completed ICU posting for critical module. ICU unit is divided into general ICU (that occupies most of the space) and cardiac ICU (CICU) for cardiothoracic cases. the cubicles are separated into infection cases and non-infection case. here are some guides.
THINGS YOU NEED TO DO:
1. change and labels all tubing with date. check cuff pressure if patient is intubated.
2. do mouth and eyes toilet to promote good hygiene.
3. do the hourly charting. everything is jotted down in a large observation chart that was attached to the table. details to write down includes vital signs, ventilator setting, CVP reading, and intake output. if the pt you are in charged in is supported by ventilator, make sure that you check the setting before charting down the
details. there's just a lot of thing to be chart and belief me, at first it is confusing.
4. check medication for the patient and prepare. common route for drug administration are IV (bolus and infusion) and enteral (where tablets are crushed and diluted in water for injection.). common drugs are:
- IV bolus = zantac, dexamethasone, antibiotics
- IV infusion = actrapid (adjusted according to glucose level, by refering to Albertis score), analgesic,
sedation (dopamine and etc), inotropic agents.
- enteral route = antihypertensive, lactulose
5. Most patient came in from OT with arterial line and venous line. differentiate it by:
- position : artery line usually at the area where pulse can be felt and venous line are subclavian,
intrajugular or brachial site.
- colour : arterial = red coloured three way, venous = blue coloured three way.
6. NO MEDICATION ARE ALLOWED TO BE GIVEN THROUGH ARTERIAL LINE.
7. Patient usually came in with triple lumen for cvp monitoring and as IV medication route. line for inotropic agent are only specific for inotropic agents. no other drugs can be administer through that line!
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| credits to gOOgle |
9. Flushing the IV lines after blood taking in ICU is simple. (refer the picture below). there are a rubberlike extension or appendage where you can pull. the line will be flushed with normal saline that is connected to the tubing. remember to adjust the three way stopper (in drip to patient direction) before doing so.
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11. tracheostomy dressing.
12. enteral feeding. feeding via Ryle's Tube and regulated by machine. to top up the diet, ensure that you clean the feeding bag with warm water and flush the tubing.
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| feeding bag credit to gOOgle |
EXTRA...
- learn about ICU bed preparation and zeroing. zeroing is done every shif.
- follow anesthesiologist round to get extra knowledge.
- involve in transporting critical ill patient. there are several things that you need to prepare beforehand whenever transporting the patient is need for diagnostic test such as CT scan.
- drug dilution.
- read and try to understand mechanical ventilation especially the modes and setting. also do extra reading on ICP monitoring.
my experience...
the patient that i was assigned to are in DNR state. she was in comatose condition and suspected to have brain death. her life was supported by mechanical ventilation, her GCS was 3/15. i remembered what my lecturer had always stressed when taking care of comatose patient, do communicate with them when performing any procedure. when i was taking her temperature, i greet her and informed the result. as i was about to chart down the result, i saw tears flowing down to her cheek. my heart sank...she passed away on thursday..may Allah blessed her....
ps: ICU is overcrowded by students! make sure you get your chance to do things and get your crosses.
