Critical / Intensive Care - UCL
Critical / Intensive Care
What is Critical Care?
• = care of critically ill patients, with impaired/declining organ function
• Lots of Staff 1:1 nursing; ( Doctors 24/7; physiotherapy; Microbiology; Labstaff etc
• Special Equipment to monitor +/ replace organ function
Purpose of Critical Care Units
• Stop worsening organ function
• Support/replace organ function
• Optimise (=improve or maximise) organ function before surgery/radiology
• Monitoring ‘high risk’ interventions eg epidural
Indications for admission- Early discussion is important
Varied / controversial
Depends on potential recovery from illness and likelyhood of success of Rx
which country (Eg USA /Australia vs UK)
Emergency
( organ function Eg CVS / RS / Hepatic / GU / Neuro / Metabolic / Burns etc
ie – leave it up to the ward clinicians
or use‘Trigger Values’ Eg Patient Emergency Response Teams (UCLH etc)
RS Resp Rate 25
RS Sa02 35%
CVS Heart Rate >125 or 40mmHg
NS Sustained Altered Consciousness
General Looks unwell or you are worried
GU Oliguria more than 4 Hrs
Metabolic Repeated Hypoglycaemia
When a ward nurse/Dr records outside these values – the team is called
( incidence of Cardiac Arrest/deaths but more ? ICU admissions
Elective
Postoperative eg AAA/Neurosurgery
Preop – if Major surgery / Comorbidities to ‘Optimise’
Monitoring - eg epidural
What Actually happens
- Aim to discharge patients in as good as their long- term state
Monitor Therapies
CVS Continuous ECG, CVP, Art Line Inotropes, Pressors, Anti-Dysrhymic Rx
Cardiac Output (Eg PA Catheter) Intra-Aortic Balloon Pump, LVAssist Device
RS Continuous RR, Sa02, Pa02 02, CPAP, Intubation, Ventilation
Renal Urine Output, Cardiac Output, Drugs (?), Haemofilter
Liver IVC pressures Support other organs/ Extracorporial Liver?
Neuro Intracranial Pressures/Flows Support other organs/ Inotropes etc
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