New Grad Radio: Intensive Care & Emergency Nurse

Physiotherapists play such an essential role in the care of the patient within the Intensive Care Unit. On today's episode, I speak with Samantha Hagan. Sam was one of the first physio's I worked with as I started as a new grad nurse within ICU. Over those first few months I learnt an incredible amount from Sam. From the specific recruitment manoeuvres; to detailed chest auscultation; Chest X-Ray interpretation; and overall, the role of the physio within ICU. Sam does a great job in outlining the role of the physiotherapist within ICU; details the rationale of specific manoeuvres including Manual Hyperinflation, and Vibes; details the equipment used; and outlines strategies for how Nurses and Physio's can best work together.

Now that we've gone over the Modes & Settings, let's start talking about some of the most common alarms, what they mean, and what we could do about them as registered nurses. There is one alarm in particular, Peak Pressure (High Airway Pressures), that has the potential to lead to an airway emergency. I outline a systematic approach to assess the situation; how to escalate, and how to overcome. The key messages are: - If you're ever unsure: Ask - If the ventilator continues to peak pressuring, the patient is not ventilating during that time - If in doubt, call for back up, and hand bag the patient using the Bag Valve Mask attached to Oxygen 15L/min. 

Now you might notice, due to turning down the level of sedation, the patient may start to take a few more spontaneous breaths on their own. This is where Pressure Support Ventilation (PSV), another type of mode, comes into it.  In today's episode, I detail the setting of Pressure Support; and mention at what stage we may switch the patient from a 'Rate' (ie SIMV) to PSV; and highlight a few key things for nurses to keep an eye on when doing so.

Welcome back to another episode of the New Grad Radio podcast! Let's continue on with another episode on Mechanical Ventilation. As I mention in the episode, there are two broad concepts when considering modes - do we have full control and not wanting the patient to breath for themselves; or is that the intention, to allow the patient to take spontaneous breaths, and even take all breaths for themselves? Today's episode describes the modes used for patients who are not breathing for themselves; whilst the next episode features modes when the goal IS for the patient to take their own breaths. 

If you've had a look at the ventilator in action, you'll notice there are numbers that remain fixed, and that there are numbers that seem to change from breath to breath. This is because there are particular settings that we mandatorily 'set' for the ventilator to deliver to the patient; whilst then we monitor the section to see what the actual patient is doing/receiving. As mentioned I cover the majority of the absolute basics; yet there are some things I haven't covered yet. This will change in the coming episodes. Today we cover: - Tidal Volume (Vt) - Respiratory Rate (RR) - Positive End Expiratory Pressure (PEEP) - Fraction of Inspired Oxygen (Fi02) - Minute Ventilation (MV) - Peak Inspiratory Pressure (PIP)

Welcome back to another episode of the New Grad Radio podcast. This episode serves as the first of many to come, highlighting the foundational concepts of Mechanical Ventilation. As I mention, I am not an expert. But I know what it's like to have started as a grad two years ago, having never seen a ventilator, nor a patient requiring mechanical ventilation. Over the last few years, I've worked in an ICU that has one of the highest percentage of patients requiring mechanical ventilation in Australia - meaning most days I turned up to work, I was directly caring for patients on a ventilator. I remember what it was like to first stand in front of the ventilator, feeling a little overwhelmed, and learning absolutely everything from scratch. I remember the questions I had when I first started. It was only a few years ago. And I'll keep those at the forefront of my mind as I create the proceeding episodes. I'll attempt to keep each episode short, compact, and to the point. If you already have a decent foundation, please feel free to skip to the episodes you're interested in. For those who have never even seen a ventilator, i'll talk through everything I can, step-by-step; commencing with this episode, being the actual machinery of the ventilator; the components; and I highlight specific brands that I have personally worked with, to highlight that ventilators can come in all different shapes and sizes, and be used in different settings. I don't profess to be an expert on this. I'd just love to pass along some of the knowledge and skills I've developed over the last few years; teach it at a foundational level, for those nurses who may be expected to be using this equipment for the first time in the weeks to come. I'd love if you could keep me updated on what you think. Need more detail, going too fast, need more clarification, don't hesitate to send a message through to the New Grad Radio Podcast Facebook page.  

