A presentation to provide a brief knowledge regarding ICU protocols used to treat critically ill patients

1. INTENSIVE CARE UNIT

2. SUPPLIES
OF
CRITICAL/INTENSIVE
CARE UNIT
SUBMITTED TO ~ MS. SAKSHI KANWAR
[LECTURER MEDICAL SURGICAL NURSING]
SUBMITTED BY ~ MS. ISHA
B.SC. (N) 3RD YEAR
ROLL NO. ~45
SUBMITTED ON~ 21/08/2023

3. INTRODUCTION
•INTENSIVE CARE UNITS (ICUS) ARE
SPECIALIST HOSPITAL WARDS THAT
PROVIDE TREATMENT AND MONITORING
FOR PEOPLE WHO ARE VERY ILL. THEY’RE
STAFFED WITH SPECIALLY TRAINED
HEALTHCARE PROFESSIONALS AND
CONTAIN SOPHISTICATED MONITORING
EQUIPMENT.
• IT IS AN ORGANIZED SYSTEM FOR THE
PROVISION OF CARE TO THE CRITICALLY
ILL PATIENTS THAT PROVIDES INTENSIVE
& SPECIALIZED MEDICAL &NURSING CARE

4. PROTOCOLS OF
ICU/CCU
• THE MOST COMMON MEANING OF
PROTOCOLS IS THE CORRECT CONDUCT &
PROCEDURES FOLLOWED IN FORMAL
SITUATIONS.
• “A SET OF RULES & GUIDELINES FOR
COMMUNICATING DATA.”
• “A DETAILED PLAN FOR A MEDICAL
EXPERIMENT, TREATMENT OR
PROCEDURE.”
• ACCORDING TO ALAN MORRIS ~ PRECISE &
DETAILED
• PLANS FOR THE STUDY OF A MEDICAL OR

5. WHAT IS THE
NEED FOR
PROTOCOLS
?

6. • Proper use of protocols helps physician
more frequently treat the similar patients.
• Protocols have potential to minimize
medical errors and increases patient’s
safety.
• It improves patients outcomes.
• It minimizes inconsistencies in the care of
similar patients.
• It can prove useful when applied in a
judicious & thoughtful fashion
• It reduces variations in the treatment of
patients.
• It may facilitate the teaching of
appropriate clinical management for
selected disease.
NEED FOR
THE
PROTOCO
LS

7. PROTOCO
LS USED IN
CCU/ICU
1. BASIC LIFE SUPPORT (BLS)
PROTOCOL
2. ADVANCED CARDIAC LIFE
SUPPORT(ACLS) PROTOCOL
3. STRESS RELATED ULCER
PREVENTION PROTOCOL
4. DEEP VEIN THROMBOSIS
PROTOCOL
5. SEDATION INTERRUPTION
PROTOCOL
6. WEANING PROTOCOL
7. ORAL HYGIENE PROTOCOL

8. BASIC LIFE
SUPPORT
(BLS)
PROTOCOL
• BASIC LIFE SUPPORT (BLS)
DEFINES SEQUENCES OF
PROCEDURES PERFORMED
TO RESTORE THE
CIRCULATION OF
OXYGENATED BLOOD AFTER
A SUDDEN PULMONARY OR
CARDIAC ARREST UNTIL
THEY CAN BE GIVEN FULL
MEDICAL CARE AT A
HOSPITAL.
• BLS DOES NOT INCLUDE THE
USE OF DRUGS OR INVASIVE

10. ACLS
(ADVANCED
CARDIAC LIFE
SUPPORT)
PROTOCOL
• ADVANCED CARDIAC LIFE SUPPORT,
ADVANCED CARDIOVASCULAR LIFE
SUPPORT (ACLS) REFERS TO A SET OF
CLINICAL GUIDELINES FOR THE URGENT
AND EMERGENT TREATMENT OF LIFE-
THREATENING CARDIOVASCULAR
CONDITIONS THAT WILL CAUSE OR HAVE
CAUSED CARDIAC ARREST, USING
ADVANCED MEDICAL PROCEDURES,
MEDICATIONS, AND TECHNIQUES.
• ACLS IS DESIGNED FOR HEALTHCARE
PROFESSIONALS WHO EITHER DIRECT OR
PARTICIPATE IN THE MANAGEMENT OF
CARDIOPULMONARY ARREST AND OTHER
CARDIOVASCULAR EMERGENCIES.

