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CCM TUTORIALS
Ireland
Приєднався 10 лис 2022
This channel is aimed at healthcare professionals and students who want to learn more. It is hosted by me - Prof. Pat Neligan, of the Department of Anesthesiology & Critical Care, University of Galway, Ireland. The concept and content originated on a website called CCMTutorials that ran between 2001 and 2015, starting when I was at the University of Pennsylvania. Two things I want you to keep in mind: "I can teach you but I cannot learn it for you" and "You are entitled to your own opinion but not your own science." I will try to keep the material posted here as up-to-date as possible. Dogma is not tolerated. I try to keep things reasonably simple - do don't be put off if the tutorials appear a little basic for you - the level of complexity escalates and I guarantee that you will learn something - even in topics that you think you already know.
I hope you enjoy these tutorials. I am delighted to receive your feedback, particularly if it is positive!
I hope you enjoy these tutorials. I am delighted to receive your feedback, particularly if it is positive!
Cardiovascular Assessment 1: Heart Rate
This is the first tutorial in the cardiovascular assessment module. In the tutorial I discuss heart rate, how it originates and how it is controlled. This is principally a discussion about sinus bradycardia and sinus tachycardia.
I go on to discuss the parasympathetic nervous system and the sympathetic nervous system, how they function physiologically and how they are impacted by drugs that we administer and disease processes. I provide a detailed discussion of adrenoceptor agonists and antagonists.
@ccmtutorials
I go on to discuss the parasympathetic nervous system and the sympathetic nervous system, how they function physiologically and how they are impacted by drugs that we administer and disease processes. I provide a detailed discussion of adrenoceptor agonists and antagonists.
@ccmtutorials
Переглядів: 34
Відео
Chest Drains in ICU explained.
Переглядів 16014 днів тому
Most professionals working in the ICU have an ingrained fear of Chest Drains, because they feel that they don't really understand them. That is particularly true of those of us who grew up with bottles and then transitioned to multicompartment systems. This tutorial starts with a discussion of the physiology of pneumothorax and hemothorax, and then progressively visits one bottle, two bottle an...
Chest Imaging in ICU - Part 3 - Diseases of the Lung in ICU
Переглядів 100Місяць тому
This tutorial looks at common lung diseases that you will encounter on chest imaging in ICU. It includes a discussion about the extrapulmonary tissues - pleural and mediastinal and lung diseases (pneumonia, ARDS, PJP etc.). @ccmtutorials Description 00:07 Introduction 01:26 Pneumomediastinum 03:40 Pleural Effusion 06:23 Pneumoperitoneum 08:13 Pericardial Effusion 09:50 Left Atrial Hypertrophy 1...
Chest Imaging in ICU - Part 2 - Hardware
Переглядів 198Місяць тому
One of the reasons that we perform portable AP chest x-rays (CXR) in the ICU is to confirm the correct positioning of hardware: endotracheal tubes, central lines, feeding tubes, pulmonary artery catheters, pacemaker wires and chest tubes. This tutorial discusses the correct position of each of these devices and looks at malplacement and complications. The ideal location of the tip of the endotr...
Chest Imaging in ICU Part 1 - Anatomy, Lobar Collapse and Consolidation
Переглядів 126Місяць тому
When patients arrive in the ICU, as soon as they are settled, an AP portable chest x-ray (CXR) is ordered. That x-ray will look different from one done in the radiology department, as the patient is likely semi-recumbent, may be in expiration and the projection is different than from an CXR taken from the back. The lung has 5 lobes - three on the right and two on the left (the left lung is smal...
Assessing Mechanical Ventilation
Переглядів 163Місяць тому
This tutorial takes you through assessing the patient who is receiving mechanical ventilation (MV) in the ICU. It is very much a "crash course" and you can learn a lot more about MV by viewing my other tutorials. Nevertheless, I believe that I have, in 40 minutes, covered sufficient ground to help you manage a mechanically ventilated patient overnight. @ccmtutorials Description 00.00 Introducti...
