SC02 - Anesthesiology - ICU Flashcards
ICU
- Functions
- Staffing
Intensive Care Unit (ICU) function:
- Therapy for life-threatening illnesses, injuries and complications
- monitoring of potentially life-threatening conditions and organ function
- provides special expertise and facilities for vital organ support
- Salvage reversible end-organ damage for eventual recovery
Staffing:
- Nurse: patient ratio of 1:1 for ventilated patient, 1:2 for lower acuity
- Qualifications in Intensive Care, ALS
- Doctors: Physicians, Anesthesiologists
- Support: Surgeons, Physiotherapists, Pharmacists, Dieticians, Microbiologists
Types of intensive monitoring in ICU
Cardiovascular:
- ECG, CVP, invasive arterial bloodpressure monitoring, temperature
Renal:
- RFT, UO (foley)
Respiratory:
- RR, Waveform capnograph (intubated)
Neurological:
- EEG
Modalities of life support in ICU
Respiratory:
- Invasive/ non-invasive ventilators, High flow O2
Renal:
- Plasmapheresis, Hemofiltration, Hemodialysis, Peritoneal dialysis, Cytokine adsorption
Cardiocirculatory:
- Extracorporeal circulation, temperature regulator, CPR
Hepatic:
- Hepatic coma care, Liver dialysis (Molecular Adsorbent Recycling System (MARS) (outdated))
Neurological:
- Acute coma care, acute post-infectious polyneuropathy care
Drug:
- Overdose/ desensitization care
Others:
- Metabolic: thyroid storms, DKA, electrolytes
- Obstetric emergencies
- Burns/ wound complications
Triage logic for ICU admission
- Patient consent/ preference
- Disease severity/ prognosis
- Reversibility of condition or organ damage
- Quality of Life: co-morbidities, disease progression and expected sequalae after admisssion
Pros and Cons of ICU admission
Pro:
- Life-saving
- Intensive therapy and monitoring to salvage important organ function
Cons:
- Invasive procedures
- Infection risks/ nosocomial infections
- Loss of self-esteem/ psychosocial co-morbidities
- Delirium development and long-term cognitive impairmen
- Long-term performance status impairment
Life-sustaining processes that can be withdrawn under patient consent
DNR/ DNACPR
Withdrawal of circulatory support: Inotropes, Vasopressors, blood products…
Withdrawal of ventilator/ limitation of ventilator settings
Withdrawal of Renal replacement therapy
End-points to measure ICU outcome
- Absolute mortality rate
- Standardized Mortality Ratio (SMR): mortality of one ICU unit compared to reference data base,
APACHE Score (Acute Physiology and Chronic Health Evaluation)
SAPS Score (Simplified Acute Physiology Score)
MPM (Mortality Prediction Model) - Quality of life during stay and after discharge
- Subjective opinion of patient comfort
Outlin APACHE score for ICU outcomeS
Definition of ARDS