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Surviving ITU Placements

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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Surviving ITU Placements

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  1. Surviving ITUPlacements

  2. 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.

  3. 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!!

  4. 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

  5. MONITORING IN ITU • Heart Rate • Blood Pressure • Temperature • Central venous pressure • Oxygen staturation • Cardiac output

  6. Head Injuries • Inter cranial pressure • Jugular oxygen saturation • Cerebral perfusion pressure • End tidal Carbon dioxide

  7. Blood Gases • PaO2 • PaCO2 • H+ • pH • HCO3 • Base excess (BE)

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

  9. MODES OF VENTILATION • SIMV • SIMV + PS • CPAP + PS • EXTERNAL CPAP • BiPAP

  10. Assessment in ITU • Communicate with nurses • Look at medical notes • Look at nursing notes • Look at last PT notes • Look at chest X-rays

  11. ASSESSMENT IN ITU • Observation • Palpation • Auscultation • Tape

  12. 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

  13. 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.

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

  15. LUNG VOLUME • Mobilising • Deep breathing • Insentive spirometer • Positioning • Bird • CPAP/ BiPAP • Bagging

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

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

  18. Typical patients 50+male • Multiple problems • Alcohol abuse • Smoking-COPD

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

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

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