Thank you for checking out my video. Follow me on Twitter and Instagram @eddyjoemd Twitter: twitter.com/eddyjoemd Instagram: instagram.com/eddyjoemd Books I recommend for ICU Beginners. Marino's The ICU Book: amzn.to/2M2oFVm The Washington Manual of Critical Care: amzn.to/2MfmDR4 The Ventilator Book: Second Edition: amzn.to/2BYbyhK The Advanced Ventilator Book: amzn.to/2nhvyTY Essentials of Mechanical Ventilation: amzn.to/2vqQAnF @eddyjoemd is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com I haven't been making as many videos as of late because I've been using my time to learn more about how to invest my money myself. I have found the following books very helpful along the way. These are affiliate links and I will make a small commission if you buy something from Amazon after you click on a link listed below. Rule #1: The Simple Strategy for Successful Investing in Only 15 Minutes a Week! by Phil Town amzn.to/2Ql27kW Invested: How Warren Buffett and Charlie Munger Taught Me to Master My Mind, My Emotions, and My Money (with a Little Help from My Dad) by Danielle Town amzn.to/2Usevy9 Payback Time: Eight Steps to Outsmarting the System That Failed You and Getting Your Investments Back on Track by Phil Town amzn.to/2UvGb56 The Dhandho Investor: The Low-Risk Value Method to High Returns by Mohnish Pabrai amzn.to/2EoYRi2 The Education of a Value Investor: My Transformative Quest for Wealth, Wisdom, and Enlightenment by Guy Spier amzn.to/2EoYSCC The Little Book That Still Beats the Market by Joel Greenblatt amzn.to/2QtLaVO One Up on Wall Street by Peter Lynch amzn.to/2XsqNrA Invest Like a Guru: How to Generate Higher Returns At Reduced Risk With Value Investing by Charlie Tian amzn.to/2ED7dBu
Starts off speaking about generalities 5:43 : The one liner is what grabs your attention 6:45 : The overnight events 7:33 : The vital signs. Do not read, show some critical thinking. How are the signs and why. Is there any important info to add? 11:36 : I’s and O’s (intake and output). Over the last 24h and balance over hospitalization. Urinary output hourly is an early predictor of improvement/ worsening. Analyze why positive or negative I/O. 13:48 : Ventilator basic information (P or V, mode, driving pressure, Fio2, PEEP, RR, TV) 15:38 : Labs. Don’t just recite them. Talk about trends. 22:55 : Culture data 23:45 : Imaging 25:05 : tubes, lines and catheters 26:40 : physical exam 29:00 : assessment and plan
YOU ARE MY HERO!!!!! I happened to find this video the night before my first ICU rotation and I made a couple notes about what to include and the best order of presenting. I was complemented by my attending on what a wonderful job i did, and it's all thanks to you!!
+ilovearizona that's great news! I'm thrilled to hear that I was able to help. That's the purpose of all this, of course. Share this with your co-residents and leave a thumbs up. Let me know if there's anything else you need help with and I can shoot the videos. The vent talk is in the works!
I am a nurse, and this is how we must give report to the MD in morning rounds lol Thank you Dr Eddy Joe for the awesome presentation, This is super helpful for the newbie nurses too who need to know what we must tell the intensivist.
Well explained! This video has made me so much more comfortable to give report during rounds, as a new grad in the MICU. Great breakdown of stating trends instead of just blurting out numbers. Makes so much more sense, and just helps bring the bigger picture together smoothly. Definitely saving this video into "favorites"!
THANK YOU, my name is abdullah from saudi arabia , i was watching y during my residency , this is my first month in my fellowship program , you were one of the reason i started ICU fellowship , thank you i know posting video take alot of time , but it helps a lot of doctors
I am in my first 10 days of ICU, intern....Yesterday our pulm-crit attending asked me in ICU during the " is it your first month in ICU" I was like "yes",,, he said try to be structured during presenting pt... The same night I hit your video and rock today,, its 5 am in morning now.... Thx alot,,,,
+johana gimenez that's a great idea. I've started writing it in my head. I've been collecting diagnoses for ICU admissions to use as examples for the video. I'll work on it soon enough. Thanks!
Today is my 14th days of ICU... still struggling on how to present the case more structurally and efficiently. Your video saves my life! Really appreciate! Looking forward to more videos!
Exactly the type of presentation I like when I round in the ICU! Thank you for teaching this important skill to Medical Students, Interns, Residents, Physician Assistants and Nurse Practitioners the right way!
As an RN this was incredibly helpful in understanding the multidisciplinary regard of presenting, this helps us know what you may need from us to help the pt. Improve outcome
I am a cardiologist from Argentina and I am rotating through icu and this information is very useful for me. very clear in your explanation. Thank you very much for the video.
Thanks for watching my talk and all the feedback. I'm working to improve this channel constantly. Please share with your friends and colleagues. Click the thumbs up button and subscribe! -EJ www.eddyjoemd.com
This is great for ICU RNs at non-academic hospitals (formerly me, now MS2). I had good experiences with the physicians helping me build my skills, but this is an EXCELLENT primer. I’m definitely voting for an Assessment/Plan video!
I am in my first week as a new grad ACNP on the CVICU. Needless to say, I'm struggling with presenting on rounds and your video helped so much! It is still overwhelming but I will be able to organize my thoughts better after watching this. Thank you so much!
My pleasure! Keep on striving to get a little better every day. Just having the initiative to look for videos to make yourself better is remarkable. Best of luck!
Super great tips even for a nursing student. I loved the part about the seemingly normal creatinine yet not so normal. I learned to always look at trends and try to understand them. Then notify the physician :)
That's what differentiates the good nurses from the great ones. My staff is phenomenal where they always try to beat me to noticing these things. Some even have a plan ready for me when they notify me of the abnormality. That gets them first bumps, high fives, and side-hugs.