Assessing Ventilation (Carbon Dioxide)
Переглядів 1032 місяці тому
This tutorial looks at the assessment of PaCO2 on the blood gas and how it interfaces with the pH and the Bicarbonate (HCO3-). The control of PaCO2 is a major physiological mechanism for maintaining homeostasis. CO2 production by the body must be balanced by CO2 elimination. PaCO2 rises when there is hypoventilation, this results in a fall in pH and an rise in HCO3 and this is called "Acute Res...
Assessing Oxygenation
Переглядів 1732 місяці тому
In this tutorial I look at the assessment of oxygenation in the critically ill patient. This includes a discussion about the PaO2/FIO2 ratio, the use of pulse oximeters and oxygen therapy techniques. The majority of patient who are admitted to ICU require targeted oxygen therapy during the course of their stay. This tutorial looks at how we assess oxygenation. The easiest method for assessing o...
Neurological Assessment in ICU
Переглядів 4672 місяці тому
This tutorial looks at neurological assessment in the ICU. It contains a discussion about the Glasgow Coma Scale, The Richmond Agitation Sedation Scale and CAM-ICU. I also cover the assessment of suffering (PAID) in critical care. @ccmtutorials
Assessing the Critically Ill Patient - Overview
Переглядів 1222 місяці тому
This is an overview of the assessment of the critically ill patient's data. @ccmtutorials
How to Examine the Critically Ill Patient 2
Переглядів 1103 місяці тому
This is the second part of the tutorial on clinical examination of the critically ill patient. Move on from the chest to the arms - are they symmetrical? Is the patient moving both arms? Any redness? What color are the fingers - any mottling? Are the fingertips necrotic? Palpate the arms and hands and feel the temperature - hot or cold? Feel the brachial and radial pulses. Move on to the abdome...
Examining the Critically Ill Patient - Part 1
Переглядів 1603 місяці тому
The Critically Ill Patient should receive a systematic head to toe front to back clinical examination each day. Before you start, stand at the end of the bed and take in the scenery. An experienced ICU doctor will acquire an enormous amount of information about a patient by eyeballing the monitor, looking at the patient's habitus, the machines, the other attached devices, infusion pumps etc. Th...
The Critical Care Patient's History
Переглядів 1963 місяці тому
You are standing at the end of the bed of a patient in the ICU. How do you go about obtaining the patient's medical history? This tutorial looks at the 4Ws of getting a history: Who - is this patient? Why - are they in ICU? What are their critical care problems? Where - are we going with this patient (what is our plan)? @ccmtutorials
Is 0.9% Saline Solution Harmful?
Переглядів 1493 місяці тому
Since the 1920s it has been known that administration of chloride rich intravenous fluids, characterized by a reduced Sodium to Chloride strong ion difference (SID), causes a progressive metabolic acidosis. This iatrogenic hyperchloremic acidosis was particularly problematic in the era before lactate and ketone measurement was widely available, prolonging critical care stay and resulting in, of...
Hyperchloremic Acidosis
Переглядів 3934 місяці тому
This tutorial covers the topic Hyperchloremic Acidosis (HCA). HCA is the only cause of "normal" anion gap metabolic acidosis and is almost always caused, in clinical practice, by excessive intravenous administration of isotonic saline (NaCl 0.9%) solution, most commonly as part of a diabetic ketoacidosis (DKA) "protocol". In the tutorial I explain that HCA is caused by a reduction in the Na-Cl ...
Euglycemic Ketoacidosis due to SGLT2 Inhibitions (Flozins)
Переглядів 3344 місяці тому
Euglycemic Ketoacidosis due to SGLT2 Inhibitions (Flozins)
Identifying the Critically Ill Patient
Переглядів 2754 місяці тому
Identifying the Critically Ill Patient
What is Critical Illness (Physiologic Reserve)
Переглядів 1455 місяців тому
What is Critical Illness (Physiologic Reserve)
Alcoholic And Starvation Ketoacidosis
Переглядів 1,6 тис.5 місяців тому
Alcoholic And Starvation Ketoacidosis
Proportional Assist Ventilation (PAV+)
Переглядів 5236 місяців тому
Proportional Assist Ventilation (PAV )
Further Thoughts About OSMOTIC DEMYELINATION (Central Pontine Myelinolysis)
Переглядів 3327 місяців тому
Further Thoughts About OSMOTIC DEMYELINATION (Central Pontine Myelinolysis)
Urinary Osmolality, Hyponatremia and Nutrition
Переглядів 1317 місяців тому
Urinary Osmolality, Hyponatremia and Nutrition
Careful Sodium Correction and Osmotic Demylination Syndrome
Переглядів 787 місяців тому
Careful Sodium Correction and Osmotic Demylination Syndrome
The Syndrome of Inappropriate Antidiuresis (SIADH) & Cerebral Salt Wasting
Переглядів 3467 місяців тому
The Syndrome of Inappropriate Antidiuresis (SIADH) & Cerebral Salt Wasting
Thanks for your work explaining this. I think moles are an inadequate unit for the task they are attributed with. Nevertheless, I appreciate the benefits of the estimations they furnish. I appreciate your work. The video was well spoken although I felt the calcs were done too fast.