Welcome back to Part 2 on a two-part segment on Blood Gases. In this episode I highlight a basic, systematic approach to analysing a blood gas, including a discussion on ‘normal’ values, a process of contacting the doctors, and speak on some nursing interventions. As I mention in the episode, this is a topic you could cover for HOURS, but I really want to provide the absolute staples, so if you have never used a blood gases, it could give you at least a foundation. Resources: - Blood Gas interpretation game (HIGHLY recommend) - https://abg.ninja/abg - Roger from Med Cram does a great job on explaining the basics. This is episode 1. It's a multi-part series found on YouTube that starts light, and ends up going DEEPER each episode. Not a bad start with this one: https://www.youtube.com/watch?v=4wMEMhvrQxE - This is a nice step-by-step guide to ABG analysis by the American Thoracic Society.  Have a look towards the end of the page, as it lists conditions associated with the analysis. It goes one step further than most fundamental lessons, giving the 'so what': https://www.thoracic.org/professionals/clinical-resources/critical-care/clinical-education/abgs.php

Weclome back to another episodes of the New Grad Radio podcast. This is Part 1, of a two-part series on the fundamentals of Blood Gases. On today's episodes, I describe: - What is a Blood Gas - How to collect a Blood Gas - How to Run a Blood Gas - Differences between Venous and Arterial samples - What information does a Blood Gas provide. I hope you enjoy. If you have any questions, don't hesitate to send a message through.

In this episode, I break down the absolute basics of central lines. In particular I mentioned the features; talk over the purpose of the 'lumens'; and speak of some particular nursing considerations. 

Welcome to the first fundamental episode for season 3. Today, i'm going to be discussing Arterial Lines. Within the episode, I will break down: - What is an arterial line - The purpose of the arterial line - Components - Nursing Considerations - Troubleshooting Here are a few resources that you might find useful: - A NSW Training Package on a few of the concepts I discussed: https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0012/221214/haemodynamic_monitoring_LP_2008.pdf - For those of you who REALLY like to know the WHY, Deranged Physiology has you covered: https://derangedphysiology.com/main/cicm-primary-exam/required-reading/cardiovascular-system/Chapter%20760/normal-arterial-line-waveforms As always, if you have any questions or comments, please don't hesitate to send me a message on the New Grad Radio Podcast FB page.

I am proud to be an intensive care nurse. I absolutely loved starting my career within this setting. However I can only imagine the apprehension of the clinicians who are currently being rapidly 'up-skilled', in order to provide assistance to intensive care unit's across Australia, as we brace during this time period of the COVID-19 pandemic. Over the period of a year, I was fortunate to have been eased, and guided into what was my new role as a graduate nurse in ICU. I was provided the opportunity to learn, grow, hone my skills, and develop in a controlled way. I can only imagine what it would be like for the nurses, from a variety of clinical backgrounds, to absorb as much as possible, in order to feel 'safe' to work in what can be an intense, and highly stressful work environment. THIS is the purpose of Season 3 of the New Grad Radio podcast. I do not profess whatsoever to be an 'expert' in ICU. Two years is not a lot of time. There is SO much more to experience and learn to get to that stage. However for the purpose of 'starting' in ICU, and the challenges that come from starting in ICU, I know those feelings intimately. Over the course of Season 3, I hope to develop content that is relevant for these nurses about to step into this new role. I will speak of concepts that I feel confident and competent to talk about....and for more advanced concepts....I will be interviewing guests with far more exposure and experience. So welcome back to the New Grad Radio podcast. If you, or someone you know would like to request topics, please send through to the New Grad Radio Podcast facebook page. 

Welcome to the FINAL episode of the New Grad Radio podcast. It has been an absolute privilege to document my journey with you all over the past two years. Thank you so very much for following my progress. You have experienced the nerves of starting; hearing what I struggled with, what I found exciting, difficult, and new. Each step of the way, you see what I was thinking at the time. I truly hope I was able to capture the essence of what was my graduate experience. I wanted the emphasis to really be on 'documenting'. To not only provide the new and exciting; but also of the things that are realistic about starting at a registered nurse. As you have heard, being a nurse is not always easy. But I wouldn't have traded my experiences for anything! In this final episode, I talk about my final week; the opportunities that are available in both ICU and ED that I haven't experienced yet; and I make a BIG announcement of what i'm up to next. (Spoiler alert; you'll be able to follow my progress next year on another podcast...listen for more details). Thank you again for listening. This has been Ben Jenkins with, the New Grad Radio Podcast. 

