Demonstrated Effective Practices to Reduce Ventilator Days in the ICU

Daily Readiness to Wean Screening, Spontaneous Awakening and Breathing Trials

Ventilation to blood gas parameters 

Safe Ventilation: Rigorous Tidal Volume Targeting based on Ideal Body Weight Calculations

Ventilator-Associated Pneumonia Prevention Bundles

Arterial Line insertion and reinsertion criteria

Tracheostomy weaning: graduated corking trials and physician prompts

Difficult to Wean Strategies: Trach Mask Sprinting, Proportional-Assist Ventilation, High Flow Therapy

ARDSnet: Low tidal volume ventilation, permissive hypercapnea

Optimal PEEP: Decremental Studies, Respiratory Inflection and Airway Opening Pressure Ratios

Respiratory Mechanics: Plateau Pressure Monitoring, Safe Driving Pressures, Compliance and Resistance Measurements 

Patient-Ventilator Synchrony: Expiratory Flow Termination and Inspiratory Rise Time Manipulation, Tube and Leak Compensation

Non-Invasive Ventilation: BiLevel closed circuit or single limb

Bedside Percutaneous Tracheostomy Assistance

Evidence-based timing for suture removal and cuff deflation

Tracheostomy Tube Changes: Downsizing and Routine

Corking, Capping, and Speaking Valve Weaning

Swallowing Assessments in partnership with Speech-Language Pathology

Patient and Caregiver Education and Training

Specialty tube options: Proximal/Distal Extended length, adjustable flange, custom tracheostomy tubes

Surgical Airway Emergencies: Decannulation, Obstruction, Hemorrhage

Direct Laryngoscopy

Video Laryngoscopy

Laryngeal Mask Airways

Intubating Catheters

Bronchoscopy-guided awake intubation

Emergency Surgical Airway Assistance

All skills are practiced frequently and are regularly evaluated under high-fidelity simulation

Diagnostic - bronchoalveolar lavage, tissue biopsy, microbiology/cytology brushings

Therapeutic

Percutaneous Tracheostomy (Assistance)

Foreign body retrieval

Emergency/Awake intubation

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Modified Level 2 Nursery Experience - Dedicated Assignment

High-Risk Delivery Attendance

Nasal CPAP, Intubation, and Mechanical Ventilation with PCV-VG

Surfactant Administration

Member of Code Pink team 

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Experienced with line placement, maintenance, sampling and troubleshooting 

Critical Care Repatriation and Medical Evacuation

Cabin Altitude and G-Force Considerations

Expanded Role

Emergency Response and Stabilization

Navigation of Global Health Systems and Structures 

International Travel

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Pre and Post Bronchodilator Spirometry

Plethysmography Lung Volume Measurement 

Single-Breath DLCO Diffusion Capacity

Bronchprovocation with Methacholine Challenge

Bedside Spirometry

Peak flow monitoring

Respiratory Mechanics: MIP, MEP, VC trending as per neuromuscular impairment order sets

Evidence-Based Policy work includes:

• Tracheostomy care bundle with Patient  Education Package

• Respiratory Pause at the time of withdrawal of life-sustaining treatment for organ donation

• Decremental PEEP study

• Bronchoscopy-Guided Percutaneous Tracheostomy Procedure 

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(Policies owned by St. Thomas Elgin General Hospital)

Proficient at Point-of-Care Risk Assessment: Droplet-Contact, High-Risk Aerosol Generating Medical Procedures 

High Flow Nasal Cannula and Self-Proning Coaching

Mechanical Ventilation under Paralysis and Proning

Working in Surge and Over-Capacity conditions

Infection Prevention and Control Practices

Personal Protective Equipment (PPE) Preservation Strategies