This document provides an introduction to intensive care units (ICU) including indications for admission and management of unconscious patients. It discusses the types and functions of ICUs as well as important equipment. Conditions commonly managed in ICUs are listed. Indications for ICU admission include threatened airways, respiratory or cardiac arrests, and altered mental status. The document outlines how to assess and initially manage unconscious patients, followed by diagnostic evaluations and ongoing care in the ICU focused on infection control, feeding, analgesia/sedation, and treating other medical needs.

1. INTRODUCTION TO
INTENSIVE CARE UNIT;
∆ INDICATIONS FOR ADMISSION
∆ MANAGEMENT OF THE UNCONSCIOUS
PATIENT.
BY DR. EMMANUEL ALI ADAMU
DEPARTMENT OF MEDICINE AND SURGERY, COLLEGE OF
MEDICAL SCIENCES, UNIVERSITY OF MAIDUGURI, BORNO
STATE, NIGERIA
2023/4/6 1

2. OUTLINE
• Introduction
• Types of ICU
• Functions of ICU
• Siting and Design
• Indications for Admission
• Management of the Unconscious patient
• Summary
• References
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3. INTRODUCTION
• The intensive care unit is a designated area within
the hospital facility that is dedicated to the care of
patients who are seriously Ill.
• It is a place where services are given to patients
with potentially recoverable diseases who can
benefit from more detailed observation and
treatment than is generally available in the
standard wards or other departments.(Petros et. al.
1995)
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4. Types of ICU's
• There are different types of ICU's depending on the
specific purpose and the level of dependency of the
patients.
• It can also be gouped based on accessibility to
Medical personnel into;
• 1. Open ICU
• 2. Semi-open ICU and
• 3. Closed ICU
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5. General ICU
• MICU- Medical ICU
• SICU- SURGICAL ICU
• M-SICU-Medical and Surgical ICU
Patients with critical illness and post operative cases are
taken care of.
The unit maily comprises of intensivist, physician,
surgeon, trained nurses, and house keeping staff.
Most common cases managed here include pneumonia,
ARDS, Severe sepsis, MODS, Post herniorraphy.
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6. SPECIFIC ICU
• TICU- Trauma ICU
• NICU-Neonatal/Neuro ICU
• PICU-Paediatric ICU
• CVICU-Cardiovascular ICU
• CCU- CoronaryCare Unit
• BICU-Burn ICU
• RCU-Renal care unit
• ITU-intensive treatment unit
• SCBU-Special care baby unit
• HDU-High dependency unit
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7. Open ICU
• Patients here are managed by every Medical
personnel.
• The intensivist only coordinates and gives expert
assistance to other specialist.
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8. Semi-open ICU
• Here patients are managed as a team between the
intensivist and the primary care physician or
surgeon.
• The intensivist gives the care while the primary
physician comes to review the patients from time
to time.
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9. Closed ICU
• The intensivist is solely responsibility for the
management and discharge of the patients.
• The intensivist takes over the management from
the moment he's received a consult to review the
patients.
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10. FUNCTIONS OF ICU
• Provide optimum life support
• Provide adequate monitoring of vital functions.
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11. SITING AND DESIGN OF AN ICU
• It should be sited in a position that is easily
accessible to the wards, theater, labor room and
the A/E unit.
• The unit should always be prepared to receive new
patients and should include the following:
• Special bed
• Cardiac monitoring system with alarm
• Oxygen and suction apparatus
• Resuscitation Unit
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12. AN ICU ROOM
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13. Special bed
• Head board should be detachable to facilitate
intubation.
• Should be firm and non-yielding to allow cardiac
massage
• Should have tilting mechanisms for change in
position.
• Rails(anxious and psychiatric patients).
• Bed side locker, over bed table and foot stool.
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14. Resuscitation Unit
It's should contain
• Syringes,needles, IV catheters, IV giving sets, blood giving
sets, scalp vein set and IV fluids.
• Spirit, swab, adhesive plaster, torniquets and arm boards.
• Airways, ET tubes, laryngoscopes, tracheostomy tray
• AMBU bags and suction catheters
• Oxygen cylinder,
• Drugs: antiarrhythmics, antihypertensives, antianginals,
anticoagulants, anticonvulsants, antibiotics etc.
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15. Other important equipment
• Defibrillator
• Cardiac pacemakers
• Mechanical ventilators
• Facility for CVP line, IAP monitor
• Portable x-ray machine
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16. INDICATIONS FOR ADMISSION
• Threatened airway
• All respiratory arrests
• Respiratory rate ⩾40 or ⩽8 breaths/min
• Oxygen saturation <90% on ⩾50% oxygen
• All cardiac arrests
• Pulse rate <40 or >140 beats/min
• Systolic blood pressure <90 mm Hg
• Sudden fall in level of consciousness (fall in Glasgow coma score >2
points)
• Repeated or prolonged seizures
• Rising arterial carbon dioxide tension with respiratory acidosis
• Any patient giving cause for concern
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17. Common Conditions Managed in
the ICU
• Neurological
• Head injuries
• Multiply injured patients
• Stroke
• Status epilepticus recalcitrant to drugs
• Spinal cord injuries
• MG, GBS, Poliomyelitis
• Respiratory
• Massive PTE
• Severe pneumonia
• Acute severe asthma
• Acute exacerbation of COPD
• Status asthmaticus
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18. • Endocrine
• DKA
• HHS
• Thyroid storm
• Adrenal insufficiency
• Renal
• Uraemia
• Severe hyperkalaemia
• Gastrointestinal
• Bleeding varices
• Hepatic encephalopathy
• Acute liver failure
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19. • Haematological
• Leukemias
• Lymphomas
• Severe immunodeficiency states
• Cardiovascular
• Heart failure
• ACS{MI and Angina}
• Dermatological
• SJS-TEN
• Bullous pemphigoid
• Erythroderma
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20. • Others
• Major burns
• Snake bites/snake and scorpion stings
• Poisoning(accidental/ suicidal)
• Severe anaphylaxis
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21. MANAGEMENT OF AN
UNCONSCIOUS PATIENT
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22. Definition
• Unconsciosness is the state in which patient is
totally unaware of both self and environment, and
unable to respond meaningfully to an external
stimuli.
• Assessed using GCS, BCS, AVPU score etc.
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23. Causes of LOC
• Lack of energy substrate
• Hypoxia
• Hypoglycemia
• Ischemia
• Alterations in neuronal functions
• Drug intoxication
• Alcohol intoxication
• Epilepsy
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24. • Osmolarity alterations
• DKA
• HHS
• Hyponatremia
• Hepatic encephalopathy
• Uraemic encephalopathy
• Hypertensive encephalopathy
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25. • Hypercapnia
• Hypothyroidism
• Hyperthermia
• Hypothermia
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26. APPROACH TO THE UNCONSCIOUS
• ABCDE of RESUSCITATION
• Management in the ICU
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27. A-AIRWAY
Head tilt, Chin lift, Jaw thrust
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28. AIRWAY CONT..
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29. B-Breathing
Listen, look and feel for normal
breathing
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30. Breathing cont…
• Symmetry
• Breathing Sounds
• Tidal Volume
• Respiratory rate
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31. C-Circulation
• Pulse
• Rate
• Rhythm
• Arterial Pressure
• Hypertension
• Hypotension
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32. D-Disability
• Disability is
determined from the
patient level of
consciousness
according to the
AVPU or GCS.
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A for ALERT
V for VOICE
P for PAIN
U for UNRESPONSIVE to any
stimulus