Well, yesterday was my final shift within the Intensive Care Unit. I knew it was going to be an emotional day. Knowing this was the last day, within the unit where I started my career. But as you’ll hear, I couldn’t have had a more pleasurable, or validating experience to finish my time in the unit.

We are incredibly fortunate as registered nurses to work within a profession that can offer so much diversity. Whether you’re working in critical care areas such as intensive care, or emergency; in the operating theatre; on a cruise ship; in a prison; in rural and remote areas; as an educator; and the list can go on and on. There is one area of nursing that I believe a lot of people have thought of at one time or another; I know I certainly have; that can offer excitement, travel, autonomy, challenge and diversity, career progression, you name it, this job has it. On today’s episode, I'll be interviewing Nick Coleman-Hicks, who currently works as a Flight Nurse, with the Royal Flying Doctor Service. Hailing from Sydney, Nick has worked within areas such as Intensive Care, and Emergency, and has completed a variety of  post graduate qualifications including a Graduate Certificate in Critical Care Nursing; and a Graduate Diploma of Midwifery, and has gained some relevant experience practicing as a midwife, which is a vital skill to work with the RFDS. Today, Nick elaborates on how he got into nursing; his incredible career thus far; his experiences as a student midwife; the benefits of working in both ICU and ED; and goes into detail of what his job entails as a Flight Nurse with the RFDS.

Starting off as a registered nurse is a daunting experience, for a variety of reasons. Over the last two years, i’d like to think i’ve shared many of my own first hand experiences of these challenges with you. A particular area, that I struggled with, and I find a lot of graduate nurses struggle with, is understanding how to work with doctors. Now what I mean by that, is that it can often be an intimidating experience, of understanding how to present information to medical staff; knowing what doctor to relay information onto; understanding at what stage they would like to be notified; and exactly what they would like to be notified about. Even the simple act of picking up the phone, and speaking with the doctor is a lot harder than you’d think. So, that’s the purpose of today’s episode. Today, I'll be interviewing Lewis Robinson. Lewis Robinson studied a Bachelor of Medicine, Bachelor of Surgery at the University of Queensland, and is currently working as a Senior House Officer (SHO) within the Emergency Department, and has now started a rotation within the Intensive Care Unit.  I’ve worked besides Lewis for the past year now, and I've seen first hand just how motivated, caring, and switched on he is as a doctor. And a big reason i’ve asked Lewis to share his experiences on the podcast, is how approachable he is, and how well he works with nursing staff, and the entire interprofessional team. In today's episode, we cover: - What motivated Lewis to become a doctor - Lewis's journey through medical school, including the types of placements all medical students must complete - Lewis's Intern Year; with an explanation of the different 'levels', or the 'hierarchy' of doctors throughout Australia - The expectations placed upon said levels of doctors - and we round out the episode, with Lewis providing some golden tips for how nurses and doctors can work cohesively as a team.

With 3 weeks left to go, I’ve started to be allocated into more resus shifts. In today’s episode, I outline why I’ve been enjoying my time in this area, and break down an actual patient presentation to highlight what it is we actually do day-to-day.

Welcome back to another episode of the New Grad Radio podcast! November 19th marks International Men’s Day. In celebration, I interview Luke Yokota. Luke is a third year RN, and a fellow ICU nurse. Luke is the driving force behind the ‘Men in Nursing’ campaign through the Australian College of Nursing (ACN). Luke has also recently been nominated for Queensland Young Australian of the Year awards. Luke is a passionate nurse, and top bloke, and I can’t wait for you to hear from him today. Here is the link to check out Luke's Initiative: The Men in Nursing Campaign - www.acn.edu.au/men-in-nursing If you have any questions for either Luke, or myself, please don't hesitate to contact me via the Facebook page: search 'New Grad Radio'. 

A few weeks prior to leaving for my previous military nursing course, I commenced one day a week back into the ICU I worked in last year. In today’s episode, I detail my experiences of working in both areas, and provide some of my thoughts of some of the challenges, and positives, of working in ICU and ED.

Welcome back to another episode of the New Grad Radio podcast! What an incredible few weeks it’s been; I’ve recently returned from another 3 week military course. This time, it was specific to Nursing Officers. In today’s episode, I detail my experiences from the course, and briefly mention some facts about military nursing, in order to demystify what we do.

In today’s episode, I talk about my recent experience of working for the first time within the Resus area of the Emergency Department. I detail what happened on the day; along with mentioning a few similarities to acute and ICU, as well as why I’m thankful it’s been 9 months before heading into this area.