This is a transcript from our podcast episode published December 20th, 2021. The podcast episode is offered for .1 ASHA CEU (introductory level, professional area). This transcript is made available as a course accommodation for and is supplementary to this episode / course. This transcript is not intended to be used in place of the podcast episode with the exception of course accommodation. Please note: This transcript was created by robots. We do our best to proof read but there is always a chance we miss something. Find a typo? Email us anytime.
A special thanks to our Contributing Editor, Caitlin Akier, for reviewing and editing drafts of our transcripts. Her work helps keep our material accessible.
[00:02:03] Kate Grandbois: Hello everybody. Uh, we're so excited for today's episode. I am here solo today while my counterpart Amy is on vacation, but I'm not lonely. I'm not alone. I have the pleasure of welcoming Sarah Penrod onto today's podcast onto the podcast today. Welcome Sara.
[00:02:21] Sara Penrod: Hi, thanks for having me. I'm so excited.
[00:02:23] Kate Grandbois: We're so excited because you're going to talk about something that I know nothing about.
And I think I say that every episode, but I really know nothing about this. You are going to talk to us about the role of the medical SLP in an ICU, and I, not only have I, I worked in a hospital, it was outpatient, but I am not a medical SLP. I have never worked in the adult population, much less in an inpatient setting, much less in an ICU.
I know very, very little about this. Um, so I'm really excited for you to teach me all the things. And I wonder if before we get started, you can tell everyone a little bit about yourself. [00:03:00]
[00:03:00] Sara Penrod: Yeah, absolutely. So my name is Sarah Penrod. I work currently full-time at an acute care hospital in Maine, uh, 637 to 650 bed hospital, depending on the emergency department, we have six critical care units at this time that I'll go into a little bit.
We have a medical ICU, surgical ICU, neuro ICU, cardiothoracic, cardiac, and currently a COVID ICU. Unfortunately. I've been in the field about 15 years. I've always worked with adults. I've been everywhere in the continuum of care. I've been in skilled nursing. I've done a little bit of outpatient. Um, I did inpatient rehab at Spalding in Boston for 10 years, which was a huge learning experience.
Um, I worked at a long-term acute care hospital in Boston with a lot of vent weaning and, um, trach involvement, which was really great experience, especially for transitioning to the ICU. Um, I am a, my current interests [00:04:00] are critical thinking in SLP. Um, and really the importance of the SLP on the interprofessional team, this, this concept right now of interprofessionalism that we'll get into where we're not operating in silos, but that we, we fully understand each other's roles and, and what each other can offer, um, is my big thing right now, you know, in acute care, we're seeing a lot of, you know, it's necessary to do a lot of advocacy and education for team members. So it's a, it's an interesting role it's um, as team focused as it is patient focused, which is, is really interesting. So that's what I do, and I love it. It's just been probably the job of my dreams being here.
Um, fast paced, acute care, um, unique patients, situations. I mean, I've seen stuff here I've never even thought of. So, um, it's been wonderful and I'm so happy to talk about, um, the role of the SLP in critical care. Cause it's something I feel really passionately about.
[00:04:59] Kate Grandbois: Well, you've [00:05:00] already said two things that really get me going, which are interprofessional collaboration and critical thinking skills for a clinician, which are two things that I don't know...
It doesn't matter to me what setting you work in, what population you work with. These are skills that empower us as clinicians that are critical to our jobs that, my very humble opinion is that we don’t talk about enough, we don't prioritize enough. So I honestly, I was surprised to hear you say those things as they relate to the ICU, but I shouldn't be surprised because they're so important.
So I'm really excited to talk a little bit more about that just selfishly, because I also find that very interesting and as a critical piece of our clinical lives, but before we get into all of the really fun stuff, um, I have to read the learning objectives and our disclosures. Um, sometimes people write in and ask me to skip this part.
I can't ASHA makes me read it. So please bear with me. I will try to get through it as quickly as possible. Learning objective, number one, identify ways the SLP can address speech, language, communication, and swallowing disorders in the [00:06:00] ICU. Learning objective number two, list the reasons for obtaining and synthesizing the most up-to-date medical information before seeing a patient in the ICU and learning objective number three, list factors that can contribute to success in therapy or confound SLP specific diagnosis.
Disclosures Sarah Penrod, financial relationships. Sarah is employed full-time in an ICU set, in an ICU setting. Sarah Penn rides, nonfinancial disclosures. Sarah does not have any non-financial relationships to disclose. Kate that's me. I'm the owner and founder of Grandbois therapy and consulting LLC, and co-founder of SLP and our cast, my nonfinancial disclosures.
I'm a member of ashes to 12 as they're on the eighth. I'm also a member of the Berkshire association for ABA and there'll be behavior analysis international and the correspondence, but that'll be in the five-year old system senators group. Okay. Boring stuff is over. Is there anything that would be nice for you to start us off with, um, with some background information, um, before we got into.
Before we hit the record button, you and I had a quick conversation about your skillset and it not being very [00:07:00] well-represented across the speech language pathology field as a whole. So out of the, all of SLPs and existence, we're willing to bet based on the demographic data that we have, it's a relatively small percentage of SLPs working in the ICU.
And I wonder if you could start us off by telling us a little bit about what qualifications you need to work in this environment, how did you get into working in the ICU?
[00:07:22] Sara Penrod: And it's a really good question. I think sort of like other jobs and you apply for a position in an acute care hospital and you sort of learn as you go.
Um, if you don't have ICU experience, you know, you're the train on the job. Um, find a mentor. I think one of the things that's interesting about critical care, I mean, there's a lot of things that are unique to critical care, but these are also the same patients that you're seeing at acute care rehab. It's just a month before or two weeks before.
Um, so these patients have similar diagnoses, similar presentations. Just worse and sicker. So, um, you know, right now there's no, there's no requirement as far as training or years of experience for working in an ICU. I [00:08:00] mean, that's just dependent on hiring you. Right. Um,
[00:08:05] Kate Grandbois: so my first question then, I guess, in terms of transitioning from that into our first learning objective, are you ready for the most general non question that anyone has ever asked you
[00:08:12] Sara Penrod: I'm ready, bring it.
[00:08:13] Kate Grandbois: What does an SLP in critical care do? What can we do for a patient in critical condition? So what are we, what can we work on?
[00:08:19] Sara Penrod: So, I mean, you're working on all the same things that we're working on. Um, prior, I mean, like that you're seeing in like skilled nursing and acute rehab. A lot of these patients in the ICU require, um, ventilation, right? It's a lot of them are either intubated.
