SICU Mx.pptx

Sicu management

1. SURGICAL ICU MANAGEMENT Dr Ashwini Modi Senior Resident SU1 DEPARTMENT OF GENERAL SURGERY (PDUMC,RAJKOT)

2. ICU- Intensive care unit A Special Unit - concerned with the care of patients with critical illness. It demands broad-based knowledge, advanced monitors organ support equipment to achieve good outcomes More sophisticated and comprehensive level of care and follow up in compare to the ordinary ward

3. Surgical ICU Increased demand with : - Advancement in operative procedure - Improved critical care services and technologies Reasons : - Failure to awake from anaesthesia - Surgeries with high risk of complication leading to Patients requiring continuous monitoring & life support post operatively.

4. ADMISSION CRITERIA IN SICU As it is an expensive resource area and should be reserved for patients with reversible medical conditions with a reasonable prospect of substantial recovery . Candidates for admission to the SICU = Reason we developed SICU. - High risk patients in the peri -operative period - Post operative patients requiring continuous hemodynamic monitoring/ventilator support , usually following:- Prolong Abdominal / GI surgeries Vascular surgery Thoracic surgery Airway surgery Craniofacial surgery Major orthopaedic and spine surgery Neurosurgical procedures

5. PATIENTS GENERALLY NOT APPROPRIATE FOR ICU ADMISSION = Those who don’t fit into admission criteria I.e. Irreversible brain damage End stage cardiac, respiratory and liver disease with no options for transplant. Brain dead non organ donors Patients with non traumatic coma leading to a persistent vegetative state Metastatic cancer unresponsive to chemotherapy and/or radiotherapy

6. Icu management team:

7. RESPONSIBILITIES OF ICU DOCTORS Physical Examination Assessment of patients Interpretation of diagnostic test results Management of airway Pharmacological management CPR management Emergency cardio version defibrillation Catheterization Invasive ventilation Discussion of management with concerned surgeons and physicians Appropriate documentation of medical history and progress in patient notes. Prescription and update of therapeutic plans Carrying all technical procedures Communicating with patients relatives, referring hospital etc. Acute and chronic pain management

8. Provides professional nursing care for the comfort and well being of patients. Evaluating the general condition of patients. Implementation of doctor’s advice for individual patients. Coordinates care delivery and education through collaboration with patient, family and all health care team providers to ensure safe, effective and quality patient care. Performing professional, clinical or technological competencies which includes:- - Vitals monitoring - RBS monitoring - ET suctioning for intubated patients - Proper care of peripheral or central IV lines - Frequent changing of positions of patients - Maintaining proper patient hygiene. RESPONSIBILITIES OF NURSING STAFF

9. Basically SICU team will focus on :

10. LIFE SUPPORT GENERAL BODY CARE Changing of position of patients every 1 hour. Body and mouth hygiene Bowel and bladder care Passive and active physiotherapy Adequate nutrition

11. RESPIRATORY CARE Using oxygen support judiciously CPAP and BIPAP care Mechanical Ventilation CVS CARE Achieving adequate tissue perfusion. Optimizing vasodilators or vasoconstrictors ECG monitoring for danger signs O2 delivering devices Flow rate (lit/min) Approx. FiO2 % NASAL CANNULA 1-6 24-44 SIMPLE FACE MASK 5-8 40-60 NRBM MASK 10-15 90-100 HIGH FLOW O2 DEVICES(VENTURI MASK) 2-15 20-60

12. RENAL CARE - Maintaining adequate fluid and electrolyte balance and correction of any abnormalities. Monitoring input to output Avoid hypovolemia and hypotension Avoid use of nephrotoxic drugs especially in those with a compromised renal function.

13. HEMODYNAMIC MONITORING ECG ✅ NIBP ✅ CVP RESPIRATORY MONITORING *ABGS✅ *CAPNOGRAPHY *PULSE OXIMETRY ✅ TEMPERATURE MONITORING✅ RFT MONITORING✅

14. ABGS ARTERIAL BLOOD SAMPLE IS USED PH- 7.35-7.45✅ PCO2- 35-45mmhg ✅ PO2- 75-105mmhg ✅ HCO3- 22-28mmol/L✅ cglu - 3.5-5.4mmol /L cLac- 0-2.0mmol /L cCa- 1.15-1.3mmol /L Na- 136-146mmol /L K- 3.7-4.7 mmolL Cl - 101-110mmol /L

15. ECG : When to consult a physician ANTERIOR WALL MI Typical ST Elevation

16. RESPIRATORY MONITORING

17. CLINICAL IMPORTANCE OF CAPNOGRAPHY Sure sign for Endotracheal Intubation Detection of untoward events like disconnections or inadvertent extubations . Cardiopulmonary resuscitation Weaning from mechanical ventilation Monitoring the non intubated patients

18. RENAL FUNCTION MONITORING URINE VOLUME: Normal- 0.5-1.0 ml/Kg/hr Oliguria- < 0.5 ml/Kg/hr URINE CREATININE: 0.4-1.4 mg/dl URINE OSMOLALITY: Normal: 350-500 mOsm /KgH 2 O Prerenal Azotemia : > 500 mOsm /KgH 2 O Acute tubular necrosis: < 350mOsm /KgH 2 O

19. DISCHARGE CRITERIA Stable haemodynamic parameters Stable respiratory status - Patient extubated with stable ABG and patent airway No need for any IV inotropic/ vasopressor support. Neurologic stability is achieved. Cardiac dysrhythmia are controlled Patients requiring chronic mechanical ventilation with their acute critical problems reversed or resolved can be shifted to ward with ventilator facilities available. Patients whose physiologic status are stabilized and no longer need any ICU monitoring.

20. Thank you !