Very helpful video, thank you! I don’t know why anyone else hasn’t noticed it, maybe your audience is younger, but I have to say that you really look like Ricky Martin but even better!
I really enjoyed watching your channel. I am a graduating IMG and wasn't sure if I wanted to go into IM, and that is mainly because I hated attending clinics seeing healthy patients with minor complaints. It was great learning about CCM. Thank you very much, and I hope to meet you one day. Good luck with your channel. Te deseo lo mejor doctor y que le vaya muy bien.
The part this video left out was introduction of staff. Otherwise if a traveler or new employee you have no idea who is even standing there in front of you on the rounding team. Every hospital does not do rounding the same. Also if your shift report from the previous nurse was terrible it makes rounding more difficult as far as the night before. If you’re sent to 3 different units before 10 am that’s killer to try to do effective rounding because you’re already behind and scrambling to look up data that you didn’t get from the night nurse. I can’t stress how important introductions are now that we have high staff turn overs of not only nurses but physicians and new travelers all the time. The most difficult part of being a travel icu nurse is being moved around several units even in the same morning and no one giving a basic introduction of who they are and their position. This can make rounding stressful. Also, at some hospitals they don’t even orient travelers to their rounding process at all. Please someone stress the importance of introductions of team members.
Thank you for this video. I’m on my last week of preceptorship in the ICU haven’t felt so confident with rounds, will definitely utilize this format thanks !
Thank you! I don't know if you do this in other videos but make sure the board is readable, as I can't make out anything on it. Regardless, I got all of the info from your talk. This is going to be so useful for my ICU rotation coming up!
+hailthefsm i appreciate your feedback and thanks for watching. I just moved so i lost the room with the board. I need to come up with something for future videos that is more legible, perhaps a screen with a PowerPoint behind me but not something overtly boring.
Fantastic! I am a nurse and also am trying to give the best report I can. Great tips. One only thing: we cannot see what is written on the board. Change lighting? Thank you! Can you make a video about how you make your decision to intubate your patient or not?
+terse2010 that's for watching and I'm glad my video helped. I'm getting away from the white board in my newer videos, new house and nowhere to hang it. I really can't make a video about that because so much goes into it. Also, that type of video can hold a significant amount of liability if I give some advice that's not completely accurate. At the end, I intubate when I know I have to intubate. Have I waited to long on certain people, definitely, but it's a skill that's constantly in development. Also, with the advent of HFNC and BiPAP, one can starve off a ton of intubations. Hope that sort of helps! Share with your nursing colleagues!
My pleasure! It took me quite a while to get this down myself bc I had diarrhea of the mouth and wanted to say everything at once. 🤮Practice practice practice!
I'm looking forward to making this video. Currently, the issue I'm having with making it is that I cannot get permission from my current hospital to film in the ICU and film their vents. I usually teach mechanical ventilation at the bedside. I'm going to try a few things with my residents and see if it's adequate to film and put on TH-cam. Thanks for watching!
Thanks for the video. I just did my first day in CICU as a PA student. I totally bombed my first presentation. I added so much unnecessary information and had the order all wrong. I got great feedback from the fellow that helped a lot. But I still felt really dumb. It looks easy and sounds easy but oral case presentation is almost an art form...LOL. I would like to request a video of "examples" of a bad case presentation (what a new student would do), and then a good presentation (what an experienced resident/fellow would do) of the same case. I think it would help to actually hear a really bad presentation and then a really good one. Does that make sense?
can you make a video about presenting a multiple co morbid complicated patient to a senior consultant at night over a phone call. - so it has to be brief but giving a proper idea
This is how I like to be presented a patient. Tell me first why you need me. "Dr, I am calling you because I am taking care of a patient who is in respiratory failure or shock or is about to code." Grab my attention. Then you can tell me about their co-morbidities that are leading to the problem at hand. I don't really care about a history of diabetes or if he's had a BKA if it's not pertinent to the reason why you're calling me. At one point I will switch from you talking to me asking questions to help me decide what the next step is. Every case is different but that's the gist. I can't speak for other specialties but, for example, when I call surgery, I tell them "I need you because of acute abdomen". Or "I need you to see this patient at some point today, not urgent, just a CYA thing". I recently called the GI doctor bc my patient needed an endoscopy and I said "I am calling you because this patient is going to need a scope for an upper GI bleed, but I need to finish resuscitating them first. Come by sooner rather than later. They're on dual anti-platelet therapy. I'm going to call IR to possible embolize the GDA if things get ugly fast." Be prepared to answer all their questions. Know the patient inside out.
Glad it helped. No, I do not expect the same from my nurses. I expect them to know the info before I get there but i don’t need them to tell me the info because I already reviewed everything before formal rounds. I made a video where I discuss what my workflow is like. It’s possibly different than most. When I get to the bedside for multidisciplinary rounds, I’ve already reviewed all the labs and results, examined the patient, covered almost everything that needs to be done. Rounds to me is just making sure everyone knows what the plans are and to give the nurses what they need to take care of the patients.
That's really helpful. I have a problem with presentation of cases (ICU patients) through a phone call to the consultant or attending physician especially during nights 😆. It is challenging because you have to give lots of information in a very concised time frame (specially if a new patient) and the consultant should take a decision based on that. Any advice?
That's where emotional intelligence and an awareness of your colleagues benefits you the most. Developing rapport with most of these folks, at least with them knowing what you look like, helps the most. For example, when I was a resident I knew all the attending physicians just because I say hello to everyone from the janitors to the hospital administrators. When I call someone for help, I usually say "Hello, I'm Eddy xxx and I'm calling you because I need help with X (dialysis, scope, ventilator issues, etc.). Right there it frames their mind where they seek details from the other info you give to justify the consult/question. I have found that to work best for me. I don't put in BS consults which also helps. I also have the patient worked up thoroughly when I make the calls so everything the consultant may want has already been ordered (except for the super expensive/perhaps unnecessary tests). I hope that helps out! You just need to figure out your strategy and test it out. Good luck!