They have tracheostomy tubes and there's a whole lot of management that SLPs can do surrounding, um, the presence of a trach. So when patients are intubated it, they thought breathing tube in their mouth. They're hooked up to a ventilator on city that because patients don't really tolerate, nor would I, you know, breathing tube in the, in the mouth and NG tube to going through the throat.
Um, and a lot of times, you know, we're working on ensuring medical stability. So these patients are sedated. At times the, he is asking us as communication in those [00:09:00] patients. Um, but a lot of times, for the most part, if patients are intubated and we're not really seeing those patients are just not quite ready.
Um, once patients have transitioned to other forms of breathing. So, um, high flow oxygen or a tracheostomy tube, that's directly into the trachea stoma, then we can start to really get involved. More consistently because these patients already use their mouths, you know, are awake. So the assessment of arousal and conditions like this, where you feeding readiness, right.
So patients who have a tracheostomy tube, may have a variety of reasons why they'd have dysphagia. Um, and we're in there to say, how did this dysphagia what's the timeline for, for eating? You know, patient has an NG tube, a feeding through, through the nose. Are they going to need a peg tube, a more permanent solution?
So we're getting in there early to try to get an idea based on, you know, medical nosies, um, how quickly they're sort of recovering, medically their physical endurance, their overall strength, ability to follow directions. Are they bombing our secretions? Does it look like their swallowing function is actually preserved?
There's just this overlay of medical complications. To try and give the [00:10:00] team an idea of, oh yeah. You're probably going to need to consider a PEG or not actually give this person a little bit more time. Um, it actually come in practice now to us only, even in patients are on the vent depending on the situation.
So patients who are otherwise strong, so you might see like a spinal cord injury patient, or even, you know, some of the stronger COVID patient for the primary dysfunction, it's really the lungs and the breathing, but everything else. It's looking pretty good. You know, motorically they’re doing well, maybe they're walking, um, oral facial musculature is intact and strong.
Um, able to coordinate breathing and swallowing even on beds that are swelling, their secretions. Those are some of those patients that you might be more aggressively offered, especially if it's working with number 20 and these, or want to eat. And a lot of these numbers, can you do a swallow study on that?
We don't have FEEs here, but, um, uh, videofluoroscopic swallowing study or FEESs would certainly be appropriate looking at intermittently looking at this fellow that's, uh, the bottom line for all the stages, right? You have to look at it to know. So a lot of these patients are more appropriate than they might seem on the chart review. So. No, go again, seeing the patient, talking to the nurse, figuring out that, figuring out that mentally, you're going to send that patient and spending [00:11:00] on the other able to gauge activities of taking PO
[00:11:02] Kate Grandbois: Can you just for a quick second define delirium because it's not like a word very casually thrown around where it is part of our vocabulary, but it is a medical presentation.
And I wonder if you could just highlight that for us for a second.
[00:11:13] Sara Penrod: Yeah. So delirium is a set of symptoms, basically, um, that is, has an underlying medical cause. Um, it can be related to the ICU day. It can be related to medication changes, um, fluid levels in the body with hydrogen and whatnot. Um, variety of symptoms you might see, um, Hallucinations and fusion confusional output.
Uh, confusional verbalizations, disorientation, configurations, um, you know, sleep disturbances. Patients are sleeping at all times of day. Their sleep wake cycle is off, um, agitation, Medis, restlessness, um, where otherwise there's not a neurological reason for this. Patients are architecting sets of symptoms and they can wax to be throughout the day.
They can maximum. I mean, it's, it's pretty tricky and it's, um, really a set of symptoms rather than a diagnosis, but you can see in the patient's chart, the medical, you know, of course [00:12:00] exacerbated by delerium, tends to get better, but it's so the older patients can learn for awhile, some of the side-effects of ICU related delirium.
So, you know, things that can be delayed and worse. Rooms that don't have windows, right? The patients are pulled out of the time-space continuum more so because I have no idea what time of day it is. Um, inability to communicate the inability to understand what's going around us. People are not awake off.
We're not consistently remembering not to get in the ICU that there's a breathing tube in their mouth. Um, you know, baseline psychiatric or personality disorders. People don't wanna be touched or held down. They don't like feeling constrained by lines and tethers. Um, uh, delirium can be made worse by those things as well.
So all of these things that you're seeing in the ICU patients, you know, So delirium is a common side effect. And oftentimes that creates a snowball effect where patients require more sedation, because maybe they're pulling out lines or they're there. So I get staff and people are unsafe. Um, so it can create the kind of snow for more sedation is that onboarded.
And then there's risk of developing secondary pneumonia now because this person is not alert enough to manage their secretions or to cough and clear their secretions. So unfortunately, the initial ideology for [00:13:00] being in the ICU is not always the end picture for patients. You know, sometimes you do get the nice clean, okay.
You know, right. MCA, CVA. And that's it, you know, how easy, um, medical course and more predictable recovery. But for most of the patients, there's a lot of. Complications and for the listeners, um, I did add some complications for some of the ICU patients where it's like, okay, you're in for this one thing, but these are the 10 subsequent things that happened that made your stay longer.
It doesn't make it clear.
[00:13:22] Kate Grandbois: You made our listeners the most beautiful, thorough handout. I have ever seen to a point where I was joking, that it kicked off a series of like slack chats amongst everybody. And on the LP next Yoda, I would really throw a beautiful, so a lot of what we're going to talk about today is listed on this hand out.
it's available for download on our website for free. There will be a link to it in the show notes. If you're driving, walking, running, folding, laundry, whatever you're doing, there is a place where all of this is written down and go check it out if you want to learn more. Okay. I'm sorry. I derailed us with my question about delirium.
I just wanted to make sure that everybody was aware that this is an actual medical presentation. I personally had never heard of it until I knew I knew someone who had experienced delirium in an ICU and was like, oh, that's the thing. So, anyway,
[00:13:59] Sara Penrod: [00:14:00] Derail away. Um, so as far as, so trachs vents, that they shouldn't, I think we do speech pathologists, do a lot of advocacy promoting. we could do a whole other podcast on trachs. I don't want to get too in the weeds on that, but complication, right? When patients come off the vent, they, they still can't talk because their cough is a place, a tight seal between tracheal walls and the tree too. So promoting our travel cuff deflated and SPIs, um, and clearly critically thinking to yourself, okay, why isn't the person tolerating cuff deflation, or why aren't they tolerating the speaking valve?
This is. The SLPs play, SLPs also can go in and be with a patient for 30, 45 minutes, depending on your hospital and your productivity requirements. But a lot of times the respiratory therapists are not able to do that so quickly as the patient can say, oh, there's pressure or, oh, they cough and have to take it off and go versus a speech pathology can go in and take an extra check and put it back on.
