Brief notes on critical care protolcols

1. PROTOCOLS FOR PATIENT
CARE
Capt FemiTF

2. FAST HUG
 FEEDING
 ANALGESIA
 SEDTION
 THROMBOPROPHYLAXIS
 HEAD ELEVATION
 ULCER PROPHYLAXIS

3. Feeding

4. FEEDING/ NUTRITIONAL SUPPORT
 Patients in icu are in hyper catabolic state
 Unable to fulfill their nutritional goals
 Enteral feeds are preferred to maintain the
gut integrity
 Parentral feeding :TPN/PPN

5. CARE WHILE GIVING FEEDS
 Ensure patient is in fowler’s position
 Ensure the correct placement of the tube.
 Test feeds of 50ml initially, if tolerated well full
feeds of 150ml 2 hourly can be started.
 Diet must be appropriate for the patients
condition.
 Diet chart should be printed and kept on patient
side

6. ANALGESIA AND SEDATION
 To relieve their pain and anxiety
 Reassurance by doctors and nurses goes long
way in reducing ICU delirium
 Assess the pain level using visual assessment
scale

7. Post operative patients
 Inj paracetamol/ injectable NSAIDs
 Epidural analgesia : requires close
observation for any adverse effects
 Infusion propofol 4mg/kg/hr
 Infusion of opioid such as fentanyl/ morphine
as per intensivist advise
 If patient is conscious PCA can be used.

8. Ventilator patients
 Check the vital parameters
 Assess the pain with critical care pain
observation tool.
 Propofol, midazolam, dexmedetomidine are
the common drugs in use.

9. a. control agitation to enable effective care.
b. Facilitate ventilation or minimize patient
ventilator dys-synchrony
c. Prevent accidental extubation or removal of
vascular access
d. Control ICP and reduce metabolic rate

11. Thrombo-prophylaxis
 Nearly all patients are admitted to ICU are at
the risk of DVT and PT
 Issues :prolonged stay of intubated or bed
ridden patients in ICU can leads to
Thromboembolism
 If a clot were embolize, this means it has
broken loose

12. Care..
 Ensure all patients have appropriate
thromboemolic prophylactic agents unless it
contra indicated
 Graduated compression stockings or
intermittent pneumatic compression device
 Thigh length elastic compression stockings
 Sequential compression devices (PCD)
 Clexane , LMWH , heparin

13. Head elevation
 Important aspect to in ICU for prevention of
- bed sores
-pressure related neuropathies
-prevention of aspiration
-prevention ofVAP

14. Head elevation
 If not contraindicated keep the patient in a
30-45 degree head up
 Ensure pt position is comfortable with air
mattresses
 Position of pt is changed every 2 hours
 During positioning should take care of airway,
lines and monitoring cables.

15. Ulcer prophylaxis
 Issues : critically ill patients develop stress
related mucosal damage ,potentially leads to
clinically significant bleeding
 The need is to prevent GI bleeding and to
prevent stress ulcers
 In case of documented UGI bleeds : stop
enteral feeds, serial Hb monitoring,
pantaprzole infusion as per advise

16. Glycemic control
 First differential diagnosis for
unconsciousness should be hypoglycemia
 Target blood sugar level of 140-180 mg/dl
 In ICU set up patients must be on insulin
sliding scale
 Check RBS 2-4 hourly
 Observe for sweating, drowsiness,
tachycardia, hypo/hypertension

17. Hyperglycemia
 Plain insulin infusion by mixing 50u insulin to
50ml NS
 Rate set by dividing the RBS level by 100
 Taper the rate once its reach the level of
200mg/dl