation Why missing factor 8 or 9 causes hemophilia bleeding Antithrombin, protein C and plasmin as the brakes on clotting How the PT, INR and aPTT work, with typical values of PT 9.5 to 12.5 seconds, INR 0.9 to 1.1 and aPTT 25 to 37 seconds Heparin, enoxaparin, HIT and protamine reversal Warfarin, vitamin K and four-factor PCC reversal Direct oral anticoagulants, argatroban and Praxbind FREE RESOURCES TO HELP YOU ON YOUR CRNA JOURNEY: Transcript Analyzer - See your cumulative, science, and last-60-credit GPAs 9-Step Application Checklist - Work through the CRNA school application process in order CRNA School Database - Search and compare CRNA programs Certification Planner - Build a CCRN, CSC, or CMC study schedule around your shifts Timeline Generator - Build a personalized CRNA application timeline Try The CRNA Club free for seven days - Explore the all-in-one CRNA school application platform. Follow The CRNA Club: Instagram: @thecrnaclub YouTube: The CRNA Club Website: thecrnaclub.com Share this episode with an ICU nurse preparing for CRNA school.