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Over View of Critical Care

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Title: Over View of Critical Care


1
Over View of Critical Care
2
Learning Objectives
  • At the end of session participants will be able
    to
  •  
  • Appreciate critical care nursing critical care
    setting.
  • Discuss history and advances of critical care
    concepts.
  • Discuss design and resources needed for critical
    care.
  • Discuss Critical care competencies,
    interdisciplinary collaboration and critical care
    team.
  • Discuss standards of care
  • Synthesis evidence based best practices
  • Discuss AACN synergy model of critical care
  • Discuss evidence based critical care nursing
    advances
  • Share knowledge gained via pre reading materials
    ( Students showing well Preparedness).

3
WWhhhaaattt IIIss Intensive CCCaaarrree
MMeeddiicciinnee???
  • European Union of Medical Specialists (UEMS).
  • ICM combines physicians, nurses and allied health
    professionals in the co-ordinated and
    collaborative management of patients with
    life-threatening single or multiple organ system
    failure, including stabilisation after severe
    surgical interventions.
  • It is a continuous (ie. 24 hours) management
    including monitoring, diagnostics, support of
    failing vital functions, as well as the treatment
    of the underlying diseases.

4
History in USA
Dr. Walter E. Dandy 1886-1946 First pioneer of
intensive care in USA Johns Hopkins Medical Center
5
History in USA
  • Anesthesiologists contribution
  • Special wards for war casualties during World War
    II
  • Post anesthetic care units in American Hospitals

6
History in Europe
  • Main events
  • Polio epidemic
  • 1946-1950
  • Development of cardiopulmonary resuscitation
  • 1960

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Anesthesiogists ccoonnttrriibbuuttiioonn oonn ICU
  • Application of anesthesiology principles to
    critical pts improved care.
  • Mortality of polio epidemic 87
  • Dropped to 27 by the use of anesthesia machines
    for ventilation of pts.

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11
DDeevveellooppmmeenntt ooff IICCUU
  • Insights to human diseases
  • Cardiopulmonary resuscitation
  • Drugs and drug delivery systems
  • Technology in monitorisation, mechanical
    ventilation and other life sustaining equipment.

12
PPiioonneeeerrss iinn TTuurrkkeeyy
  • First units were founded by
  • Prof. Sadi Sun (Istanbul University Hospital)
  • Prof. Cemalettin Öner (Haydarpasa State Hospital)

13
Types ooff IICCUUss
  • Open units.
  • Primary physician is responsible for admission,
    treatment and discharge of the patient (USA).
  • Closed units.
  • Responsibility for admission, treatment and
    discharge of the patient is transfered to a
    specilaised ICU team (Europe).

14
DDeevveellooppmmeenntt of tteecchhnnoollooggyy
15
DDeevveellooppmmeenntt of tteecchhnnoollooggyy
16
DDeevveellooppmmeenntt of tteecchhnnoollooggyy
17
DDeevveellooppmmeenntt of tteecchhnnoollooggyy
18
Intensive CCare
  • High acuity
  • High risk of death (30-45 mortality)
  • High turnover (1200 pts/year/22 beds)
  • High stress (for family, for HCW)
  • High danger (infection to pts HCW)
  • Very high costs (1-2 of GNP in USA)

19
TTyyppeess oof IICCUU ppaattiieennttss
  • Stable patients, hi-risk to develop serious
    complications (needs close monitoring)
  • Acute MI, high risk surgical patients
  • Head trauma, sepsis
  • Unstable patients needing frequent medical
    interventions
  • Respiratory failure
  • Circulatory shock, acute decompansation of
    illness

20
TTyyppeess oof IICCUU ppaattiieennttss
  • Terminal illness or irreversible loss of
    consciousness.
  • Terminal cancer, permanent brain damage.

21
WWhhaatt ddoo wwee do in ICU?
Monitoring
  • ECG
  • Heart rate, rythm, ischemia.
  • Blood pressures
  • Noninvasive
  • Invasive
  • Arterial, central venous, pulmonary artery
  • Hemodynamic measurements
  • Cardiac output
  • Pulse oxymetry and capnography
  • Intracranial, intraabdominal pressures
  • Many others

22
WWhhaatt do wwee do in ICU?
  • Hemodynamic support
  • Inotrope and vazoactive medication
  • Sedation and analgesia
  • Treatment of underlying illness

23
WWhhaatt do wwee do in ICU? MMeecchhaanniiccaall
VVeennttiillaattiioonn
24
WWhhaatt do wwee do in ICU? MMeecchhaanniiccaall
VVeennttiillaattiioonn
25
WWhhaatt do wwee do in ICU? OOrrggaann
SSuuppppoorrtt
26
WWhhaatt do wwee do in ICU? EEnntteerraall///PPPaa
arrreeennnttteeerrraaall NNutrition
27
WWhhaatt do wwee do in ICU? CPR
28
WWhhaatt ddoo wwee do in ICU? NNuurrssiinngg
CCaarree
29
IInntteennssiivvee CCaarree UUnniittss iinn
CCeerrrraahhppaassaa HHoossppiittaall
  • Sadi Sun Intensive Care Unit (22 beds)
  • Emergency Intensive Care Unit (4 beds)
  • Neurosurgical Intensive Care Unit (13 beds)
  • Neonatal Intensive Care Unit
  • Coronary Intensive Care Unit

30
IInntteennssiivvee CCaarree TTrraaiinniinngg in
Turkey
  • Current status
  • Anesthesiology (4 years)
  • Pulmonary medicine (5 years 3 years ICU)
  • Internal medicine (5 years 3 years ICU)
  • Pediatrics (5 years 3 years ICU)

31
Design Resources
  • Specially designed space
  • Specialized life saving equipment
  • Specialized nurses doctors
  • Example SIH ICUs

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Nurses Competencies Skilled in
  • Hands on
  • Decision making
  • Hemodynamic monitoring
  • Handling life saving Eqpts
  • ACLS
  • Airway managment
  • IV access
  • Defibrilation
  • A lot more
  • Highly Professional knowledgeable
  • Competent
  • Team Player
  • Leading from Front
  • A.S.K

36
Achievement
37
Make a Choice
38
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