Thank you. Some debriefing. I can do some coaching exercises. So we sometimes have been more time with the patient, which allows us to critically think differently. Um, We're at the big holders of the PMBC and also that you can talk as well. And a lot of times for respiratory, their priorities are a little, you know, more medical.
I want this patient to be [00:15:00] able to breathe a lot better than they are right now. It's like, okay, well, can we compromise? Can the patient wear it while I'm in here? Can they wear it when the nurses is in here, you know, so. Those interprofessional conversations. Um, and then if you have a theory that there's some sort of obstruction or that the patient needs a smaller trach, you're having these conversations with the team for maybe an ENT consult or a pulmonary consult to see what can we do to get this person who's otherwise improving is being held up by the trach scenario.
So playing a key role there.
[00:15:29] Kate Grandbois: And I, I was just about to say this all sounds like it's a key component is successfu interdisciplinary collaboration, communication, documentation for when you're passing, if you can't pass each other in the hall. Because it sounds like a lot of these decisions, there's a ripple effect.
It's influencing a lot of what else? A lot of other variables that are happening in the ICU is that an accurate reflection?
[00:15:51] Sara Penrod: Oh, a hundred percent. And a lot of, I think you probably spend as much time in critical care, looking at the chart and communicating with the team as you do [00:16:00] with the patients. I mean, these patients.
They are critically ill. They're significantly weak. They're very deconditioned. Um, there's not always a whole lot they can do, but you were spending a significant amount of time advocating for them and problem solving. I mean, some of the patients that we're seeing with COVID, you know, um, You know, resp, quick, respiratory failure, you know, we're, we're, the team is doing so much to keep these people alive and keep them breathing.
So whose job is it to think about what the swallowing might look like when this is over? Um, you know, a lot of times they're not thinking about that in the moment. So families are having conversations about, will they be able to eat? When will they be able to talk, you know, Looking at patients, even when they're on the vet of the vent to sort of predict, um, some of that swallowing physiology and the longer term care, I mean, this can lead to avoiding peg tubes.
Long-term feeding tubes for some of these patients. So
[00:16:55] Kate Grandbois:this is, this brings me to a question about something that you mentioned before. Again, before we hit the record button, before we [00:17:00] get into our second learning objective, you mentioned how important it is for the SLP to get involved early. In the ICU stay.
Can you tell us a little bit more about that.
[00:17:09] Sara Penrod: Yeah. I mean, you know, it's really, it's really important that the, that the team and the families understand, um, you know, the plan for eating and the plan for communication, um, how the speaking valve works, for example, Ways that the family can communicate with the patient.
You know, we didn't even, we didn't even get into really any of the language assessments or the AAC assessments.
[00:17:37] Kate Grandbois: You still can, we'll make time. It's good. I derail with questions all the time. It's cool. We'll get back to it.
[00:17:40] Sara Penrod: No, I love it. But yeah. So the, the importance of getting in there early, um, you know, a lot of times patients are trying to communicate or asking for ice chips and, you know, based on chart review, you might say this person is not appropriate to eat, but you say, okay, can I clear this person for ice chips and reduce their [00:18:00] frustration, reduce their anxiety, improve their oral care, improve their, you know, the oral bacteria in the mouth, just from the natural process of swallowing.
It’s so key, um, not to mention how crazy would you go if you couldn't have any moisture in your mouth, aside from like a green sponge, don't want to think of
[00:18:15] Kate Grandbois: every, oh, I
[00:18:16] Sara Penrod: know. I have the most sympathy for patients when they're like, I just want a big drink of water. It's like, heck yeah, you do you and me both. You know, so, um, and it goes back to that reducing of delirium potentially.
I mean, there's research showing that early SLP intervention can help shorten hospital stays shortened time to decannulation shortened time spend NPO potentially, you know, um, shortening time spent with dysphasia, potentially avoiding long-term, um, nutrition placement, um, With being able to modify a diet texture or such things.
So. You know, and it's really helpful, even if you're not seeing the patient consistently, it's really helpful to be able to be reviewing the chart and being [00:19:00] communicating with the team like, Hey, you know, I don't feel safe seeing this person right now, but here are my parameters. So that the team is not just wondering and not just, you know, arbitrarily placing a peg.
It's like, oh no speech said, you know, once they were doing pressure support on the ventilator or once they could sit upright for 20 minutes that they would, um, more aggressively assess the swallowing or assess the communications. Um, super beneficial, just so that the team knows kind of what's the trajectory here.
A lot of times I'm saying this is not safe because you know, patients on a hundred percent oxygen, they can barely catch their breath with one episode of swallow happening. But if you can get them down to, you know, a certain amount 50 liters, let's say, and they can tolerate, um, you know, PT and OT mobilization a little bit more, that's my parameters for this patient or whatever it is.
Um, so everybody's on the same page
[00:19:52] Kate Grandbois: again, that collaboration piece. I mean, that's gotta be so important.
[00:19:56] Sara Penrod: Totally necessary. Yeah. You can't operate in a silo. [00:20:00] And we have a really good communication system with our physicians that we're able to just chat them really quickly and say, Hey, these are my thoughts.
Um, which has really, I think, changed the practice just to be able to, to summarize concisely. This is what I'm thinking and say it in a, in a more direct way it's been, it's been really wonderful.
[00:20:16] Kate Grandbois: That's awesome. Well, I wonder if you could tell us a little bit more now about the language assessment and AAC assessment.
[00:20:24] Sara Penrod: Yeah, absolutely. So there's sort of two camps, right? There's there's this camp of patients who have like a true language disorder, you know, like, uh, uh, left MCA CVA, or, um, you know, some, sometimes you're seeing that with those right-sided strokes, you know, significant dysarthria you're seeing apraxia. So you're sort of conducting it just as you would in rehab or in a skilled nursing facility.
Um, keeping in mind, those, those medical aspects, you know, what, what lines are in place in the patient's room, um, you know, those kind of safety parameters, but then you're, you're really looking at language sort of the same way, you know, is this [00:21:00] person awake long enough to communicate or is arousal the issue?
You know, can they follow directions, can they answer yes, no questions. Are they able to make their wants and needs known? And then there's sort of this other side of communication, that's really, is this a medically induced communication disorder? You know, sometimes you're seeing, it's not really dysarthria, but it's certainly a motor speech, um, communicative efficiency issue because of significant deconditioning or, um, significant lethargy or overall, you know, significant physical weakness or, or low effort on the part of the patient where it's like, I don't even, I don't even have the energy to communicate at the sentence level at this point. Um, you know, a lot of the ventilator patients, no communication deficits per se, but they're so weak that it's even difficult to mouth words.
