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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!
Diagnosis and Management of Septic Shock
This tutorial looks at the identification and management of the patient with septic shock. Based, principally, on the Surviving Sepsis guidelines, I do sprinkle some of my own opinions into the mix.
Description
00:00 Introduction
01:10 Clinical Scenarios
05:48 Definitions
07:14 Pathophysiology
11:34 Screening for Sepsis
16:44 Septic Shock - Vasoplegia, Multiorgan Failure and SOFA score
19:10 Lactate as a Screening Tool
23:50 Managing the Patient with Septic Shock in 10 Steps
36:10 Review and Preview
@ccmtutorials
Description
00:00 Introduction
01:10 Clinical Scenarios
05:48 Definitions
07:14 Pathophysiology
11:34 Screening for Sepsis
16:44 Septic Shock - Vasoplegia, Multiorgan Failure and SOFA score
19:10 Lactate as a Screening Tool
23:50 Managing the Patient with Septic Shock in 10 Steps
36:10 Review and Preview
@ccmtutorials
Переглядів: 65
Відео
Hypovolemic Shock
Переглядів 101Місяць тому
This tutorial looks at hypovolemic shock - how to understand it, assess it and treat it. @ccmtutorials
Hypotension and Shock and Working the Problem
Переглядів 88Місяць тому
This tutorial looks at the problems of Hypotension and Shock. I define the difference between the concepts - not all hypotensive patients are shocked and not all shocked patients are hypotensive. I then go through a system for exploring the hypotensive or shocked patients' status to determine the underlying problem - illustrated by a series of clinical scenarios. @ccmtutorials
What is BP and How To Measure It
Переглядів 84Місяць тому
One of the most common physiologic and pathologic abnormalities that we get called for is dysfunctional blood pressure: hypotension and hypertension. This tutorial looks at the question - "What is Blood Pressure" the components and its regulation. I then go on to discuss arterial pressure monitoring, invasive (via arterial lines) and non invasive (using oscillometers) and the strengths and weak...
Pulse, Pulsatility Index and Pulse Pressure Variation
Переглядів 1192 місяці тому
This tutorial looks at the pulse, what it is, the waveform and how that reflects systole and diastole. I then go on to look at the pulse waveform on pulse oximeters and the pulsatility index. Finally, I discuss the essential topic of Pulse Pressure Variability. @ccmtutorials
Cardiovascular Assessment 1: Heart Rate
Переглядів 1052 місяці тому
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 ...
Chest Drains in ICU explained.
Переглядів 2303 місяці 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 1193 місяці 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 2214 місяці 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 1664 місяці 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 2184 місяці 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 1454 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 2754 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 1,1 тис.5 місяців 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 1525 місяців 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 1565 місяців тому
How to Examine the Critically Ill Patient 2
Examining the Critically Ill Patient - Part 1
Переглядів 2135 місяців тому
Examining the Critically Ill Patient - Part 1
Euglycemic Ketoacidosis due to SGLT2 Inhibitions (Flozins)
Переглядів 5247 місяців тому
Euglycemic Ketoacidosis due to SGLT2 Inhibitions (Flozins)
Identifying the Critically Ill Patient
Переглядів 3627 місяців тому
Identifying the Critically Ill Patient
What is Critical Illness (Physiologic Reserve)
Переглядів 1777 місяців тому
What is Critical Illness (Physiologic Reserve)
Alcoholic And Starvation Ketoacidosis
Переглядів 2,3 тис.8 місяців тому
Alcoholic And Starvation Ketoacidosis
Proportional Assist Ventilation (PAV+)
Переглядів 6869 місяців тому
Proportional Assist Ventilation (PAV )
i liked it ..... thanks
Superb = outstanding presentation, useful material
Excellent explanation for avoiding over use of crystalloids.
Thank you!
Thank you for the wonderful video Prof.Neligan.Its really informative .
Your typhoon show was a diversion, though I managed already, meaning you have the backings of hi tech group clouds manipulators and aliens Extra- Terrestials to whatever species, too late for them, they're scouted, wrong mistake their alien mother spaceships and alien planets shall explode instantly a programmed event in time. Let it be
All ammos, missiles, torpedoes used, fired and launched and aircrafts casualties if ever used in warfare invasion of the forces of the CaesarKing to U.K create inventory and quick replacement double the number in weapons replacements in manufacturing facilities of the CaesarKing, energy to money conversion now ordered as funds and from the troops financial funds allocations and additional money funds from the space mining funds from the CaesarKing space force budgeted for my forces be quickly allocated my AI Quantum Satellites and my forces budget committee. Let it be
My tech and specialized armies and lethal weapons of the CaesarKing I, invade United Kingdom, now! A dose of your medicine backfired to you George Clooney, I think you're done. Space Weapons and 150 Stealth fighter jets of the CaesarKing with it's commanded attack missile drones and 1,000 cruise missiles to rain to targets, quick deployments and movements, attack by layers to whichever direction all domain strategy. Now I know your intention for trap layed with your other connivees. You can never win Abaddon against the CaesarKing I. invade! Let it be
awesome stuff. are L and D isomers reversed?
Thank you so much for your excellent presentation I learned a lot of new things as an intensivist and thank you too for changing the background music at the end of the presentations. I wish you the best
Great stuff - this isn’t in the acid base playlist
Would love it if you did more pharmacology and pKa stuff, to make learning it easier! For eg, does the pKA and protein binding of pressors and inotropes make a difference? What about paralytic agents?
Thank you for your excellent presentation.May I ask you to change the background music that you put at the end of presentations cause it is so sad as your voice is.
once again thank you so much the whole world needs you HEALTHCARE personnel or not. Not only an added KNOWLEGDE but you execute the value of your teaching effectively.
Very informative and clearly explained 👍
your extraordinary amazing -
Hi Could I please contact you to discuss this further ? I was the victim of an NHS cover up where I lost 50% of my eyesight due to this condition, the neuro at the time mentioned it as the likely cause in my notes but this was never communicated to me, I only found out after I requested my notes. Currently looking for someone who knows about the condition to answer a few questions as I’m building my case. If you could help could you please give me your email? I am based in Northern Ireland. Thanks!
VC/PC/PSV are all closed-loop modes of mechanical ventilation. For example, in pressure support, flow is maniupulatd to maintain a preselected pressure. Furthermore, how would a ventilator know what parameters/alarm limits if it was an "open system." I think the term you are looking for is "automated" closed-loop control.
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