Over View of Critical Care

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Over View of Critical Care
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Learning Objectives

• At the end of session participants will be able
  to
•  
• Appreciate critical care nursing critical care
  setting.
• Discuss history and advances of critical care
  concepts.
• Discuss design and resources needed for critical
  care.
• Discuss Critical care competencies,
  interdisciplinary collaboration and critical care
  team.
• Discuss standards of care
• Synthesis evidence based best practices
• Discuss AACN synergy model of critical care
• Discuss evidence based critical care nursing
  advances
• Share knowledge gained via pre reading materials
  ( Students showing well Preparedness).

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WWhhhaaattt IIIss Intensive CCCaaarrree
MMeeddiicciinnee???

• European Union of Medical Specialists (UEMS).
• ICM combines physicians, nurses and allied health
  professionals in the co-ordinated and
  collaborative management of patients with
  life-threatening single or multiple organ system
  failure, including stabilisation after severe
  surgical interventions.
• It is a continuous (ie. 24 hours) management
  including monitoring, diagnostics, support of
  failing vital functions, as well as the treatment
  of the underlying diseases.

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History in USA
Dr. Walter E. Dandy 1886-1946 First pioneer of
intensive care in USA Johns Hopkins Medical Center
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History in USA

• Anesthesiologists contribution
• Special wards for war casualties during World War
  II
• Post anesthetic care units in American Hospitals

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History in Europe

• Main events
• Polio epidemic
• 1946-1950
• Development of cardiopulmonary resuscitation
• 1960

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Anesthesiogists ccoonnttrriibbuuttiioonn oonn ICU

• Application of anesthesiology principles to
  critical pts improved care.
• Mortality of polio epidemic 87
• Dropped to 27 by the use of anesthesia machines
  for ventilation of pts.

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DDeevveellooppmmeenntt ooff IICCUU

• Insights to human diseases
• Cardiopulmonary resuscitation
• Drugs and drug delivery systems
• Technology in monitorisation, mechanical
  ventilation and other life sustaining equipment.

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PPiioonneeeerrss iinn TTuurrkkeeyy

• First units were founded by
• Prof. Sadi Sun (Istanbul University Hospital)
• Prof. Cemalettin Öner (Haydarpasa State Hospital)

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Types ooff IICCUUss

• Open units.
• Primary physician is responsible for admission,
  treatment and discharge of the patient (USA).
• Closed units.
• Responsibility for admission, treatment and
  discharge of the patient is transfered to a
  specilaised ICU team (Europe).

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DDeevveellooppmmeenntt of tteecchhnnoollooggyy
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DDeevveellooppmmeenntt of tteecchhnnoollooggyy
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DDeevveellooppmmeenntt of tteecchhnnoollooggyy
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DDeevveellooppmmeenntt of tteecchhnnoollooggyy
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Intensive CCare

• High acuity
• High risk of death (30-45 mortality)
• High turnover (1200 pts/year/22 beds)
• High stress (for family, for HCW)
• High danger (infection to pts HCW)
• Very high costs (1-2 of GNP in USA)

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TTyyppeess oof IICCUU ppaattiieennttss

• Stable patients, hi-risk to develop serious
  complications (needs close monitoring)
• Acute MI, high risk surgical patients
• Head trauma, sepsis
• Unstable patients needing frequent medical
  interventions
• Respiratory failure
• Circulatory shock, acute decompansation of
  illness

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TTyyppeess oof IICCUU ppaattiieennttss

• Terminal illness or irreversible loss of
  consciousness.
• Terminal cancer, permanent brain damage.

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WWhhaatt ddoo wwee do in ICU?
Monitoring

• ECG
• Heart rate, rythm, ischemia.
• Blood pressures
• Noninvasive
• Invasive
• Arterial, central venous, pulmonary artery
• Hemodynamic measurements
• Cardiac output
• Pulse oxymetry and capnography
• Intracranial, intraabdominal pressures
• Many others

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WWhhaatt do wwee do in ICU?

• Hemodynamic support
• Inotrope and vazoactive medication
• Sedation and analgesia
• Treatment of underlying illness

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WWhhaatt do wwee do in ICU? MMeecchhaanniiccaall
VVeennttiillaattiioonn
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WWhhaatt do wwee do in ICU? MMeecchhaanniiccaall
VVeennttiillaattiioonn
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WWhhaatt do wwee do in ICU? OOrrggaann
SSuuppppoorrtt
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WWhhaatt do wwee do in ICU? EEnntteerraall///PPPaa
arrreeennnttteeerrraaall NNutrition
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WWhhaatt do wwee do in ICU? CPR
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WWhhaatt ddoo wwee do in ICU? NNuurrssiinngg
CCaarree
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IInntteennssiivvee CCaarree UUnniittss iinn
CCeerrrraahhppaassaa HHoossppiittaall

• Sadi Sun Intensive Care Unit (22 beds)
• Emergency Intensive Care Unit (4 beds)
• Neurosurgical Intensive Care Unit (13 beds)
• Neonatal Intensive Care Unit
• Coronary Intensive Care Unit

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IInntteennssiivvee CCaarree TTrraaiinniinngg in
Turkey

• Current status
• Anesthesiology (4 years)
• Pulmonary medicine (5 years 3 years ICU)
• Internal medicine (5 years 3 years ICU)
• Pediatrics (5 years 3 years ICU)

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Design Resources

• Specially designed space
• Specialized life saving equipment
• Specialized nurses doctors
• Example SIH ICUs

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Nurses Competencies Skilled in

• Hands on
• Decision making
• Hemodynamic monitoring
• Handling life saving Eqpts
• ACLS
• Airway managment
• IV access
• Defibrilation
• A lot more

• Highly Professional knowledgeable
• Competent
• Team Player
• Leading from Front
• A.S.K

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Achievement
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Make a Choice
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