You know what I mean? Um, so helping these patients, you know, some of the patients who maybe have a little bit better mobility are able to use letter [00:22:00] boards, um, or there's a couple of apps, like, um, I think it's passy muir has a type to text for patients who are, um, tricky, customized that can just kind of type and chat as they go that's really efficient.
Um, but then there's, you know, the other medical aspects. So when patients are not just deconditioned, you know, they don't have the pulmonary drive to, to have their voice come out clearly and audibly, or they don't have the, um, the endurance and the stamina to produce, you know, output at the phrase or sentence level.
Um, So you're giving the staff often tips on how to ask questions that that sort of maximize their communicative efficiency.
[00:22:38] Kate Grandbois:You've used the word deconditioning a few times. I've never heard that word before and chances are, if I've never heard it someone else hasn't heard it. So I'm going to ask you what.
[00:22:47] Sara Penrod: It's so funny, the things you take for granted, isn't it in what you do.
[00:22:49] Kate Grandbois: Yeah. And then a few sentences ago you used the word deconditioning, which I sort of assumed was a strength related issue, but then you also talked about weakness. [00:23:00] So what is deconditioning?
[00:23:02] Sara Penrod: So patients, there's all kinds of stats on this and I don't know them really off the top of my head, but so you know that as we age our muscles, um, just don't function the same way.
Right. And they get weaker at a certain rate.
Kate Grandbois: I don't want to think about it.
Sara Penrod: Okay. I was just going to say, I think it starts at 40 and your muscle strength, and I don't want to hear it.
[00:23:20] Kate Grandbois: I don't want to hear about that. I won't tell anyone my age, but
[00:23:25] Sara Penrod: I think it doesn't start till age 70 or 80. So I think we're all good here.
Kate Grandbois:Perfect. Perfect. Moving on.
Sara Penrod: But patients who naturally lose a bit of strength and endurance every year to a certain degree, it's exacerbated when they're in the hospital. A because they're in bed and they're not moving around. And the muscles, their strength and functioning reduces precipitously when they're not using the muscle.
So that like use it or lose it scenario is, it's precipitously worse for someone who's over 70. Add into that critical illness. Right? So, um, changes in their oxygenation, [00:24:00] changes in their, um, metabolism, the way they're processing food. Add to that there's probably potentially some degree of pre frailty or frailty.
You know, the body's not processing nutrition the same way. There's probably oftentimes underlying medical conditions that are causing... They, these, all of these things that people can kind of function with can get quickly exacerbated, um, with a critical illness. So think about like a, a stroke or, um, a cardiac event.
Um, You know, underlying, uh, like diabetes or underlying hypertension. These are all going to kind of put people at risk for more rapid deconditioning. Um, your question as to de-condition deconditioning versus strength is a really good one. And there's a lot of talk in that in our field right now, because can we talk about strength if we're not doing manometry right. Like if we're specifically talking about, um, you know, oral pharyngeal strength, can I say a person has weakness by looking at their swallowing? If I'm not doing manometry, there's kind of [00:25:00] this conversation. So manometry is when. Um, almost like an NG tube down someone's throat, a monomitor and have them swallow.
And it basically has these sensors all the way down the monometer that actually says, okay, how strong is the pharyngeal squeeze? Or I think it started with esophageal manometry because there's all these issues with the esophagus. Right? How do we assess it? So the tube that goes all the way down the esophagus And then when there's esophageal peristalsis it monitors and you actually get this readout of where the muscles are working. Oh yeah. Oh, we could do a whole podcast on the esophagus
[00:25:34] Kate Grandbois: I know. I'm sorry I keep derailing with my very novice question. Um, okay. So you were talking about, um, helping patients who are, you know, having a hard time communicating for either communication disorder, reasons or medically other medical reasons and using additional external supports, like typing or an app.
Help facilitate more [00:26:00] communication while they are in an ICU.
[00:26:02] Sara Penrod: And a lot of times in the ICU, the patients are kind of dependent on their caregivers. And we see this a lot of times in institutions, unfortunately, but, um, so providing that education to the nursing staff, you know, um, And encourage the patient to give, um, you know, shorter responses to save endurance or asking yes, no questions to kind of maximize, to making sure you're both on the same page and that things are not getting lost. Um, yeah, we often get consults for communication boards. Um, I think this is true of anywhere that you get a consult for a communication board. There's just so much that compounds a patient's ability to use, uh, a communication board, you know, vision, obviously.
Desire to use said communication board, you know, underlying, uh, receptive and expressive language. All of that is just made worse in the hospital. So, um, AAC is a great place to start. It's just, it's really tricky. The, a lot of these patients are just too sick, um, or they're only awake a certain amount during the day.[00:27:00]
So we do spend some time we've, we've been consulted a couple of times to do language assessments on patients who are intubated, um, when the team is trying to gauge whether or not the patient, um, is consistently answering questions, would you want a tracheostomy tube? Would you want a PEG. This person still has capacity, but we're sort of trying to get the idea.
Um, are they consistently responding? So we've been asked to assess there a couple of times there's tons of resources for ICU, you know, letter boards and low-tech AAC. Um, it's just, you really, it is a unique patient who can consistently and effectively use it. We've found.
[00:27:38] Kate Grandbois: Okay. That's really good to know.
And I wonder if now is a good time to start talking about our second learning objective related to how, I mean, you've talked about all of this data that you're surrounded by all of this information that you're aggregating across different team members. And how can you efficiently, how do you efficiently do that in the ICU?
[00:27:59] Sara Penrod: [00:28:00] Yeah. So like I was saying it, you really do spend a ton of time on the chart. I mean, in the, in the chart reading and, and sort of synthesizing in your own way before I go see a patient in the ICU, I always do a chart review. I mean, that minute, not even in the morning before I make my lists, but before directly, before I go see the patient to, to check their labs, check their vitals, um, and then check in with the nurse, you know, try to get an idea of what the plan is for the day. So is the patient having a procedure? Are they, um, you know, on, you know, are their position positioning restrictions because of blood pressure issues or an entra-, extra ventricular drain that they can't be moved because, um, pressures in the head are being monitored, stuff like that. So really up to the minute, and then you're looking at what the team is planning for the day. So sometimes you'll see in the notes that the team is, you know, considering a long-term feeding tube placement, you're, you're involved in some of that decision making sometime.
Um, what are the ventilator weaning, um, [00:29:00] plans for the day, you know, oh, person's going to come off of the vent today. Maybe it would be a good time to take a look at them off of the vent. Um, A lot of the medication changes, you know, are they lightening the sedation? Okay, they're going to turn off the sedation at 10.
