Surviving ITUPlacements

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• Lots of machines• Overwhelming• Frightening• Arrests frequently• Blood• Scared of making people worse• Casualty/ER style!!

 

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

• Heart Rate

• Blood Pressure

• Temperature

• Central venous pressure

• Oxygen staturation

• Cardiac output

Head Injuries

• Inter cranial pressure

• Jugular oxygen saturation

• Cerebral perfusion pressure

• End tidal Carbon dioxide

Blood Gases

• PaO2

• PaCO2

• H+

• pH

• HCO3

• Base excess (BE)

Ventilator

• Setting

• Tidal volume

• Respiratory Rate

• Peak Airway Pressure

• Minute Volume

• Fraction of inspired O2

MODES OF VENTILATION

• SIMV

• SIMV + PS

• CPAP + PS

• EXTERNAL CPAP

• BiPAP

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 ITU

• Observation

• Palpation

• Auscultation

•Tape

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• Ward fitITU• Active treatment passive treatment WOB1. Rest/sleep2. Positioning3. Pacing4. Relaxation5. Breathing re-education6. BiPAP/CPAP7. Ventilation•  *Intubating and ventilating a pt is a MDT decision with consultant

having final say.

SPUTUM RETENTION

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

LUNG VOLUME

• Mobilising• Deep breathing• Insentive spirometer• Positioning• Bird• CPAP/ BiPAP• Bagging

 

• FINALLY……. 

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

VASCULAR

• What it involves?

• Diabeties

• V.V

• Ischaemia-grafting

• Arterial and venous ulcers

• Aortic aneurysms

• Amputees post op

Typical patients

50+male

• Multiple problems

• Alcohol abuse

• Smoking-COPD

Physio input

• CHEST PHYSIO POST OP

• MOBILITY PHYSIO BEFORE D/C

• VV- in/out

• Aneurysms- aim 1 week.

• Amputees- awaiting wound heeling

• Use M/D notes

• Work alongside O.T

• Transfering pt to suitable physio….D/C, outpatients, further rehab.