12. DRUGS
USED IN
ACLS
PROTOCO
L
1. EPINEPHRINE
2. VASOPRESSIN
3. ADENOSINE
4. ATROPINE
5. AMIODARONE
6. LIDOCAINE
7. PROCAINAMIDE
8. SOTALOL

13. STRESS ULCER
PREVENTION
PROTOCOL

14. STRESS
ULCER
PROPHYLAXI
S
• HAEMORRHAGE FROM STRESS ULCERATION
IS SECONDARY GI BLEEDING (NOSOCOMIAL
GI BLEEDING), WHICH IS DISTINCT FROM
PRIMARY GI BLEEDING (GI BLEEDING THAT
RESULTS IN HOSPITALIZATION)
PROPHYLAXIS ~
1. >250MG HYDROCORTISONE /DAY
2. PPIS (OMEPRAZOLE, ESMEPRAZOLE
,40MG, BD)
3. RANITIDINE (50MG, TDS, IV)
(150MG, BD, ORALLY)

15. DEEP VEIN THROMBOSIS
PROTOCOL
• Hospitalized patients are at increased risk of developing DVT (approximately
50%), increasing the risk of Pulmonary Embolism.
• Pulmonary Embolism is one of the most common but preventable causes of
death in hospitalized patients.

16. THROMBOPROPHYLAXIS

17. SEDATION
INTERRUPTION
PROTOCOL
• A DAILY INTERRUPTION OF SEDATION
IS A STRATEGY DESIGNED TO: REDUCE
EXPOSURE TO SEDATIVE AGENTS.
• ALLOW ASSESSMENT OF
NEUROLOGICAL STATUS. ASSESS
READINESS FOR EXTUBATION, AND.
REDUCE DURATION OF MECHANICAL
VENTILATION
• PROPOFOL AND DEXMEDETOMIDINE
SHOULD BE USED AS FIRST LINE
AGENTS FOR SEDATION OVER
BENZODIAZEPINES IN CRITICALLY ILL,
MECHANICALLY VENTILATED ADULT
PATIENTS.

18. BENEFITS OF DAILY
SEDATION INTERRUPTION
• LOWERS THE MORTALITY RATE
• DECREASES DEPENDENCY ON
MECHANICAL VENTILATOR
• PREVENTS OVER SEDATION
• HELPS IN NEUROLOGICAL
ASSESSMENT
• HELPS TO AVOID DRUG
ACCUMULATION

19. WEANING PROTOCOL
• A WEANING PLAN STARTS WITH ASSESSING
THE ABILITY OF THE PATIENT FOR
SPONTANEOUS BREATHING.
• WEANING IS THE PROCESS OF DECREASING
THE DEGREE OF VENTILATOR SUPPORT AND
ALLOWING THE PATIENT TO ASSUME A
GREATER PROPORTION OF THEIR OWN
VENTILATION

20. THREE MAIN STRATEGIES ARE
USED BY CLINICIANS TO
PERFORM SPONTANEOUS
BREATHING TRIALS ~
1. SIMV (SYNCHRONIZED
INTERMITTENT MANDATORY
VENTILATION )
2. PSV (PRESSURE SUPPORT
VENTILATION)
3. T-PIECE TRIAL

22. ORAL HYGIENE PROTOCOL

23. ORAL
HYGIENE
Oral hygiene cleaning the teeth
and the oral cavity of the
patient. It includes the measures
to prevent the spread of disease
from mouth and increase the
comfort of the patient
ARTICLES-Articles needed for
unconscious patients- A tray
containing the following articles-
1. Face towel
2. Mackintosh with draw sheet
3. Artery forceps
4. Dissecting forceps
5. Tongue depressor
6. Mouth gag
7. Potassium permanganate
(1gm:5000ml)
8. Gauze piece
9. Emollients( Boroglycerine, Vaseline )
10.Cotton applicator

24. RATIONALE FOR GOOD
ORAL HYGIENE
• ORAL CARE PROTOCOLS
(USUALLY INCLUDED IN
VAP BUNDLES) SHOW
DECREASE IN INCIDENCE
OF VAP
• ORAL CARE REFLECTS
PREVENTIVE MEASURES
AIMED AT REDUCING
PATHOGENIC ORGANISMS,
AND PROMOTING
HOLISTIC PATIENT CARE
• PATIENT COMFORT

25. ADVANTAGES &
DISADVANTAGES OF
PROTOCOLS

26. Advantages Disadvantages
1. Reducing
unnecessary
variability in care.
2. Quick adoption of
new information to
the bed side
3. Streamlining of
care.
4. Educational aids
5. Improved
communication
6. Cost containment
1. Use in
inappropriate
patient.
2. Loss of
individualization of
care.
3. Potential to be
obsolete if not kept
current.
4. Maybe Designed
around Low quality
evidence.