Can you please make a vido on respiratory failure, types and management...Extremely thankful,,,,Its a headache for now.. ACS is fine and straight forward...EKG, Trop and hx = BB, ASA, Nitrostat, Fluid, lovenox, +/- statin, morphin,,, Boom !!!
+Sher Ali Khan I'd love to! Great suggestions! I recently finished fellowship, got married, moved, and am about to start my attending job so it'll take me a bit to make some more videos.
The plan is to do far more videos but time is my limiting factor, unfortunately. I built a schedule to get one done a month but a new job and finishing fellowship has been kicking my butt! Thanks for watching!
I wish you the best during your rotation. Let me know if something comes up that's not quite clear or where you need more elaboration. Share with your co-trainees!
It’s not hard. The majority of the data is learned by articles. The other stuff is in just a few easy to access books. It’s not ever day I have a big TH-camr on my page 😉💪🏼
That’s on my ever-growing to do list but I do plan on tackling it sometime this year. I do prefer, personally, a problem based approach more so than a systems based approach. Which would you prefer? I’d likely tackle both.
By the way , my consultant says many times that my endorsement is very bad , yea literally " very bad " , now am picking up all these information and it's just an hour before my next 8 pm round . I would dazzle him now ☻☻
It helps to get straight to the point. When I call my GI consultant, for example. I say more or less the following, in different terms of course: Hello, this is Eddy of Critical Care. I have a xx yo pt with a GI bleed (melena, hematochezia, or hematemesis) that needs (or does not need) a scope right now. They are hemodynamically stable (or unstable), clinically they look good or bad and will be ready for you within the next xx minutes. They have a hx of peptic ulcer disease and have been treating their back pain with ibuprofen. Hb is X, they've gotten 2 units of blood and 2 are cooking, they have great access and we can have vasopressors at the bedside to help you sedate the patient comfortably for the procedure without worrying too much about hemodynamics. Anything else you need before you come and take care of our patient? Then again, I am now an attending but once I earned the trust of my consultants as a resident or a fellow, life was a lot easier and it was a piece of cake to play nicely in the sandbox.
Enjoyed the video, but Damn! 30:20 with no details? All this from a dayshift nurse who has known the patient for an hour, while gathering two fists full of drugs for a 9AM pass? Why is this not a page on the EMR that nightshift can do, since they know the patient? Often times, from the nursing perspective, this is just a checklist for restraints, foley, VTE, line days, PUD, etc.
+harrykP9 I'm glad you enjoyed the video. What details should I add? Honestly my attention span is rather short so I can't watch a 30 minute video myself. Perhaps I can make a video on the details you're requesting. Regarding the checkout from nurses: just like you as the physician in the ICU needs to know big picture stuff first, the same applies to your nurses. They know exactly what they need to take care of their patient at 7:05 if they arrived at 7am. When I arrive at the hospital, as soon as I get checkout from my colleague, I take a lap and do a quick assessment and talk to every nurse. Good luck!
No I mean, that had you fleshed it out with vitals, labs, Hx, etc it would have gone longer. In my experience, rounds that Intensivists insist on are usually just a check list we go down and check off JCAHO and NPSG. My initial thoughts were "You don't want to know the vital signs or labs, but you don't know that they are on pressors?" I had thought this was for nursing, since that's what I had searched for, but you are including Interns and others. I love the idea of rounds, but for nursing, they are usually more frustrating than anything else. I just wish they could make a rounding page that would give everyone a snapshot of the patient. There are various kardex's and summary pages, but they all seem to leave things out or drown you in information. This was very informative, I guess I was just looking for a hack or formula that would cut out the superfluous part of rounding. Ultimately, it is heavily dependent on the doctor and what their morning has looked like so far. Thanks again.
Do the attendings really want us to turn off sedation for our exam? Because I believe the attending and resident will examine the pt as well. Then I will too. I can't imagine turning off sedation 3x for that, especially if the pt is vented or in pain
Short answer is yes. First of all, most patients who are on the vent should have daily sedation holidays where their sedation is held by default. If your institution isn't doing this already, it is recommended by the SCCM. Sounds like a quality improvement project you can tackle. One should be targeting a RASS score of zero for your vented patients (there are a few exceptions). That means a balance of analgesia to where the pt is vented, is awake and interacting with everyone, watching tv, but has no complaints other than the tube bothering in the back of their throat. It's an art more than a science with regards to achieving this, but it certainly is possible for 80% of pts if you do it right. Training nursing staff to be cool with this is also feasible given the willingness of staff to push the boundaries. My goal is to be able to walk past the rooms of my vented pts to check on them, call their name from the door, ask them if they're doing okay, and have them give me a thumbs up. That's a 5 second assessment AND informal neurological exam right there. Without turning off sedation, however many times during the day you want, you cannot do an appropriate neurologic exam. There have been numerous cases where a pt has been over-sedated and had a CVA that no one picked up on until it has been too late to intervene on it. If you turn off sedation, i.e. propofol gtt and the pt is in pain or anxious, then you need to make sure you have adequate analgesia on board. Let me know if this helps. Best of luck!
I think it would be horrible to be awake or semi-awake while on vasopressors, adrenaline -- liquid stress. I hate the hydralazine (more it getting the feeling of being on dose no-doz, and the 110 heart rate) and that's supposed to reduce blood pressure (it does a little, morphine worked much more).
Pts on vasopressors don't feel them. Their body isn't making enough endogenously so we supply enough to keep them alive, not over treat. I don't know in what context you're referring to using hydralazine. Morphine reduces blood pressure but in a completely inappropriate way for blood pressure management.