Maybe noon would be a good time to see this patient. So sort of hour by hour, things can be changing for these patients. So you're working with the teams overall plan for their medical stability and recovery, the nurses plan for the day, um, the patient family coming in to visit and, and family members having questions about what they can do, et cetera.
So you, you know, it's a lot of back and forth. It's a lot of rescheduling on you. You know, a lot of times you make a plan in the morning and you do not stick to it even slightly because things are changing so rapidly.
[00:29:49] Kate Grandbois: I wonder if you could talk a little bit about the role of counseling. You've mentioned communicating with caregivers and families, and I have to assume that these individuals are grieving.
They're scared. Their loved [00:30:00] one is in the ICU for whatever reason. Are there component, do you find that there are a lot of counseling components involved in this job? I mean, I have to assume. Yes, but maybe you can tell us a little more about it.
[00:30:11] Sara Penrod: You know, it's we just, not long ago, reopened to family visitors.
We had been closed in the ICU for a while for COVID reasons. And it's sort of like, whoa, I forgot what it's like to have family at the bedside. You know what I mean? Especially in critical care. Um, yeah, there's lots of counseling. Um, Kind of having a similar conversation with the family. Where do you think that their swallowing and communication is going to go?
Um, I often talk to families about what they'll see in rehab, especially if patients don't seem to be progressing that quickly in the hospital. You know, I, I, I build up rehab, um, and talk about things that they'll work on in rehab to try to, you know, give families, um, Yeah. You know, have them hold onto hope and remind them that this is a very different loved one than you will see once they get to rehab them or once they even make [00:31:00] it to the medical floor and out of the ICU. Um, I talk a lot about, um, swallowing recovery and things that impact impaired swallowing. So a lot of times, like I said, for these ICU patients, they're super sick. It's not; It causes a secondary dysphasia.
Yes. But it's not like, um, you know, sometimes you're suspecting or you're finding that the actual physiology is fine, but because this patient can't coordinate breathing and swallowing, or because they can't stay awake for five minutes or because they don't have the endurance to take more than a few sips, they do require either a modified diet or a feeding tube.
So you're, you're sort of making sure that they understand that this is not a, you're not going to eat again. This is. A lot of this is made worse by your current medical or current pulmonary issues. Um, and I find patients and families, um, really appreciate hearing that kind of information, like, okay, it's yeah you're not allowed to eat, but it's because of these other reasons, not because you, can't not because you never will, again. [00:32:00] And same for communication, you know, um, a lot of times it's around the tracheostomy tube and the, and the ventilator we talk about when when the patients will be able to use the speaking valve and how they'll be able to communicate and other things that, um, you know, strategies for other types of communication.
So we, we do more so now than, um, you know, even a few months ago, It's good to have families back in the room. You can see the difference in patient responses consistently.
[00:32:27] Kate Grandbois: I bet. I'm also thinking about, you know, this, this concept of synthesizing information in an ICU, because this is a situation where a person's status is changing hour by hour, sometimes I assume.
[00:32:37] Sara Penrod: Oh yeah, definitely. Yeah. A lot of this, we, you and I talked about like the critical thinking aspect
[00:32:45] Kate Grandbois: that was going to be my next question is this, how does that, how that relates to critical thinking?
[00:32:48] Sara Penrod: Yeah. So I always think of this concept in the ICU, what is causing what, you know what I mean? So a lot of times patients have aspiration and pneumonia and dysphasia, [00:33:00] um, but which caused which, you know what I mean?
So sometimes patients are developing a pneumonia which can change mental status, which can cause aspiration. Um, then now that you've got this diagnosis of dysphasia, um, sometimes people are in with all kinds of GI stuff, abdominal stuff, you know, you've had nausea and vomiting. Now you've got, um, pneumonia and now you've got, you know, difficulty breathing.
And now actually you really can't swallow because you actually can't breathe and your body can't tolerate, um, that, um, that swallow apnea. So. You know, that synthesizing the information again, you're looking at, okay. What, what are the events that were leading up to this, this pneumonia and, um, the research of John Ashford, he always talks about, um, pneumonia being an opportunistic secondary, secondary dysfunction.
So these patients are critically ill and then this pneumonia kind of develops in this opportunistic way. So you're, so you're really, I think trying to get an idea of [00:34:00] the chicken and the egg, what is causing what for these patients, um, and that helps you prognosticate and it helps you talk to the team about what you're seeing.
Um, cause you're able to give. The big so what, you know, like, yes, this person's on honey thick liquids, but, but, so what and why, and what does it mean to the team and what does it mean for the, for the patient's care? Ultimately.
[00:34:24] Kate Grandbois: that's, I, I love this concept. Critical thinking is such an important piece of what we do.
And I'm not sure that we're explicitly taught how to prioritize information. I also heard this is my new favorite acronym. POEMS patient oriented evidence that matters. And it comes out of research from, I think, pharmacology about how to prioritize different, um, or no, it's not pharmacology it's it's medical data management.
This is like a whole area of research that I randomly recently stumbled across. And it's related to what you're talking about in terms of exactly what you said. [00:35:00] So what, what matters? What, what is the information that you have that matters and in. There, it sounds like you're in a work setting where the data that's coming at you is just massive.
That's way more data than I get about my pediatric kids, you know, my pediatric clients who are changing, but not hour to hour, you know, the hour to hour change and a pediatric client is, are you hungry and ready for snack? That's that's it. You know, I mean, not to say that there aren't medically complex, you know, pediatric kiddos out there, but this is a very different work setting that you're in constantly trying to aggregate information and prioritize it.
[00:35:41] Sara Penrod: Yeah. So you're starting in the day with a chart review, but to your point, I mean, sometimes you're literally going up to some of these units and you're walking around the unit to get to eyeball these patients because sometimes the chart, you know, you suspect, oh my gosh, this person has been through so much.
They're going to look absolutely terrible. And you go in and [00:36:00] they're out of bed. They're in the chair. I mean, The lines and the drains and the alarms, and sometimes the IVs. I mean, you see a wall of 15 IVs running at one time, you know what I mean? So to a certain degree, it just takes getting used to it because you're like, you know, I could see a novice clinician being like, None of these people should eat. None of them should have speech, you know, but you do develop a certain, you know, desensitization to that kind of stuff, which I think is a good thing for the patients and comes with experiences. You're like, okay, well, let me get in there. Let me move some things around, see what I can do.
But then sometimes you do a chart review and you're like, oh, it sounds like this person is going to be ready for a cheeseburger and you'll go see them. And it's. And they just look terrible. And that's that deconditioning and weakness that we're talking about. Um, you know, how frail is this person is hard to, it's hard to gauge just by chart review alone.
