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Sunday, July 11, 2021

THE BEGINNER’S GUIDE TO INTENSIVE CARE PDF Download | Medical Books PDF Download By Nurses Note


The idea of your first day working in intensive care can be a daunting prospect. In the remainder of the hospital, the intensive care unit (ICU) is often perceived as a vastly complex world of ‘life support’, ventilators and inotropes. In reality, with the benefit of time, you will realise that the ICU continues the basic tenets of treatment carried out in the rest of the hospital, except with closer monitoring and some additional interventions, which require a high staff-to-patient ratio. Often, basic medical treatment is continued but with the addition of organ support, to maintain physiology in as normal a state as possible, allowing time for the actual treatment of the underlying condition to work. Using sepsis as an example, the treatment is antimicrobial medication. However, the profound vasodilation and resulting hypotension could result in death before the antibiotics can work. Vasoactive agents are employed to maintain end-organ perfusion while the antibiotics and the patient’s own immune system work to combat the cause of the sepsis.

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        Patients are admitted to the ICU for a number of reasons. Common indications for ICU admission include hypotension unresponsive to fluid resuscitation (e.g. sepsis), myocardial infarction, cardiac arrest, the requirement for advanced respiratory support (e.g. severe asthma, COPD exacerbation), the requirement for sedation, head injury, status epilepticus, cardiac arrest, severe liver disease, advanced post-operative monitoring due to comorbidities or severity of surgery (e.g. laparotomy, aortic aneurysm repair) and requirement for renal support. This admission may be planned or emergent, with emergencies making up over 75% of admissions. Survival to discharge from critical care varies dramatically depending on the reason for admission and any physiological impairment but is approximately 85%, including elective admissions. Patients admitted from the emergency department have a 71% survival to critical care discharge.

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     The nurses in the ICU are a vital part of patient care and can make your life very easy. They may well know much of what has happened to a patient even if it is not well documented in the medical notes, and can make your daily reviews quicker. As with many aspects of medicine, when you begin in ICU, they may well know much more than you about their area of expertise. In addition, in ICU, the medical staff are significantly outnumbered by nursing staff, as the nurses look after one to two patients each. Do not be afraid to ask for their advice if you are unsure about something, and if they are unhappy with your plan for their patient, it is well worth reconsidering. It may well be that your plan is appropriate, but often they will have greater insight into how things are usually done in the ICU.

     Other trainees can be an invaluable source of help when you are first starting in intensive care. Anaesthetic trainees make up a large part of the trainee workforce, in addition to medical trainees. There may also be trainees on an intensive care medicine training programme, either alone or in conjunction with another speciality. Some ICUs have advanced critical care practitioners, who are often very experienced ICU nurses or other associate healthcare professionals who have undertaken training approved by the Faculty of Intensive Care Medicine (FICM). Their role can vary from trust to trust, but they are qualified to undertake many of the tasks usually associated with ICU doctors. Obviously, the consultants are available for advice in addition to the other team members mentioned, and guidelines require a consultant to be available at all times and to carry out twice-daily ward rounds. Consultant presence is very high in critical care, and the junior medical staff are very well supported by seniors. Do not be afraid to call your consultant; if on call, they will be expecting it!

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