Coronary care unit

... and he survived into ei- into his, his 80s without ever having a coronary event, which was kind of shocking in a way, uh, uh, uh, uh, itself.

When I was a, a, a trainee, pretty much everybody I saw in, uh, in, in training and as an early, uh, CICU faculty member, uh, uh, you know, um, at, at, at my prior institution, you know, had an anterior MI or had an MI.

You know, my original work, and I think Harlan knows a little bit, was focusing on the population of patients who had MIs in association with heart failure or poor heart pump function or LV dysfunction, which was highly prevalent and a very high-risk cohort.

I've actually-- Our f- our trainees, when they see a patient presenting into our, into the CI- CICU with a f- a young person with an anterior myocardial infarction, which can typically affect heart pump function, um, more s- s- severely, that's a new thing for them.

They're like, "Wow, I, I haven't seen a 55-year-old who came in with an MI," right? You know, like they, you know, it happens and, and it still does, but it's rarer, and it was all we did, 24/7, was take care of the patients.

And then, you know, as we built reperfusion strategies to try to identify a culprit lesion and reperfuse, meaning improve the blood flow downstream from that lesion, uh, originally with thrombolytics and then, um, and then stents deployed in the setting of an MI for the right patients.

So our treatment of heart failure dramatically changed.

Prevention is growing, like primary prevention.

And I'm Sheila Kahn.

Today we're joined by Kimberley Reed, a clinical nurse too in the cardiac ICU, whose passion for creativity extends far beyond the hospital.

Rather, she's caring for critically ill patients, baking sourdough bread, crocheting, or receiving sound healing during a busy shift.

Kimberly has found meaningful ways to restore herself through creative practice.

Kimberly, welcome to our Art Meets Medicine.

We're so glad you're here.

To begin, can you introduce yourself and share a little bit about your journey into nursing and what drew you specifically to cardiac ICU?

My name is Kimberley Reed.

I'm a pediatric cardiac ICU nurse, clinical coach, and the host of Chat with Nurse Nat.

Today, we're sharing the second episode of the CICU Bedside Foundation series, Single Ventricle Physiology.

This conversation takes single ventricle physiology back to the bedside, starting with one of the most important concepts, one pump, two workloads.

We'll talk about understanding where your patient is in their stage circulation, ventricle function, AB valve regurgitation, and ultimately how to recognize what your patient is asking you to do.

Is that support the pulmonary blood flow, support systemic blood flow, or improve overall cardiac output? So whether you're newer to the CICU or looking to strengthen the way you think through single ventricle physiology at the bedside, we hope this conversation gives you a framework you can take directly into your next shift.

All

right, guys, let's get into the episode.

She's like an encyclopedia of cardiac information.

He didn't, he said to us, you didn't ask me if you could do one fast or, but yeah, you can survive one.

and the next day was the closing day for signing up or whatever and we said if you put it in writing so we emailed him and he wrote back so me and my friend um said right we're doing an Ironman the very next day I was admitted to CCU in the cardiac ward and told I've had a heart attack

oh god

yeah oh so that's why I have a tattoo on my wrist because it reminds me that I can do anything um

Yeah.

Yeah.

Yeah, I mean, I was in CCU for over a week.

They were trying to figure out what had happened.

Thanks, everybody, for joining another episode of Sox Pre-Rounds.

I have one of my best friends in the field of critical care cardiology here with us today, Ricky Handra, who is the co-director of the Cardiac Intensive Care Unit at Vanderbilt and someone I consider one of the leading experts in cardio OB.

And I think the perfect person to talk with us about cardiogenic shock and high-risk pregnancies in the CICU.

Ricky, thank you for joining us.

Yeah.

I always find that we get maybe one or two a month.

So it's something that happens common enough where the cardiac intensive care unit expert has to know how to manage these folks, but doesn't happen enough where you, at least myself, can consider myself an expert.

So I was wondering if you could just walk us through kind of your initial approach to the pregnant person that comes in with cardiogenic shock.

The event is a little bit different, but this PV loop sort of idea is the same, that as you plot pressure and volume against each other, the integrals work.

So, you know, these concepts aren't a lot different than I think what, you know, you guys probably use in the CVICU already or the CICU.

I think it's sort of a mixed unit is what Karen told me before.

All right, so these are the goals.

Very common.

We see more South Asians in CCU or coronary care unit in the hospital where they came with a heart problem or a heart attack, and we suddenly discover, "Oh, well, you also have diabetes." And they learn about their new diagnosis of diabetes at the time of heart attack.

Now, it didn't happen like a switch on overnight.

They were having high metabolic risk over time, and they were either had diabetes that was not paid attention to or discovered earlier, or they did not get routine check to understand their metabolic health, and suddenly the body could not handle it, and they ended up having a heart attack.

And in addition, I know you do a lot with Action Network, as well as other various academic arenas within PCICS and Action Network and PC4.

And I think one of the things that makes you unique is you're part of this community of people who do both CICU as well as heart transplant.

So can you maybe just summarize for the members what your contributions to PCICS have been so far and what you've enjoyed about it?

Yeah, so actually I was a categorical fellow trying to decide what I wanted to do with my life when I attended a PCICS meeting in Miami at the time.

That's great.

And I know that you have certainly done a lot for PCICS, as you just articulated.

And having the perspective of someone who's in heart failure, as well as CICU, one of the questions we've been asking people is about the biggest challenge to our field in Pete's cardiac critical care.

So from your perspective, from that combined lens, what do you feel like is our biggest challenge? And how do you feel like PCICS should address it?