Intensive Care Unit Flashcards
What is Intensive Care?
Specialist hospital wards that provide treatment and monitor for people who are severely ill, also called as critical care or intensive therapy units(ITU).
Who invented ICU?
Copenhagen 1952 by
Dr Bjorn ibsen
What’s the Good in ICU?
Physiological monitoring
Organ support and lots of nursing
What is Physiological monitoring ?
Basic non-invasive monitoring -ECG, BP, Spo2
Invasicve Monitoring- CVP,IABP,Cardiac output, intracranial pressure
Respiratory monitoring- ETCO2, Ventilatory Parameters
Point of care testing - Blood gas analysis, and usually Hb/Hct, Na, K, Cl, Ca, Lac
also sometimes TEG, TnI, etc. (unit specific)
What are the indications for Monitoring?
Diagnosis: data may help differentiate between alternative diagnoses.
e.g. PAC: ARDS vs. cardiogenic pulmonary oedema
Surveillance: at risk of deterioration where rapid detection and intervention will modify outcome.
e.g. ICP monitoring in TBI.
Guiding Treatment: monitor response to therapy and adjust.
e.g. BP/CO response to vasoactive drugs
what is Non-invasive monitoring?
Quite useful !
continuous ECG
NIBP
Pulse oximetry
Ischaemia is poorly seen in Continuous ECG
What is NOn-invasive blood pressure?
Measures Systolic/Diastolic/Mean(MAP)
AF may lead to inaccuracy
Wrong cuff size may overestimate BP
What is Mean Arterial Pressure?
Good number is 65
MAP=DBP+SBP-DBP/3
What is Pulse pressure?
difference between the diastolic and systolic
Invasive monitoring
Indications are diagnosis, surveillance, titration of therapy but it can also monitor some parameters which cannot be monitored non- invasively e.g ICP, CO
Invasive pressure monitoring
What is Central Venuous pressure
Very low values (<4mmHg) imply hypovolaemia
Very high values (>18mmHg) suggest pump failure
Requires central line:
Infection risk (CLABSI)
Pneumothorax
Bleeding
Thrombosis
Invasive Blood pressure ?
Very Useful !
Systolic/Mean/Diastolic
beat to beat measure
Waveform gives more information
* Contractility
* Filling status
Requires arterial cannula:
* Bleeding risk
* Thrombosis/Embolism( VERY BAD)
* Can draw blood for ABG
Intracranial Pressure monitoring is placed for?
Traumatic brain injury
Head injuries and increase the ICP
What is Cardiac output Monitoring?
- Variety of technologies
- Useful to diagnose cause of shock
- May be useful to guide treatment
- Continuous monitors all invasive
- Most require central and arterial lines