Critical care Unit

Organization Classification Principles Special equipments – ventilator, cardiac monitor & defibrillator Infection control protocol Monitoring Ethical and legal aspects Death and dying Drugs used in icu

Meaning ) is a specialized facility in a hospital that provides intensive care medicine. Many hospitals also have designated intensive care areas for certain specialties of medicine, as dictated by the needs and available resources of each hospital.

The Critical care or intensive care unit is the term used to describe “the care of patients who are extremely ill and whose clinical condition is unstable or potentially unstable.”

Definition Critical care unit is defined as the unit in which comprehensive care of a critically ill patient who is deemed recoverable is carried out. Critical care unit is a specially designed and equipped facility staffed by skilled personnel to provide effective and safe care for dependent patients with life threatening or potentially life threatening problems.

Purpose Continuous Monitoring and treatment. Required emergency interventions. care for patients who are medically unstable or seriously ill. Care for patients who do not have much chance for recovery due to the severity of their illness or traumatic injury.

History 1854 Crimean war – Florence Nightingale Dr. W.E. Dandy – 3 bedded Neurosurgical unit in US 1927 first hospital for premature born infants in Chicago II nd world war – shock wards 1947-48 outbreak polio Epidemic – respiratory ICU 1950 peter safar anathetist ‘Advanced support of Life’ (sedated & ventilated)

History 7. Nurses practice – sick patients located near the nurses station receive more attention. 8. 1990- development of various specialty & ICU significantly reduced the mortality and hopital stay time 9. Major surgeries – liver transplant, kidney transplant and pancreatectomy

Organization of ICU Central unit with a back up services of Sophisticated investigations Imaging techniques Physiotherapy Super specialities Beside Medical & surgical ICU Trauma unit Burns Respiratory care ICCU cardiac surgery Neurosurgery

Location Calm & Quiet environment Close relationship with Imaging techniques Physiotherapy Trauma unit Burns Respiratory care Laboratory

Size of the ICU Average 6-8 Less than 6 becomes uneconomical > 12 becomes unwide Precious yrs discharge X average length of stay Size of the unit = ---------------------------------------------------------- X 2 365

Design of the unit

Should permit direct view of the unit – square, U shaped or rectangle. Cubicles separated with walls/papers or opaque glasses Doors should be wide enough Provision for visitors and not to disturb the client/ Nursing team Each cubicle should have window

6. Calendar and clock in the unit/ cubicle 7. Rapid communication system 8. Centrally placed monitor

Ancillary area Nurses station Utility room Admission room Room for specialized equipment Conference or class room Nurses waiting/resting room Doctors waiting/resting room Lab Pantry Visitors room Store room & Changing room

Infrastructure

1. Rails alongside the bed 2. Wall sockets for oxygen and pressurized air as well as for suction. At least 2 oxygen and pressurized air outlets are needed and 3 aspirators per patient. 3. A bell or intercom for calling the nurse should be at each bed. 4. A table and a telephone with an outside line should be at the bedside. 5. Armchairs should be on hand, preferably adjustable ones, to allow patients to sit up if they can.

Models Open ICU model Closed ICU model Mixed ICU model Intensivist model Intesivist co management model