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Surviving ITU Placements. 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. General thoughts of ITU. Sick people Noisy/Busy People dying Smell

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introduction to itu
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.
general thoughts of itu
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!!
what itu is actually like
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
monitoring in itu
MONITORING IN ITU
  • Heart Rate
  • Blood Pressure
  • Temperature
  • Central venous pressure
  • Oxygen staturation
  • Cardiac output
head injuries
Head Injuries
  • Inter cranial pressure
  • Jugular oxygen saturation
  • Cerebral perfusion pressure
  • End tidal Carbon dioxide
blood gases
Blood Gases
  • PaO2
  • PaCO2
  • H+
  • pH
  • HCO3
  • Base excess (BE)
ventilator
Ventilator
  • Setting
  • Tidal volume
  • Respiratory Rate
  • Peak Airway Pressure
  • Minute Volume
  • Fraction of inspired O2
modes of ventilation
MODES OF VENTILATION
  • SIMV
  • SIMV + PS
  • CPAP + PS
  • EXTERNAL CPAP
  • BiPAP
assessment in itu
Assessment in ITU
  • Communicate with nurses
  • Look at medical notes
  • Look at nursing notes
  • Look at last PT notes
  • Look at chest X-rays
assessment in itu11
ASSESSMENT IN ITU
  • Observation
  • Palpation
  • Auscultation
  • Tape
analysis
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
treatment
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.
sputum retention
SPUTUM RETENTION
  • Mobilising
  • Deep breathing/ ACBT
  • Re-hydration
  • Positioning
  • Postural drainage
  • Flutter etc.
  • Humidified Oxygen
  • Bird
  • Bagging
  • Suctioning
lung volume
LUNG VOLUME
  • Mobilising
  • Deep breathing
  • Insentive spirometer
  • Positioning
  • Bird
  • CPAP/ BiPAP
  • Bagging
slide16
FINALLY…….
  • Although ITU seems daunting, remember it is one of the safest environments to work in!
vascular
VASCULAR
  • What it involves?
  • Diabeties
  • V.V
  • Ischaemia-grafting
  • Arterial and venous ulcers
  • Aortic aneurysms
  • Amputees post op
typical patients
Typical patients

50+male

  • Multiple problems
  • Alcohol abuse
  • Smoking-COPD
physio input
Physio input
  • CHEST PHYSIO POST OP
  • MOBILITY PHYSIO BEFORE D/C
  • VV- in/out
  • Aneurysms- aim 1 week.
  • Amputees- awaiting wound heeling
slide20
Use M/D notes
  • Work alongside O.T
  • Transfering pt to suitable physio….D/C, outpatients, further rehab.
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