A lot of times you'll go up and you'll say, okay, this person looks, look, it looks like they're ready for speech by chart review. I go off, they physically look like they're ready. I talked to the nurse. [00:37:00] Oh, we just had to, um, put them on a bunch of sedating medications because of X, Y, or Z. It's like, oh, oh, okay.
I'm circling back. Try back at 2:00 PM. Um, or this person might go for a procedure, so they can't have anything. So. You know, you can see them a little bit, but it won't be a full assessment. And then you're kind of gauging like, oh, okay. Oh, this person's ready to eat, but you know, they're not allowed to sit up because they have to have their spinal x-rays and they have to be clear to sit up.
Okay. Well, if we're going to feed them later, then we'll just come back later. So, um, I can't oppress upon your listeners, how intense it is to be up there in those units. And I say up there, cause ours is the sixth and seventh floor, but they can be on any floor. Um, but, um, just to even be walking around and, and you really get a sense of the gravity, um, you know, there’s multiple interprofessional teams everywhere.
You know, the docs are constantly rounding. They're rounding with clinical dieticians, with clinical pharmacists. [00:38:00] Um, with the nurse. I mean, it's a huge team of anywhere from eight to 10 people. Um, sometimes you have to specialist, you know, um, pulmonary is rounding with the teams. It's, it's really intense.
And to think that each of these team members has a, you know, we all have our priorities for these patients. We all have sort of these agendas. We want to push. I want my patients to talk and communicate and eat; pulmonology wants their lungs to be clear and their breathing to be at a certain level. So, um, it's intense.
It's changing a lot. Um, but there's, there's so much room for speech, um, to advocate really advocacy and education, because like I said, you think that. I think this might've been before we were recording, but you, you expect physicians, these people are, are some of the brightest minds in the, in their fields.
You expect them to understand the weeds of swallowing the way I do. I expect them to understand, oh, swallow apnea and, and the, the effects on pulmonary functioning. And it's really not the [00:39:00] case. I mean, we really are specialized in this area and I really do think about swallowing physiology in the impacts hours every day and the physicians have an understanding, but it's not the same as the critical thinking that we're expected to bring to it. So. It's it's wonderful. I obviously, I, I love that your podcast is under SLP nerd cast, cause I'm like to nerd out so hard.
[00:39:28] Kate Grandbois: Well, and I'm learning as I'm talking to you that you are maybe in like nerd supreme, which is, uh, which is, uh, a title we have yet to dole out.
So congratulate, you're just the, all this information. I mean, maybe it's because I don't work in this setting, but you, this is like an incredible amount of information that's being thrown at you. I mean, you met, you used the word intense and high into high energy, I think before describing this work setting and the way that you're, you're doing such a great job describing it in terms of how much data management you're [00:40:00] doing and how much critical thinking you're doing on a, I don't know, minute to minute, hour by hour on a, on a routine, um, repeated basis across your shift.
And I have to assume that data management and technology are a huge component of this. Now that most of our hospitals have moved over. So when I started working, I was at an outpatient hospital. We use paper that's how not that I'm aging myself, but we did. And then they tried to make us, they tried to make us use an LMR or an EMR, and everybody was grumpy about it because we knew how to use our paper.
And we didn't use dictation yet. But now that we have these data management systems and this chat feature that you talked about, I mean, I guess, cause I work in assistive technology. It's making me sort of interested in it, but that must be a critical component to be able to digest and analyze and prioritize this information since it's so fast paced and you're changing things are changing so quickly.
[00:40:55] Sara Penrod: Oh, absolutely. Yeah. The, I mean, we could go into good and bad [00:41:00] about, um, electronic medical records. Right. Um, but yeah, it's totally necessary. And there's a couple of features in the system that we use that help keep up to date with like labs and vitals and stuff like that minute by minute. Um, also I, the nurses in critical care are just, I mean, you think I have an understanding of medical aspects. I mean, these nurses are phenomenal, their understanding of meds and dosages and, um, they have such unique um, ability to synthesize this information differently because they spend so much time with the patients and they have to do so much functional care with them.
You know what I mean? Um, so sometimes, you know, we're the communication specialists, but if, if I'm not getting something out of a patient. I'm definitely checking in with the, with the nurse. Like I'm not getting anything, like, are we concerned about a change in status here? Or am I not doing it right? Oh no, if you, oh, this patient, if you go to his right, because he has an old, you know, war injury and he can't hear out of his left ear.
It's [00:42:00] like, these are the things that sometimes they're not in the medical chart that the nursing staff knows because they're doing all this problem solving and trial and error before you even get there for hours and hours and hours. And they are, the nurses are such a resource. Yeah. It's there. They're really wonderful.
Actually, there, we have an SLP here who is now a critical care nurse and used to be an SLP, which I think is such an interesting transition. Yeah. Yeah.
[00:42:27] Kate Grandbois: Wow. Good for that person. That's like a, that's a double threat right there. That's a lot of information
[00:42:31] Sara Penrod:. Bedside swallow screen? I got it.
[00:42:35] Kate Grandbois: Wow. That's really impressive.
That's really, really impressive. Um, do you want to tell us a little bit about, um, the transition to the SLPs role in therapy or the diag, the SLP related diagnosis that happen? I'm just thinking about our third learning objective and I have a sneaking suspicion. You have another well of knowledge to share with us.[00:43:00]
[00:43:00] Sara Penrod: Yeah. Um, so our third learning objective is, is sort of the factors. I was thinking things like confound the diagnoses. So this is kind of like what I was thinking is what we were talking about. Like what's causing what, right? Like all these things that can impact, um, your ability to do therapy and your ability to make diagnoses, right?
So the nutritional lines that a patient has, for example, um, they may not have alternative nutrition in place. So once patients are extubated, oftentimes the oral feeding tube goes with it. And oftentimes the team wants speech to look at them before they decide, okay, are we going to put in an NG tube or are we going to put in, you know, a peg tube, a more permanent solution.
Um, but there's a million reasons based on chart review that you don't want this person to eat. So a lot of times the medical status is confounding. You know, it's like, yeah, this person might be able to swallow, but their medical staff, I mean, they cannot [00:44:00] tolerate a drop of aspiration. So I don't even want to give them more than an ice chip or a drip of water or something like that.
Um, you know, sometimes they're, they have lines that restrict their position, their positioning, like I said, the ventricular drains, um, if they're draining CSF, um, patients have to be clamped to be moved. They have what's called an arterial line, which is a line that goes, um, it's a catheter that goes directly into the artery that tracks the blood pressure closer to the source.
