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. 

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

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. 

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.