@@eddyjoemd oh okay, for some reason I thought you said that in your ABIM video haha sorry. You don't know me haha I used your video to help prepare for my IM-ITE!
It's a joke stemming from the point that if you think of it, you should hypothetically start the patient on argatroban and start the wild goose chase to see if they really do have HIT.
Far, but closer than yesterday. Your critical care nursing skills and experience will be immensely valuable when the time comes to put it into practice as an MD. You'll be leaps and bounds ahead of your peers. Save as much money as you can while you're working. You'll definitely need it. You'll get there!
Hello. For some reason your channel appeared on my YT feed. M.D., certified by 3 boards, including the ABIM & ABIM (CVD), staff & taught 1000 bed med. center and med. school. Good luck with your YT activities and practice.
Ah! You beat me by one board certification! Thanks for your contributions to the academic world. I passed up a couple academic jobs to stretch my legs on my own. I'm glad that there are physicians such as yourself.
I'm actually board-eligible in another specialty, too. While teaching I maintained a very active practice as well, including an abundance of critical care. I doubt that I would do it all again. Things are changing rather dramatically in medicine and I'm not sure those changes are for the best, but best of luck to you.
Haha I don't know why but I'm enjoying seeing ICU residents getting grilled by attendings every morning, some of them are getting red, nervous, or paled especially when they are getting blunt comments.
+drveronicasharma thanks! I will definitely consider your suggestion. I could definitely handle my colleagues though. I'm going to hammer out a bunch of videos in the upcoming months. Thanks for watching a,
How long is the intro ?Instead of telling us what you are gone to tell us , could you just telll it like : "Ladies and gentlemen , here is the way I do when .... First , I " Since there is a title to your video , one who click , knows what he is looking for .
Thank you for checking out my video. Follow me on Twitter and Instagram @eddyjoemd
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Books I recommend for ICU Beginners.
Marino's The ICU Book: amzn.to/2M2oFVm
The Washington Manual of Critical Care: amzn.to/2MfmDR4
The Ventilator Book: Second Edition: amzn.to/2BYbyhK
The Advanced Ventilator Book: amzn.to/2nhvyTY
Essentials of Mechanical Ventilation: amzn.to/2vqQAnF
@eddyjoemd is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com
I haven't been making as many videos as of late because I've been using my time to learn more about how to invest my money myself. I have found the following books very helpful along the way. These are affiliate links and I will make a small commission if you buy something from Amazon after you click on a link listed below.
Rule #1: The Simple Strategy for Successful Investing in Only 15 Minutes a Week! by Phil Town
amzn.to/2Ql27kW
Invested: How Warren Buffett and Charlie Munger Taught Me to Master My Mind, My Emotions, and My Money (with a Little Help from My Dad) by Danielle Town
amzn.to/2Usevy9
Payback Time: Eight Steps to Outsmarting the System That Failed You and Getting Your Investments Back on Track by Phil Town
amzn.to/2UvGb56
The Dhandho Investor: The Low-Risk Value Method to High Returns by Mohnish Pabrai
amzn.to/2EoYRi2
The Education of a Value Investor: My Transformative Quest for Wealth, Wisdom, and Enlightenment by Guy Spier
amzn.to/2EoYSCC
The Little Book That Still Beats the Market by Joel Greenblatt
amzn.to/2QtLaVO
One Up on Wall Street by Peter Lynch
amzn.to/2XsqNrA
Invest Like a Guru: How to Generate Higher Returns At Reduced Risk With Value Investing by Charlie Tian
amzn.to/2ED7dBu
My pleasure! I owe you a response to your other question.
Starts off speaking about generalities
5:43 : The one liner is what grabs your attention
6:45 : The overnight events
7:33 : The vital signs. Do not read, show some critical thinking. How are the signs and why. Is there any important info to add?
11:36 : I’s and O’s (intake and output). Over the last 24h and balance over hospitalization. Urinary output hourly is an early predictor of improvement/ worsening. Analyze why positive or negative I/O.
13:48 : Ventilator basic information (P or V, mode, driving pressure, Fio2, PEEP, RR, TV)
15:38 : Labs. Don’t just recite them. Talk about trends.
22:55 : Culture data
23:45 : Imaging
25:05 : tubes, lines and catheters
26:40 : physical exam
29:00 : assessment and plan
You’re the best. Thank you so much 🙏🏻
thanks for this video very helpful
Thanks 😊
thanks!!
Awesome explanations
YOU ARE MY HERO!!!!! I happened to find this video the night before my first ICU rotation and I made a couple notes about what to include and the best order of presenting. I was complemented by my attending on what a wonderful job i did, and it's all thanks to you!!
+ilovearizona that's great news! I'm thrilled to hear that I was able to help. That's the purpose of all this, of course. Share this with your co-residents and leave a thumbs up. Let me know if there's anything else you need help with and I can shoot the videos. The vent talk is in the works!
I am a nurse, and this is how we must give report to the MD in morning rounds lol
Thank you Dr Eddy Joe for the awesome presentation, This is super helpful for the newbie nurses too who need to know what we must tell the intensivist.
Glad you enjoyed it!
Well explained! This video has made me so much more comfortable to give report during rounds, as a new grad in the MICU. Great breakdown of stating trends instead of just blurting out numbers. Makes so much more sense, and just helps bring the bigger picture together smoothly. Definitely saving this video into "favorites"!
Glad you got something out of it! 💪🏼💪🏼💪🏼
THANK YOU, my name is abdullah from saudi arabia , i was watching y during my residency , this is my first month in my fellowship program , you were one of the reason i started ICU fellowship , thank you
i know posting video take alot of time , but it helps a lot of doctors
I am in my first 10 days of ICU, intern....Yesterday our pulm-crit attending asked me in ICU during the " is it your first month in ICU" I was like "yes",,, he said try to be structured during presenting pt... The same night I hit your video and rock today,, its 5 am in morning now.... Thx alot,,,,
+Sher Ali Khan very happy to hear this! Keep doing great!