And that mine has to be moved with the patients, almost like little chips with
[00:44:34] Kate Grandbois: no one can see my face. My eyes are getting big. I'm like, oh my God, that's that, that is very serious stuff. That's very, very serious stuff. And I hate to simplify it into that, but this is. This is, you're talking about you're in that this is so redundant.
You're in an ICU. This is life and death. I mean, this is critical medical stuff. I mean, I've known that the whole time, but when you start talking about arterial [00:45:00] lines and needing to get clamped, I just have to assume as an SLP, trying to aggregate, not only aggregate all this information, but prioritize it.
Yes. You want your patient to communicate, but that might not be the top 10 things that the team 50 things that the team is worried about and trying to find your place in that that's a whole other skillset.
[00:45:23] Sara Penrod: Yeah. Yeah. It really is. Yeah. The, so you're a lot of times what's confounding either your diagnosis or your ability to treat is just these complex medical situations.
And that's kind of where you get into this critical thinking. Cause you're like, You know, based on chart review or based on how someone looks, it can be very easy to say, Nope, not appropriate, not safe. And I think you could make a case for no SLP in the ICU for that reason, but that doesn't help our patients and research is showing that.
So, um, You know, learning how to work the equipment, learning which patients are [00:46:00] safe, learning how to move them or just completely deferring to the nursing staff is okay too. You know, a lot of times they're one-to-one nursing ratio or two to one, two patients for one nurse. So they're, they're a really good resource.
They're there for you they have time. Most often when you go up to see a patient in critical care, the nurse is already in the room, um, they're always easy to find and easy to locate. So they're a huge resource. So you're, you're asking this patient, the nurse, I often will ask them. How do you think they'll do on swallowing or what communication needs do they have before I go see them?
It often doesn't change whether I'm going to go see them or not. But I think it, it adds a piece to the picture, right? Like the nurses, like, oh, I think they're going to swallow fine, but they're on all this Dex. So they're totally sedated. So it's hard to catch them when they're awake. Dexamethazone is a sedating methods.
[00:46:53] Sara Penrod: Sorry. Yeah. Um, Right. All this common terminology. [00:47:00]
[00:47:01] Kate Grandbois: It's fine. I mean, it's, it's one of those things where, you know, there are probably a lot of people listening who work in a hospital who knew exactly what that was, but I have to ask because I don't
[00:47:08] Sara Penrod: love it. So, um, You know. Okay. So this patient is totally sedated.
Um, but I think they swallow fine. And this is one of those compounding factors where it's like, okay, what do you do? You're talking to the team. How long are we thinking this person's going to need such significant sedation. Um, if we're thinking a really long time, then maybe a peg is the way to go. Um, If the person's alert and awake for maybe a half an hour a day, should we put them on a diet so that they have something to do to, to sort of reduce their restlessness, reduce their agitation, improve, you know, normalcy and routine and oral care and oral comfort.
Um, even though you're not anticipating this is going to sustain their nutrition and a lot of days you're going to have to hold off because maybe the arousal isn't enough. Um, but the, the, the swallowing physiology supports eating. So what can we [00:48:00] do safely, um, in an environment despite all of these, these medical factors.
Um,
[00:48:07] Kate Grandbois: and I also have to assume that in terms of the SLPs role in the ICU, let's say you have a patient who is, you know, very complex, very sick, is very fragile. And through your data analysis and critical thinking, you've determined that working on your goals is really not a top priority. I have to assume that even if it never really becomes a top priority your presence and role on the team in terms of educating people or consulting sets that patient up better for rehab, is that an accurate statement?
[00:48:45] Sara Penrod: A hundred percent, I think.
You know, being able to sort of predict what kind of a rehab candidate someone will be is one of our responsibilities, I mean, for PT, OT, and speech, right? Sometimes these patients are [00:49:00] critically ill. They're just being evaluated and the case managers are already like, are we talking long-term care or are we talking acute rehab?
What are we thinking here? Um, and those things change really frequently, but the case managers have to be starting to set this plan into place. Um, some of what I specialize in is disorders of consciousness and low level cognition. So trying to determine which patients are appropriate for a disorders of consciousness program versus long-term care versus, you know, palliative interventions, um, you know, A lot of that plays a role too.
And that's just, that just happens to be one of my specialties. Um, but the, the PTs and OTs in, in the ICU play a huge role with that too. And oftentimes we're sort of having these conversations together. It really depends to what the, what the patient's diagnoses are. I mean, a lot of times some of these like cardiac patients, for example, They look acutely terrible.
Right? So they've had like a CABG times for, you know, [00:50:00] um, and then they had all these sort of subsequent issues. They had difficulty excavating after the procedure, and then they ended up with a tracheostomy tube. A lot of these patients get significantly de-conditioned because their, their heart hasn't been working right for however long, causing them to either have an acute event or to need this massive surgery.
So there's sort of this precipitating course of weeks or months, and now they're like extra deconditioned. Um, it can keep them in like a cardiothoracic ICU for a longer time. And that's one of the units where I'm like, none of these people should be eating. They just are so weak. They all have this junky cough.
They all just kind of look like they can't breathe. Um, so, you know, seeing them through their course of the hospitalization initially thinking like, oh my goodness, they're going to need, you know, inpatient rehab. And then a lot of times they end up in sort of like an intermediate level of care and then they end up on maybe the medical surgical floor.
And then actually, you know, they're [00:51:00] tolerating their regular thin diet and they're working with PT and OT and they're walking. So sometimes your initial estimations of what someone will be able to do is totally wrong, but you're keeping that conversation fluid. And I have found it to be the cardiac patients that tend to surprise me, um, where I'm like, well, if I just don't know if that person will ever eat again and they ended up like, you know, tolerating a diet and looking so much better because so many, you know, think about they've had that, that cardiac procedure now.
So many things are improving, you know, their, their blood flow to their body, their muscles are getting stronger and they're having all of this other medical improvement, which we know corresponds to improvement in, um, oral pharyngeal swallowing functioning based on the research. So
[00:51:41] Kate Grandbois: I can't help, but feel like your knowledge base extends so far beyond what we learn in graduate school.
Like in graduate school, I did not learn about, about heart and blood supply to the muscles. And how, and just think following the breadcrumbs about how [00:52:00] much that impacts your job as an SLP, is this something that you learn? I mean, I was going to make a bad joke and say through osmosis, but just like talking to nursing and I mean, how do you get this knowledge?
I mean, it seems like this knowledge is critical to your job in an ICU.
[00:52:20] Sara Penrod: Yeah, I guess, I guess just over time. I mean, I also have a specific interest. I sometimes think I should have been like an ENT PA or something like that. I, I have a very particular interest in the way um, the body works and the way I think Descartes, right.
