Surviving ITU Placements

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Surviving ITUPlacements
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INTRODUCTION TO ITU

•  
• ITU Ventilated or at risk of 2 or more organ
  failures.
•  
• HDU Self-ventilated or at risk of 1 organ
  failure.
•  
• General wards Self-ventilated with basic level
  of nursing care.

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 General thoughts of ITU

• Sick people
• Noisy/Busy
• People dying
• Smell
• Lots of machines
• Overwhelming
• Frightening
• Arrests frequently
• Blood
• Scared of making people worse
• Casualty/ER style!!
•  

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What ITU is actually like

• Calm
• Supportive
• Large presence of medical staff
• People who are critically ill
• Cleaners! (very clean)
• Demand for beds. Moved out ASAP
• Highly trained staff. Each person knows their job
• Friendly and approachable
• Infection control

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 MONITORING IN ITU

• Heart Rate
• Blood Pressure
• Temperature
• Central venous pressure
• Oxygen staturation
• Cardiac output

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Head Injuries

• Inter cranial pressure
• Jugular oxygen saturation
• Cerebral perfusion pressure
• End tidal Carbon dioxide

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Blood Gases

• PaO2
• PaCO2
• H
• pH
• HCO3
• Base excess (BE)

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Ventilator

• Setting
• Tidal volume
• Respiratory Rate
• Peak Airway Pressure
• Minute Volume
• Fraction of inspired O2

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MODES OF VENTILATION

• SIMV
• SIMV PS
• CPAP PS
• EXTERNAL CPAP
• BiPAP

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Assessment in ITU

• Communicate with nurses
• Look at medical notes
• Look at nursing notes
• Look at last PT notes
• Look at chest X-rays

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ASSESSMENT IN ITU

• Observation
• Palpation
• Auscultation
• Tape

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Analysis

• IS THE PATIENT STABLE ENOUGH TO BE TREATED?
• If the pt is unstable will they deteriorate
  further without PT input?
• Will PT cause further instability? 
• ? ? WOB
• ? SPUTUM RETENTION 
• ? ? LUNG VOLUME

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Treatment

• Ward fit?ITU
• Active treatment? passive treatment
• ? WOB
• Rest/sleep
• Positioning
• Pacing
• Relaxation
• Breathing re-education
• BiPAP/CPAP
• Ventilation
•  Intubating and ventilating a pt is a MDT
  decision with consultant having final say.

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SPUTUM RETENTION

• Mobilising
• Deep breathing/ ACBT
• Re-hydration
• Positioning
• Postural drainage
• Flutter etc.
• Humidified Oxygen
• Bird
• Bagging
• Suctioning

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LUNG VOLUME

• Mobilising
• Deep breathing
• Insentive spirometer
• Positioning
• Bird
• CPAP/ BiPAP
• Bagging
•  

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• FINALLY. 
• Although ITU seems daunting, remember it is one
  of the safest environments to work in!

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VASCULAR

• What it involves?
• Diabeties
• V.V
• Ischaemia-grafting
• Arterial and venous ulcers
• Aortic aneurysms
• Amputees post op

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Typical patients

• 50male
• Multiple problems
• Alcohol abuse
• Smoking-COPD

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Physio input

• CHEST PHYSIO POST OP
• MOBILITY PHYSIO BEFORE D/C
• VV- in/out
• Aneurysms- aim 1 week.
• Amputees- awaiting wound heeling

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• Use M/D notes
• Work alongside O.T
• Transfering pt to suitable physio.D/C,
  outpatients, further rehab.