4:55 "brainless application..... "🤣🤣🤣🤣🤣🤣🤣🤣
Thank you so much ❤
Great tutorial! Both new information and review. Also reminded me of my undergrad days when I had pre-exam "Krebs nightmares"!
Absolutely brilliant! Thank you 🤓
The severity of the hypoxemia defines the severity of the ARDS: -Mild ARDS - The PaO2/FiO2 is >200 mmHg but ≤300 mmHg on ventilator settings that include positive end-expiratory pressure (PEEP) or CPAP ≥5 cm H2O. Alternatively, the SpO2/FiO2 is >235 mmHg but ≤315 mmHg (if the SpO2 ≤97 percent)
Thank you so much for your excellent lectures. As an intensivist I have hearned a lot
Best,easily explained
Very informative. Thanks
Thank you for this explanation! How much salt can someone with SIADH consume at max?
Thank you for your excellent presentation. Why is your voice so sad during your lectures?
Thank you for your excellent presentation. I think the music in the background is producing sadness
Thank you so much. That was brief,effective and excellent
I was in the ICU for 11 weeks. I was told later that I was 'difficult to wean'. I had no idea the process was so complex. Thank you for explaining. From a patient perspective being ventilated for so long was:- exhausting because the nightmares made me afraid to fall asleep, frustrating and boring because I couldn't speak or move or eat, and ultimately terrifying when I spent the first night without the ventilator and every single breath was hard work.
hope all are fine now
@@ApulicaOfficial Thank you - I am
thank you
7 year survivor, semi para, speech, balance, no strength. Neuro-dr, apologized to my mom, dad and bro, while I was in COMA. Couple days later, same dr told my mom and dad that I was brain and asked for permission. Mother had to be hospitalyzed. Memory loss still. 1 month later, started waking up. My family went and talked to a lawpig, hospital had deleted. Erlanger Hospital ER, Chattanooga, TN. 90-94 USAF, NTM
Great tutorial Dr Nelligan, vital skills to learn
at time 6:52 I thought for bases if pkA of drug is less than pH of the environment its more ionized form predominates. in the video it seems like you are saying that a local basic anesthetic in an acidic environment will be ionized? can you clarify?
Any thoughts on CPM without having hyponatremia corrected. Na levels around 130.Other causes of CPM?
Very insightful presentation. I have really learnt a lot
Nice content sir. Learned something new.🎉
Thank you very much.
Thank you very much for this detailed and informative video.
What about elderly patients that have a c4 spinal injury thats on a vent? The dr is pushing a trach when the patient has been on the vent for 7 days. The patient was admitted conscious and breathing.
Thank you
Promo-SM
You're so awesome for taking the time to teach all this... amazing!
Great playlist, Thank you so much Professor. You have a new student in Morocco.
Why When we using ATC in VC mode have constant inspiratory flow can't use it at mandatory breath which I read the Drager V600 manual told me. sorry for poor english😢
Properly set tube diameter or check your flow sensor, might need replacement or check airway patency even the circuit
Hi can u tell me what is low lung aeration?
Keep doing it..
SIMV mode on Hamilton vent that gives total breaths, how do you determine patient's spontaneous breaths
E X C E L L E N T
Awesome, please keep on sharing your knowledge
Thanks - I appreciate the positive comment