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ORGANIZATION OF
INTENSIVE CARE UNITS
Prof. Amir B. Channa
Professor
Department of Anaesthesia
King Khalid University Hospital
Critical Care
of
MORIBUND Patient
Definition of Critical Care:
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1.Holistic Approach
2.Challenges
General care
CNS
Respiration
CVS
Renal
Hemopoetic system care
Renal replacement therapy
Holistic Approach
GIT
Nutritional care: fluid & electrolyte status
maintenance
Psychological
Locomotor system
Skin care
Prevention of nosocomial infection
Patients are/may become
immunocompromised
In case of death or demise sympathy with
Design of ICU
Services required
Basic requirement of
ICU
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CCU
Burns ICU
Pediatric ICU
Neonatal ICUs
Multidisciplinary ICU
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Patient Care in
the ICU
Assess current status, interval history, and
examination
Review vital signs for interval period (since
last review)
Review medication record, including
continuous infusions: Duration and dose.
Change in dose or frequency based on
changes in renal, hepatic or other
pharmacokinetic function. Changes in route
of administration. Potential drug interactions
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catheter related.
Stress gastritis
Deep venous thrombosis and pulmonary
embolism
Decubitus ulcers
Psychosocial needs and adjustments.
Toxicity of drugs (renal, pulmonary, hepatic,
CNS)
Development of antibiotic-resistant organisms.
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Nutrition
Set goals for appropriate nutrition support
Avoid or minimize catabolic state
Acquired vitamin K deficiency while in ICU
Avoidance of excessive fluid intake
Diarrhea (lactose intolerance, low
protein,hyperosmolarity drug-induced,
infection)
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Nutrition
Minimize and anticipate hyperglycemia
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output, shock
Nephrotoxic drugs
Obstruction of urine outflow
Interstitial nephritis
Manifestation of systemic disease, multiorgan
system failure
Degree of preexisting chronic renal failure
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Diabetic
Ketoacidosis
Evaluate degree of volume depletion and relationship
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Hyponatermia
Consider volume depletion (nonosmolar
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Hypernatermia
Diabetes insipidus
Diabetes mellitus
Has patient been water-depleted for a
long-time?
Concomitant volume depletion?
Is the urine continuing to be poorly
concentrated?
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Hypotension
Volume depletion
Sepsis (Consider potential sources; may need
to treat empirically)
Cardiogenic (Any reason to suspect?)
Drugs or medications (prescribe or not)
Adrenal insufficiency
Pneumothorax, pericardial effusion or
tamponade, fungal sepsis, tricyclic overdose,
amyloidosis
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Swan-Ganz
Catheters
Site of placement (safety, risk, experience of
operator)
Coagulation times, platelet count, bleeding
time, other bleeding risk
Document in medical record
Estimate need for monitoring therapy
Predict whether interpretation of data may be
difficult (mechanical ventilation, valvular
insufficiency, pulmonary hypertension)
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Upper Gastrointestinal
Bleeding
Rapid stabilization of patient
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Upper Gastrointestinal
Bleeding
Determine when excessive amounts
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Fever, Recurrent
Or Persistent
New, unidentified source of infection
Lack of response of identified or
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Fever, Recurrent
Or Persistent
Incorrect empiric antibiotics
Slow resolution of fever (deep-seated
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Pancytopenia
(After Chemotherapy)
Fever, presumed infection, response to
antimicrobials
Thrombocytopenia and spontaneous
bleeding
Drug fever
Transfusion reactions
Staphylococcus, candida, other
opportunistic infections
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Pancytopenia
(After Chemotherapy)
Infection sites in patient without
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DESIGN OF AN ICU
Single entry and exit point
Attended by the unit receptionist
NO Through traffic of goods
People to other hospital areas must
NEVER be allowed
Rooms for public reception
Patient management and support
services.
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PATIENT AREAS
Each patient bed area in an
adult ICU requires a minimum
floor space of 20 m2 (215 ft2)
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Automatic
control
Patient
Clinician
Transducers
equipment
Display
Computer
DBMS
Reports
Mouse and
keyboard
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ICU
Bed
Nurse station
WEB
connection
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Bed
Bed
Bed
Telemetry
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And more...
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OPERATIONAL POLICIES
Clear cut administrative policies
An open ICU has unlimited access to multiple
doctors
A closed ICU has admission
Quality assurance, continuing education and
research
Consideration of relatives
Effective communication
Physical environment
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OPERATIONAL POLICIES
Other supportive measures
Social worker
Counselor
Priest or religious
Follow-up counseling
Emotional support for staff
Death occurs
Family should be allowed privacy to mourn, to
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Factors influencing
outcome from a critical
illness
Patient factors
- Pervious health status
- Physiological reserves
- Biological age
- Co morbidity
Disease factors
- Type of disease
- Severity of disease
Treatment factors
- Treatment available?
- Timing if therapy
- Suitability of therapy
- Response to treatment
General scores
PRISM (Pediatric RISk of Mortality)
DORA (Dynamic Objective Risk Asse
ssment)
PELOD (Pediatric Logistic Organ Dys
function)
PIM II (Paediatric
Index of Mortality II)
PIM (Paediatric Index of Mortality)
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Specialized : Neonatal,
Surgical, Meningococcal septic
shock
CRIB II (Clinical Risk Index for Babies)
CRIB (Clinical Risk Index for Babies)
SNAP (Score for Neonatal Acute Physiol
ogy)
SNAP-PE (SNAP Perinatal Extension)
SNAP II and SNAPPE II
MSSS (Meningococcal Septic Shock Scor
e)
Pediatric Trauma
Scores
Pediatric Trauma
Score
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Pediatrics : therapeutic
intervention, nursing
ICU scores
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Maximum points
Temperature
Mean arterial pressure
Heart rate
Respiratory rate
Oxygenation
Arterial pH
Sodium
Potassium
Creatinine
Haematocrit
White cell count
Glasgow coma scale
Acute physiology score
Age
Chronic health evaluation
APACHE II score
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4
4
4
4
4
4
4
8
4
4
12
16
6
5
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Patient Care in the ICU
76
+4
+3
+2
41
39-40.9
+1
+1
Temperature
MAP
160
130-159
110-129
70-109
50-69
49
HR
180
140-179
110-139
70-109
55-69
40-54
RR
50
Oxygenation1
pH
7.7
7.6-7.69
Na+
180
160-179
K+
6.6-6.9
Creat
Hct
60
50-59.9
46-49.9
WCC
40
20-39.9
15-19.9
15-GCS
FIO2
35-49
500
38.5-38.9 36-38.4
25-34
350-499
12-24
200-349
10-11
< 200
7.5-7.59 7.33-7.49
155-159
34-35.9 32-33.9
6-9
> 05/24/15
0.5 record A-aO2
3.5-5.4
2.5-2.9
30-45.9 20-29.9
3-14.9
1-2.9
+4
29.9
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PaO2> 70 61-70
7.25-7.32 7.15-7.24 < 7.15
120-129
3-3.4
30-31.9
+3
150-154 130-149
5.5-5.9
+2
111-119
55-60
< 55
110
<2.5
< 20
<1
Patient
Care in the ICU
FIO2< 0.5 record
PAO2
77
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