ICU Department Overview and IV Therapy

Intensive Care Unit (ICU) Department

• The ICU is a specialized department within a hospital
• Provides critical care to patients with severe or life-threatening illnesses and injuries
• Staffed by trained healthcare professionals
• Equipped with advanced medical technology
• Monitors and treats patients requiring close observation and intensive medical care

Role of the ICU Department

• Monitors vital signs such as heart rate, blood pressure, and oxygen levels
• Uses advanced monitoring equipment to quickly detect changes in a patient's condition
• Employs advanced treatments and technologies (e.g., ventilators, IV medications, dialysis)
• Provides support to families of patients during difficult times

Multidisciplinary Care

• ICU teams consist of critical care physicians, nurses, respiratory therapists, pharmacists, and other specialists
• Working together to develop and implement a comprehensive care plan for each patient

Services Provided by the ICU Department

• Ventilator Support (mechanical ventilation for patients who cannot breathe on their own)
• Medication Management (administration of sedatives, pain relief, and antibiotics)
• Nutritional Support (specialized nutrition through IV feeding or feeding tubes)
• Rehabilitation Services (assistance with recovery and regaining strength)

Departments of the ICU

• Medical ICU (MICU) : Focuses on patients with severe medical conditions
• Surgical ICU (SICU): Cares for patients recovering from major surgeries
• Neonatal ICU (NICU): Specialized care for premature and critically ill newborns
• Cardiac ICU (CICU): Focuses on patients with severe cardiac conditions
• Trauma ICU: Focuses on patients who have sustained severe injuries

Increased Mortality Rates and Delayed Treatment Due to Lack of Reliable ICU Services

• Critical conditions can worsen rapidly without immediate access to specialized care
• Many critically ill patients may not survive if access to ICU services isn't timely

ICU Vital Signs Monitoring Equipment

• Heart Rate Monitors: Measures the number of heartbeats per minute.
• ECG or EKG: Records electrical activity of the heart, providing information about heart rhythm and function.
• Pulse Oximeters: Non-invasive devices that measure heart rate and blood oxygen levels.
• Wearable Monitors: Allow for continuous heart rate monitoring.
• Blood Pressure Monitors: Measure the force of blood against artery walls.
  • Manual: Require stethoscope and sphygmomanometer
  • Digital: Automatically inflate the cuff and produce readings
• Oxygen Saturation Monitors (Pulse Oximeters): Measures the percentage of hemoglobin saturated with oxygen.
• Calibration: Ensures that monitoring devices provide accurate and reliable readings.
• Maintenance: Keeping equipment free of dust, checking batteries, and ensuring software is current.

Understanding Cardiac Monitoring Devices: ECG Machines and Telemetry

• ECG Machine: Records electrical activity of the heart.

  • Electrodes: Small adhesive pads on the skin to record electrical signals.
  • Lead Wires: Connect electrodes to the ECG machine.
  • Display Screen: Shows ECG waveforms of the heart.
  • Printer: Creates a hard copy of ECG readings.

• ECG Waveforms:

  • P wave: atrial depolarization (contraction of the atria)
  • QRS complex: ventricular depolarization (contraction of the ventricles)
  • T wave: ventricular repolarization (relaxation or recharging phase of ventricles)

• Types of ECGs: Stress Test ECG (monitors heart during physical activity), Holter Monitor (portable ECG for 24/48 hours)

Understanding Ventilators: Modes, Settings, and Techniques

• Assist-Control Ventilation (AC): Ventilator delivers pre-set number of breaths, patient can trigger additional breaths.
• Continuous Positive Airway Pressure (CPAP): Maintains constant pressure in the airway throughout the breathing cycle.
• Bilevel Positive Airway Pressure (BiPAP): Provides two different levels of pressure (IPAP for inhalation, EPAP for exhalation).

Understanding Oxygen Delivery Systems

• Nasal Cannula: Delivers low to moderate concentrations of oxygen.
• Simple Face Mask: Delivers higher concentrations of oxygen.
• Non-Rebreather Mask: Delivers high concentrations of oxygen.
• Venturi Mask: Delivers precise oxygen concentrations.
• High-Flow Nasal Cannula (HFNC): Delivers heated and humidified oxygen at high flow rates.

Understanding IV Pumps and Infusion Devices

• Gravity Pumps: Use gravity to deliver fluids.
• Electronic Infusion Devices (EIDs): Provide more controlled and precise fluid delivery.
• Programming and Safety Checks: Essential to ensure patient safety.
  • Sets flow rate (in mL/hr)
  • Tracks the total volume infused
• Types of IV Fluids:
  • Crystalloids: Small molecules that pass through membranes.
    • Isotonic: Same osmolarity as blood plasma (e.g., Normal Saline)
    • Hypotonic: Lower osmolarity (e.g., 0.45% NaCl)
    • Hypertonic: Higher osmolarity (e.g., 3% NaCl)
  • Colloids: Larger molecules that remain in the blood vessels longer (e.g., Dextran, Hydroxyethyl Starch)

Understanding Blood Transfusion Equipment and Protocols

• Blood Warmers: Heat blood products before transfusion to prevent hypothermia.
• Infusion Devices: Control and regulate blood flow during transfusions.
  • Gravity Infusion Sets: Basic devices.
  • Electronic Infusion Pumps: Provide precise control over flow rate
• Safety Protocols: Double-checking medication orders, monitoring insertion sites, constantly monitoring the patient for adverse reactions.

Understanding Dialysis and Renal Replacement Therapy

• Hemodialysis: A procedure that uses a machine to filter waste, salts, and fluid from the blood.
• Continuous Renal Replacement Therapy (CRRT): A form of dialysis used for critically ill patients who require continuous treatment.

Monitoring Neurological Function Understanding ICP and EEG in the ICU

• Intracranial Pressure (ICP): Measures pressure within the skull.
  • Types of ICP Monitors: Invasive methods (e.g., ventriculostomy, subarachnoid bolts) and non-invasive methods (e.g., transcranial Doppler).
• Electroencephalography (EEG): Records electrical activity in the brain.
• Uses for Monitoring: Diagnosing and managing various neurological conditions, such as seizures, sleep disorders, and encephalopathy.