Voting for a video of assessment and plan !!! Please. Thanks !!
+johana gimenez that's a great idea. I've started writing it in my head. I've been collecting diagnoses for ICU admissions to use as examples for the video. I'll work on it soon enough. Thanks!
Let’s go Eddy! We need the vid! Haha
Today is my 14th days of ICU... still struggling on how to present the case more structurally and efficiently. Your video saves my life! Really appreciate! Looking forward to more videos!
Glad I could help! Keep working hard and you'll get there!
This is super super helpful for me as a Nursing student on an ICU rotation .
Glad that it helped out, Jason. Share it with your classmates! 👍🏼
Exactly the type of presentation I like when I round in the ICU! Thank you for teaching this important skill to Medical Students, Interns, Residents, Physician Assistants and Nurse Practitioners the right way!
Thanks, Diego! Glad to see that I'm not the only one who likes my patients to be presented in this format.
As an RN this was incredibly helpful in understanding the multidisciplinary regard of presenting, this helps us know what you may need from us to help the pt. Improve outcome
I’m glad you found it helpful!
I am a cardiologist from Argentina and I am rotating through icu and this information is very useful for me. very clear in your explanation. Thank you very much for the video.
I’m glad that the content was helpful! Mucha suerte en la rotación!
I am starting my job as ICU resident, this Vedio is a jam , loved it
Thanks for watching my talk and all the feedback. I'm working to improve this channel constantly. Please share with your friends and colleagues. Click the thumbs up button and subscribe!
-EJ www.eddyjoemd.com
eddyjoemd directly to my interns, homework. #criticalthinking
too many ads
This is great for ICU RNs at non-academic hospitals (formerly me, now MS2). I had good experiences with the physicians helping me build my skills, but this is an EXCELLENT primer.
I’m definitely voting for an Assessment/Plan video!
I’m glad you’re getting something out of this, Andrew. Best of luck in your journey. The A/P video is in the works.
I am in my first week as a new grad ACNP on the CVICU. Needless to say, I'm struggling with presenting on rounds and your video helped so much! It is still overwhelming but I will be able to organize my thoughts better after watching this. Thank you so much!
My pleasure!!
I really enjoyed this video! I am a new nurse in ICU and this helped me a lot.
I am thrilled!
freaking out about starting micu tomorrow and this was a big help!
There's nothing abnormal about freaking out on your first day of anything. Do the best you can do and the next day do it better.
Thanks, this is great! I’ll keep your tips in mind when reporting to the attendings during interdisciplinary grand rounds at the ICU
My pleasure! Keep on striving to get a little better every day. Just having the initiative to look for videos to make yourself better is remarkable. Best of luck!
Super great tips even for a nursing student. I loved the part about the seemingly normal creatinine yet not so normal. I learned to always look at trends and try to understand them. Then notify the physician :)
That's what differentiates the good nurses from the great ones. My staff is phenomenal where they always try to beat me to noticing these things. Some even have a plan ready for me when they notify me of the abnormality. That gets them first bumps, high fives, and side-hugs.
Very helpful video, thank you!
I don’t know why anyone else hasn’t noticed it, maybe your audience is younger, but I have to say that you really look like Ricky Martin but even better!
Glad you liked the video! It’s possibly bc Ricky Martin is Puerto Rican and I’m his Cuban neighbor 🤣🤣. Thank you!
Thank you so much! I know this is meant for physicians and midlevels but as a new grad RN who starts in the MICU this fall this is so helpful!
I’m glad you found it helpful! Best of luck with the new gig, Andrea! Congrats on finishing your training
I really enjoyed watching your channel. I am a graduating IMG and wasn't sure if I wanted to go into IM, and that is mainly because I hated attending clinics seeing healthy patients with minor complaints. It was great learning about CCM. Thank you very much, and I hope to meet you one day. Good luck with your channel. Te deseo lo mejor doctor y que le vaya muy bien.
Muchas gracias!
Fantastic vedio sir very usefull and practical piece of information and you teaching style is also very good .
Thank you
The part this video left out was introduction of staff. Otherwise if a traveler or new employee you have no idea who is even standing there in front of you on the rounding team. Every hospital does not do rounding the same. Also if your shift report from the previous nurse was terrible it makes rounding more difficult as far as the night before. If you’re sent to 3 different units before 10 am that’s killer to try to do effective rounding because you’re already behind and scrambling to look up data that you didn’t get from the night nurse. I can’t stress how important introductions are now that we have high staff turn overs of not only nurses but physicians and new travelers all the time. The most difficult part of being a travel icu nurse is being moved around several units even in the same morning and no one giving a basic introduction of who they are and their position. This can make rounding stressful. Also, at some hospitals they don’t even orient travelers to their rounding process at all. Please someone stress the importance of introductions of team members.
I am grateful for your help.. I'll become more if you give us a video about assessment & plan
Thank you for this video. I’m on my last week of preceptorship in the ICU haven’t felt so confident with rounds, will definitely utilize this format thanks !
Best of luck!
This video has helped a ton...please make more...
Glad it helped! Always open to suggestions. Happy new year, btw!
Impressive, I m faculty in General Surgery in India, I use this each time I teach
Glad I could provide helpful content!
Thanks for sharing this tips. I love the details and examples you give. You seem a little anxious.. but that is Ok with thanks again
It was my first big video. I’ve been told I’m better now and trying to get better every videos. I’m glad you enjoyed the video and gained from it. 👍🏼
Thank you! I don't know if you do this in other videos but make sure the board is readable, as I can't make out anything on it. Regardless, I got all of the info from your talk. This is going to be so useful for my ICU rotation coming up!