Descartes screwed us all up because it made it. So like now we're all specialized. We broke up the body into parts. It's like, no, you study this and you study this and you study this and we kind of forgot about the way the body works as a whole, right?
Yes, exactly.
I mean, if you have respiratory failure, what happens?
Your kidneys help to start to compensate to perfuse your blood with oxygen. [00:53:00] That, that blows my mind. It's like, what do you mean? Somebody comes in with pneumonia and then they had a kidney injury. How does that work? Um, and why does it look like when patients are experiencing this problem? Their dysphagia is worse.
Let me look into that more. It just comes back in from years of experience. We'll get better with some things, talking to doctors. And then, you know, CEUs I try to seek out the most medically in depth to use. I can find cause I find it fascinating
[00:53:23] Kate Grandbois: Not onlythat, but I feel like what you're describing are the skills that you're demonstrating as we're talking are reflective of a transdisciplinary team, which is different than an inner disciplinary team or multidisciplinary team.
Right. So the different members of the team working in silos, but working together. Right. So. Versus teaching each other versus yes, I'm an SLP, but I have my nursing bag of tricks where I have my tea bag of tricks that I can use within appropriated with, to have this launch because my team member taught these things to me.
And I think at the pap trans disciplinary team is, is, is powerful. They're very redundant sentence. It's really important to be able to have this peer to peer education, particularly when you're working with people who are so clearly ill.
[00:53:58] Sara Penrod: Oh, totally. Yeah. They're a big [00:54:00] theme. I think the next couple of years interprofessional team, and it is defined as the hoop and that key point that you mentioned that we understand that the depth breadth and other goals, you can set a whole career to learn.
I mean, I'm asking for GI inservice because we want to more in depth, understand what can GI do if I'm saying, okay, everyone has a UBS and I'm recommending a GI consult. Well, what actual tools does GI have? If I better understand those, I'm better understanding when it's appropriate to give these consults and what might be the outcome there by cutting down on inappropriate consults, et cetera, et cetera, et cetera, you know, reducing, wasting, um, the patient, he gets the more accurate tasks.
So, you know, the relationship we could go on and on just about the relationship between swallowing in the esophagus, because who's in charge of the relationship, I'm in charge of what they swallow. But once you get to the UES, I'm not charging more. If I don't understand what's happening. And the buck might stop with me or it might still course of assessment.
That's not necessarily right. It's probably one of my favorite aspects. That'd be medical SLP.
[00:54:55] Kate Grandbois: I mean, it's also sounds like it's a critical component to you being able to do your job successfully.
[00:54:59] Sara Penrod: I think so. [00:55:00] Yeah.
[00:55:00] Kate Grandbois: So in our last couple of minutes, is there anything else more you want to tell us about these, these confounding diagnoses and the relationships between these variables as a, as an SLP who was either interested in the ICU
[00:55:09] Sara Penrod: Yeah. One of the main assets is cognitive. I mean, condition is like this whole overarching concept, right? Um, you as LP, I think it's important that we know how to tease out medical related cognitive changes from a cognitive disorder. You know, you don't want patients unnecessarily carrying this diagnosis of a cognitive impairment when you suspect it's, you know, fluid related, kidney function, really oxygen related, um, you know, delirium related.
So being very clear as to this is a presentation, but. You know, this is the ideology, or, you know, I suspect that when these things improve, this, these functional things will improve. Um, because cognition is sort of a term that gets thrown around, which has probably expanded rehab. Cause it's like, well, no cognition is a attention and problem solving.
And what you're talking about is medication side effects or, you know, um, metabolic disarray causing X, Y, and Z. So. Specifically, I think it's important [00:56:00] not to be misdiagnosing people with things, but understand what's going on. And, um, communicating that to the team and monitoring that, you know, it seems so strange to pick someone up for cognitive treatment where you're kind of monitoring their cognitive improvement, but, you know, say somebody who's in with intractable seizures, they're getting all kinds of medications.
It's like, you're not going to go in there. You might have orientation, but you're going to say, well, this person has taught me that in therapy. You're gonna say we're gonna have each of these meds, um, stabilize a little bit, and we're gonna do another look. And you know, we're going to make all the delirium recommendations, you know, try to maximize sleep during the day, all these of standard things.
Um, I think it's important to be mindful of what you're diagnosing people with when, um, there's medic medical factors at play.
[00:56:38] Kate Grandbois: I think that’s an incredible point, um, in, I wonder if, as our sort of parting thought, if there are. I don't know any advice, any words of wisdom, any additional information that you want to leave our listeners who might want a little more, who are interested in this, but aren't doing it yet, or maybe they are like you and they, you know, have digested some of this additional information. What other parting words of advice do you have for our [00:57:00] listeners?
[00:57:00] Sara Penrod: So to SLPs friends in ICU, I would say check the labs.
Trying to understand, find somebody who understands what the mutations and what the lobbying for what, seeing that you do change the way you frame, what you do as well,
because there are reasons that they should be able to do what.
The things that people in the ICU can do, and it is your responsibility to find those things. And then for people who are looking to get into the ICU, um, I would say, you know, start with a per diem job and, and make sure that if you get hired that you have really good training and mentorship, um, Cause a of this stuff makes sense, but if nobody tells you to do it, it's not necessarily obvious.
So having a really good mentor, um, a mentor who thinks critically and who thinks that SLP in critical care is important. I think it's, it's hard to do something like this on your own. Um, I think [00:58:00] if you're in an ICU and you feel like you don't get good feedback, I would saytry reaching out to doctors just with, you know, on patient that kind of backups.
And I put my hand up the resources
I know is extremely competitive, but there's, there's a lot of stuff out there. And, um, you know, do your own personal research on what's the funding and how that impacts, um, functioning patients, all of those kind of follow up.
[00:58:25] Kate Grandbois: Well, thank you so much for all of your wisdom. It's abundantly clear that, you know, a lot of things I now know because you've taught me more things.
We're still grateful for your time. And so grateful for our, for sharing all your knowledge with us. Again, for anybody who maybe missed this earlier in the episode, Sarah has made a handout that is available for download for free. It's a lot of information. So if you're out and about, and you didn't write anything down, but you want a reference list or something to keep it, your doctor have you, um, it's available for download.
There will be a link in the show notes. And thank you again for joining us
[00:58:48] Sara Penrod: before. Thank you so much. You want to really make kid super important and it's accessible and affordable. It's so necessary. So I really appreciate it.
[00:58:58] Kate Grandbois:Thanks that’s very nice of you to say.
Comentários