33. GLASGOW COMA SCALE
•I. Motor Response
6 - Obeys commands fully
5 - Localizes to noxious stimuli
4 - Withdraws from noxious
stimuli
3 - Abnormal flexion, i.e.
decorticate posturing
2 - Extensor response, i.e.
decerebrate posturing
1 - No response
•II. Verbal Response
5 - Alert and Oriented
4 - Confused, yet coherent, speech
3 - Inappropriate words and jumbled
phrases consisting of words
2 - Incomprehensible sounds
1 - No sounds
•III. Eye Opening
4 - Spontaneous eye opening
3 - Eyes open to speech
2 - Eyes open to pain
1 - No eye opening

34. E-Exposure
• The patient’s clothes should be removed or cut
in an appropriate manner so that any injuries
can be seen.
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35. Secondary survey
• SAMPLE history
• S-symptoms and signs
• A-allergy
• Medications
• P-PMHx
• L-last oral intake
• E-Events leading to the condition
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36. PHYSICAL EXAMINATION
• General physical examination
• Neurologic examination
• The eye examination
• Fundoscopy
• Ventilatory pattern
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37. Physical exams …
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38. Physical exams…
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39. Physical exams cont…
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40. Laboratory investigations
- Electrolytes
- Calcium
- Blood urea nitrogen
- Glucose
- NH3
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41. Imaging
• In coma of unknown etiology, CT or MRI must be
performed.
• Radiologically detectable causes of coma;
- Hemorrhage
- Tumor
- Hydrocephalus
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42. Other Investigations
• Lumbar puncture
• EEG
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43. MANAGEMENT IN THE ICU
• Following the mnemonic I FAST HUG
• I-Infection control
• F-Fluid management
• A-Analgesia
• S-Sedation
• T-Thromboprophylaxis
• H-Head up position
• U-Peptic Ulcer prophylaxis
• G-Glycaemic control.
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44. Infection control
Meticulous hand washing before and after procedures.
Frequent suctioning.
Infection control bundles
-VAP prevention bundle
-CAUTI Prevention bundle
-BSI prevention bundle
-Bed sore prevention bundle
Use of antibiotics
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45. Feeding
• Enteral is the most preferred route.
• It can be via NG tube, gastrostomy, jejunostomy.
• If Enteral route is contraindicated, total parenteral
nutrition can be opted for.
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46. Analgesia
• Multimodal analgesia
• PCM, NSAIDs and Opioids
•SEDATION
• Benzodiazepines:midozalam
• Propofol
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47. THROMBOPROPHYLAXIS
• Pharmacological; heparin
• Mechanical; TED stocking, Calf compressions
•HEAD-UP POSITION
• To prevent ventilator associated pneumonia (VAP),
orthostatic pneumonia, and aspiration
pneumonitis.
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48. BED SORE PROPHYLAXIS
• Regular turning of patients
• Use of pneumatic or hydromatresses
• Application of hygroscopic powders eg talc.
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49. GLYCAEMIC CONTROL
• Regular blood glucose monitoring
• Give insulin if indicated
• Achieve euglycaemia of 4.5-8.0mmol/L
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50. SUMMARY
• The role of ICU cannot be overemphasized.
• Management of critically ill conditions that were earlier
unsatisfatory have now been revolutionised.
• The anaesthetist/ intensivist is the chief coordinator of
the activities taking place in an ICU and so shall be
consulted during design and staffing of the facility.
• The modern trend is the addition of mobile ICU’s that
will give pre-hospital services to improve patient
management outcomes.
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51. References
• Intensive care unit manual (Lanken) review PDF
• Lecture notes on the management of an unconscios
patient. ppt.
• Kumar and Clark’s Clinical Medicine 10th Ed.
• https://pubmed.nbci.nlm.nih.gov/indications for
ICU admission
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THANK YOU FOR LISTENING!
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