+hailthefsm i appreciate your feedback and thanks for watching. I just moved so i lost the room with the board. I need to come up with something for future videos that is more legible, perhaps a screen with a PowerPoint behind me but not something overtly boring.
Great presentation, very much helpful for beginners 👏👏
Happy to help!
Fantastic! I am a nurse and also am trying to give the best report I can. Great tips.
One only thing: we cannot see what is written on the board. Change lighting?
Thank you!
Can you make a video about how you make your decision to intubate your patient or not?
+terse2010 that's for watching and I'm glad my video helped. I'm getting away from the white board in my newer videos, new house and nowhere to hang it.
I really can't make a video about that because so much goes into it. Also, that type of video can hold a significant amount of liability if I give some advice that's not completely accurate. At the end, I intubate when I know I have to intubate. Have I waited to long on certain people, definitely, but it's a skill that's constantly in development. Also, with the advent of HFNC and BiPAP, one can starve off a ton of intubations. Hope that sort of helps!
Share with your nursing colleagues!
This is a really helpful video! Thank you
My pleasure!
Any advice for a new-grad nurse going directly to the ICU?
That is fantastic, long time looking for such wonderful presentation. thanks a mill
+mohamed ali glad I could help!
Thanks for this video...ur explanation was really useful for me
+jerina elsa glad I could help!
Thank you , this is very helpful!!
I’m struggling with this now- thank you!
My pleasure! It took me quite a while to get this down myself bc I had diarrhea of the mouth and wanted to say everything at once. 🤮Practice practice practice!
eddyjoemd I have diarrhea too haha. I’ll keep practicing! 🙏
Awesome video! Thank you!
My pleasure!
Really helpful... thanks
My pleasure!
U r looking super fit ....thanks for the video
Thank you for this video. I found it to be very helpful. Can you make a video about ventilators, settings, how you choose them, ect?
I'm looking forward to making this video. Currently, the issue I'm having with making it is that I cannot get permission from my current hospital to film in the ICU and film their vents. I usually teach mechanical ventilation at the bedside. I'm going to try a few things with my residents and see if it's adequate to film and put on TH-cam. Thanks for watching!
Thanks for the video. I just did my first day in CICU as a PA student. I totally bombed my first presentation. I added so much unnecessary information and had the order all wrong. I got great feedback from the fellow that helped a lot. But I still felt really dumb. It looks easy and sounds easy but oral case presentation is almost an art form...LOL.
I would like to request a video of "examples" of a bad case presentation (what a new student would do), and then a good presentation (what an experienced resident/fellow would do) of the same case. I think it would help to actually hear a really bad presentation and then a really good one. Does that make sense?
Super helpful, thanks!
My pleasure
Great presentation
Thanks!
Thank You again
My pleasure again, Cesar! 😜
This was great 👍
💪🏼💪🏼💪🏼
Thank you so much! I wish I had discovered this sooner!
Glad it is helpful!
can you make a video about presenting a multiple co morbid complicated patient to a senior consultant at night over a phone call. - so it has to be brief but giving a proper idea
This is how I like to be presented a patient. Tell me first why you need me. "Dr, I am calling you because I am taking care of a patient who is in respiratory failure or shock or is about to code." Grab my attention. Then you can tell me about their co-morbidities that are leading to the problem at hand. I don't really care about a history of diabetes or if he's had a BKA if it's not pertinent to the reason why you're calling me. At one point I will switch from you talking to me asking questions to help me decide what the next step is. Every case is different but that's the gist. I can't speak for other specialties but, for example, when I call surgery, I tell them "I need you because of acute abdomen". Or "I need you to see this patient at some point today, not urgent, just a CYA thing". I recently called the GI doctor bc my patient needed an endoscopy and I said "I am calling you because this patient is going to need a scope for an upper GI bleed, but I need to finish resuscitating them first. Come by sooner rather than later. They're on dual anti-platelet therapy. I'm going to call IR to possible embolize the GDA if things get ugly fast." Be prepared to answer all their questions. Know the patient inside out.
@@eddyjoemd Thank you so much! This really helped! I will be using this apporach.
Great video 👍
Thanks!
Thanks. This really helps. Also, do you expect the same from your nurses during interdisciplinary rounds?
Glad it helped. No, I do not expect the same from my nurses. I expect them to know the info before I get there but i don’t need them to tell me the info because I already reviewed everything before formal rounds. I made a video where I discuss what my workflow is like. It’s possibly different than most. When I get to the bedside for multidisciplinary rounds, I’ve already reviewed all the labs and results, examined the patient, covered almost everything that needs to be done. Rounds to me is just making sure everyone knows what the plans are and to give the nurses what they need to take care of the patients.
thats was helpfull, thank you doc
+Ohood Abdulrazaq glad to be able to help!
That's really helpful. I have a problem with presentation of cases (ICU patients) through a phone call to the consultant or attending physician especially during nights 😆. It is challenging because you have to give lots of information in a very concised time frame (specially if a new patient) and the consultant should take a decision based on that. Any advice?
That's where emotional intelligence and an awareness of your colleagues benefits you the most. Developing rapport with most of these folks, at least with them knowing what you look like, helps the most. For example, when I was a resident I knew all the attending physicians just because I say hello to everyone from the janitors to the hospital administrators. When I call someone for help, I usually say "Hello, I'm Eddy xxx and I'm calling you because I need help with X (dialysis, scope, ventilator issues, etc.). Right there it frames their mind where they seek details from the other info you give to justify the consult/question. I have found that to work best for me. I don't put in BS consults which also helps. I also have the patient worked up thoroughly when I make the calls so everything the consultant may want has already been ordered (except for the super expensive/perhaps unnecessary tests). I hope that helps out! You just need to figure out your strategy and test it out. Good luck!
This was awesome, if your team is hiring NP’s, I will love to join, such a wealth of knowledge. Thanks for your time, great education.
Doesn't seem like we're hiring at this time. Got a great team with us at the moment but keep that motivation up and you'll learn a ton!
live-streamed ICU rounds...what is the meaning of it?...I am an architect ..and try to make a research about ICU during covid-19
With iv solumedrol can that lower WBC? I thought it can cause immunosupression.
seriously very helpful
+ali naqvi thank you! I look forward to making some more in the near future
Dr Eddy is going to keep you on your toes. 😂😂😂
Can you please make a vido on respiratory failure, types and management...Extremely thankful,,,,Its a headache for now.. ACS is fine and straight forward...EKG, Trop and hx = BB, ASA, Nitrostat, Fluid, lovenox, +/- statin, morphin,,, Boom !!!
+Sher Ali Khan I'd love to! Great suggestions! I recently finished fellowship, got married, moved, and am about to start my attending job so it'll take me a bit to make some more videos.
Very helpful, Thank you so much, I hope you continue uploading more videos !!!!! I'll be waiting 👍🏼👍🏼👍🏼👍🏼
The plan is to do far more videos but time is my limiting factor, unfortunately. I built a schedule to get one done a month but a new job and finishing fellowship has been kicking my butt! Thanks for watching!
Whats the 3 letter acronym we are not supposed to say during rounds? I didn’t get what he said 😢
HIT for heparin induced thrombocytopenia 😉
@@eddyjoemd Thank you, I am a new graduate nurse recently hired at ICU I am freaking out
One day at a time. That’s all you can do. 👍🏼
@@eddyjoemdthank you so much, you’re so kind ❤
Power intervals (make sure the sprints are at full level 20) on the bowflex max trainer keeps me off of diabetes medication.
Sweet! Anything to keep you off of medications is great!
Please do assessment
Useful video. ..fantastic
Thank you very much
My pleasure! Thanks for watching
Am a third year Anaesthesia training and tomorrow am starting my 3 month ICU rotation Johannesburg. ..through your video am going with A+ Confidence
I wish you the best during your rotation. Let me know if something comes up that's not quite clear or where you need more elaboration. Share with your co-trainees!
Definitely will let you know
Dude. We seriously are too much alike. I recommend ALL the same books. All of them. 😂
It’s not hard. The majority of the data is learned by articles. The other stuff is in just a few easy to access books. It’s not ever day I have a big TH-camr on my page 😉💪🏼
Can you do a video on assessment and plan? Let’s say septic shock
That’s on my ever-growing to do list but I do plan on tackling it sometime this year. I do prefer, personally, a problem based approach more so than a systems based approach. Which would you prefer? I’d likely tackle both.
Oh i gave u just now a thumb lol. Great .. so beneficial for my PICU rounds
I'm glad you got some benefit out of it! Also, thanks for the subscription! Best of luck
By the way , my consultant says many times that my endorsement is very bad , yea literally " very bad " , now am picking up all these information and it's just an hour before my next 8 pm round . I would dazzle him now ☻☻
It helps to get straight to the point. When I call my GI consultant, for example. I say more or less the following, in different terms of course: Hello, this is Eddy of Critical Care. I have a xx yo pt with a GI bleed (melena, hematochezia, or hematemesis) that needs (or does not need) a scope right now. They are hemodynamically stable (or unstable), clinically they look good or bad and will be ready for you within the next xx minutes. They have a hx of peptic ulcer disease and have been treating their back pain with ibuprofen. Hb is X, they've gotten 2 units of blood and 2 are cooking, they have great access and we can have vasopressors at the bedside to help you sedate the patient comfortably for the procedure without worrying too much about hemodynamics. Anything else you need before you come and take care of our patient?
Then again, I am now an attending but once I earned the trust of my consultants as a resident or a fellow, life was a lot easier and it was a piece of cake to play nicely in the sandbox.
This is really comprehensive and smooth but needs practice
Absolutely, but that's why we train for so long; to become proficient. Again, best of luck!
Thank you!!!!!!!!!!!
My pleasure!
Enjoyed the video, but Damn! 30:20 with no details? All this from a dayshift nurse who has known the patient for an hour, while gathering two fists full of drugs for a 9AM pass? Why is this not a page on the EMR that nightshift can do, since they know the patient? Often times, from the nursing perspective, this is just a checklist for restraints, foley, VTE, line days, PUD, etc.
+harrykP9 I'm glad you enjoyed the video. What details should I add? Honestly my attention span is rather short so I can't watch a 30 minute video myself. Perhaps I can make a video on the details you're requesting.
Regarding the checkout from nurses: just like you as the physician in the ICU needs to know big picture stuff first, the same applies to your nurses. They know exactly what they need to take care of their patient at 7:05 if they arrived at 7am. When I arrive at the hospital, as soon as I get checkout from my colleague, I take a lap and do a quick assessment and talk to every nurse. Good luck!
No I mean, that had you fleshed it out with vitals, labs, Hx, etc it would have gone longer. In my experience, rounds that Intensivists insist on are usually just a check list we go down and check off JCAHO and NPSG. My initial thoughts were "You don't want to know the vital signs or labs, but you don't know that they are on pressors?" I had thought this was for nursing, since that's what I had searched for, but you are including Interns and others. I love the idea of rounds, but for nursing, they are usually more frustrating than anything else. I just wish they could make a rounding page that would give everyone a snapshot of the patient. There are various kardex's and summary pages, but they all seem to leave things out or drown you in information. This was very informative, I guess I was just looking for a hack or formula that would cut out the superfluous part of rounding. Ultimately, it is heavily dependent on the doctor and what their morning has looked like so far. Thanks again.
Do the attendings really want us to turn off sedation for our exam? Because I believe the attending and resident will examine the pt as well. Then I will too.
I can't imagine turning off sedation 3x for that, especially if the pt is vented or in pain
Short answer is yes. First of all, most patients who are on the vent should have daily sedation holidays where their sedation is held by default. If your institution isn't doing this already, it is recommended by the SCCM. Sounds like a quality improvement project you can tackle.
One should be targeting a RASS score of zero for your vented patients (there are a few exceptions). That means a balance of analgesia to where the pt is vented, is awake and interacting with everyone, watching tv, but has no complaints other than the tube bothering in the back of their throat. It's an art more than a science with regards to achieving this, but it certainly is possible for 80% of pts if you do it right. Training nursing staff to be cool with this is also feasible given the willingness of staff to push the boundaries. My goal is to be able to walk past the rooms of my vented pts to check on them, call their name from the door, ask them if they're doing okay, and have them give me a thumbs up. That's a 5 second assessment AND informal neurological exam right there.
Without turning off sedation, however many times during the day you want, you cannot do an appropriate neurologic exam. There have been numerous cases where a pt has been over-sedated and had a CVA that no one picked up on until it has been too late to intervene on it. If you turn off sedation, i.e. propofol gtt and the pt is in pain or anxious, then you need to make sure you have adequate analgesia on board.
Let me know if this helps. Best of luck!
Why full-control vent a patient that is breathing on his own?
pure gold
Gracias María Cristina! Saludos!
I think it would be horrible to be awake or semi-awake while on vasopressors, adrenaline -- liquid stress. I hate the hydralazine (more it getting the feeling of being on dose no-doz, and the 110 heart rate) and that's supposed to reduce blood pressure (it does a little, morphine worked much more).
Pts on vasopressors don't feel them. Their body isn't making enough endogenously so we supply enough to keep them alive, not over treat. I don't know in what context you're referring to using hydralazine. Morphine reduces blood pressure but in a completely inappropriate way for blood pressure management.
Whats the 3 letter acronym not to say?
HIT
Please use a "Microphone Lavalier" and you will get a better sound quality.
I've since fixed the mic issues. Check out my more recent videos. I'm a forever amateur, though. There's a limit to my capacities.
Am I the only person who cannot read what is written on the board? I am just asking
I can't read my own handwriting either. That's why I stopped with that format 🤣🤣
Hey Eddie, I thought you were going into heme onc!?
🤣🤣 never! I was actually going to do hospital medicine. I can't tell who this is based on your name. 🤔
@@eddyjoemd oh okay, for some reason I thought you said that in your ABIM video haha sorry. You don't know me haha I used your video to help prepare for my IM-ITE!
Ohhhh haha! I really dislike heme/onc for myself which is why I was curious. Hope the exam went well!
Watching this video at 20k+ subscribers when he says “my new year resolution is to get more subscribers and currently 47 subscribers”
Skip to 4:50
You should also state that the video should be played at 1.25 or 1.5x. It's more tolerable. 😴🤣
Damm man good work! I need a tutor lol
Why can’t u say HIT during rounds? Everybody knows it means heparin induced thrombocytopenia..
It's a joke stemming from the point that if you think of it, you should hypothetically start the patient on argatroban and start the wild goose chase to see if they really do have HIT.
eddyjoemd thx 4 replying .... wish u can be my mentor in my medical journey
That's flattering! I would likely just be disappointing. Where are you in your journey?
eddyjoemd still far .. working in ICU/CCU .. RN .. need to do 4 science courses and take MCAT ..will start next spring .. thx so much
Far, but closer than yesterday. Your critical care nursing skills and experience will be immensely valuable when the time comes to put it into practice as an MD. You'll be leaps and bounds ahead of your peers. Save as much money as you can while you're working. You'll definitely need it. You'll get there!
Who are you? What are your background and qualifications?
I'm Eddy Joe. I'm a board certified internal medicine physician and board certified intensivist. How about you? Nice to meet you.
Hello. For some reason your channel appeared on my YT feed. M.D., certified by 3 boards, including the ABIM & ABIM (CVD), staff & taught 1000 bed med. center and med. school. Good luck with your YT activities and practice.
Ah! You beat me by one board certification! Thanks for your contributions to the academic world. I passed up a couple academic jobs to stretch my legs on my own. I'm glad that there are physicians such as yourself.
I'm actually board-eligible in another specialty, too. While teaching I maintained a very active practice as well, including an abundance of critical care. I doubt that I would do it all again. Things are changing rather dramatically in medicine and I'm not sure those changes are for the best, but best of luck to you.
Haha I don't know why but I'm enjoying seeing ICU residents getting grilled by attendings every morning, some of them are getting red, nervous, or paled especially when they are getting blunt comments.
pls make more videos !
dont ask for subscribers the intellectual egoistic idiots that med students and doctors are they will judge u . but really really good worthy video .
+drveronicasharma thanks! I will definitely consider your suggestion. I could definitely handle my colleagues though. I'm going to hammer out a bunch of videos in the upcoming months. Thanks for watching a,
25 people didn't watch the video till the end
How long is the intro ?Instead of telling us what you are gone to tell us , could you just telll it like : "Ladies and gentlemen , here is the way I do when .... First , I " Since there is a title to your video , one who click , knows what he is looking for .
As an experienced ICU RN I still found this so helpful! Thanks Doc you’re amazing. PS will you marry me? Haha jk ;)
I’m glad you found this video helpful! I’ll talk to my wife about it but I think she’ll say make me say no 🤣🤣
I know some of what you're saying... hehehe
You’re above remarkably average, pal!
U r handsome
Thanks!
warning …….loooooong intro
😴😴😴 what time should the viewer skip to? add it so they can click on your link and skip to it. 😉