27. EQUIPMENTS & SUPPLIES
OF CCU/ICU

28. EQUIPMENTS & SUPPLIES
• MEDICAL EQUIPMENT AND SUPPLIES
MEANS ITEMS USED FOR
THERAPEUTIC OR DIAGNOSTIC
PURPOSES ESSENTIAL FOR PATIENT
CARE.
• EQUIPMENT NUMBERS & TYPES ARE
DECIDED BASED ON THE EXISTING
STANDARDS OF THE COUNTRY AND
THE SERVICES PROVIDED.
• THERE SHOULD BE A FUNCTIONAL
SYSTEM IN PLACE TO ENSURE THE
SAFE AND ACCURATE FUNCTIONING
OF THE MACHINES AND EQUIPMENT.
PERIODICALLY, THE MONITORS HAVE

29. BASIC EQUIPMENTS NEEDED TO ORGANIZE
A LEVEL III ICU/CCU IS AS FOLLOWS :
1. VENTILATOR
2. MULTI CHANNEL MONITOR
3. DEFIBRILLATOR AND PACEMAKER
4. INFUSION/SYRINGE PUMPS
5. FLUID & BED WARMER
6. PORTABLE TRANSFER MONITOR
7. SPECIALIZED BEDS
8. BEDSIDE TROLLEY, DRUG CART, &
EMERGENCY CART
9. PATIENT LIFTING DEVICE
10. BEDSIDE ULTRASOUND & ECHO
MACHINE
11. IABP OR VENTRICULAR ASSIST
DEVICE

30. FOR EVERY PATIENT, THE
FOLLOWING MONITORS SHOULD
BE AVAILABLE:
• ECG MONITOR
• PRESSURE MONITOR
• TEMPERATURE MONITOR
• END-TIDAL CO² MONITOR
• PULSE OXIMETER
• NON INVASIVE ARTERIAL PRESSURE MONITORING
• ECMO (EXTRACORPOREAL MEMBRANE OXYGENATION)

31. VENTILATOR
• A MEDICAL VENTILATOR (OR SIMPLY
VENTILATOR IN CONTEXT) IS A MACHINE
DESIGNED TO PROVIDE MECHANICAL
VENTILATION BY MOVING BREATHABLE AIR
INTO AND OUT OF THE LUNGS, TO DELIVER
BREATHS TO A PATIENT WHO IS PHYSICALLY
UNABLE TO BREATHE, OR BREATHING
INSUFFICIENTLY.
• AT LEAST ONE PER BED.

32. VENTILATOR

33. MONITOR
• MONITORS IN INTENSIVE
CARE UNITS (ICUS)
PROVIDE INFORMATION
RELATED TO VITAL
PARAMETERS IN
NUMERICAL AND
WAVEFORM FORMATS

34. EMERGENCY CART
• A CRASH CART IS A SET OF
TRAYS/DRAWERS/SHELVES
ON WHEELS USED IN
HOSPITALS FOR
TRANSPORTATION AND
DISPENSING OF EMERGENCY
MEDICATION/EQUIPMENT AT
SITE OF MEDICAL/SURGICAL
EMERGENCY FOR LIFE
SUPPORT PROTOCOLS
(ACLS/ALS) TO POTENTIALLY
SAVE SOMEONE’S LIFE.

35. INFUSION PUMP
• AN INFUSION PUMP IS A
DEVICE THAT DELIVERS
FLUIDS INTO A
PATIENT’S BODY IN A
CONTROLLED MANNER.
• IT IS USED TO DELIVER
NUTRIENTS OR
MEDICATIONS SUCH AS
HORMONES,
ANTIBIOTICS,
CHEMOTHERAPY
DRUGS, AND PAIN

36. DEFIBRILLATOR
• DEFIBRILLATION IS A TREATMENT FOR LIFE-
THREATENING CARDIAC DYSRHYTHMIAS,
SPECIFICALLY VENTRICULAR FIBRILLATION AND
NON- PERFUSING VENTRICULAR TACHYCARDIA.
• A DEFIBRILLATOR DELIVERS A DOSE OF ELECTRIC
CURRENT (OFTEN CALLED A COUNTER-SHOCK) TO
THE HEART.
• THIS PROCESS DEPOLARIZES A LARGE AMOUNT OF
THE HEART MUSCLE, ENDING THE DYSRHYTHMIA.
SUBSEQUENTLY, THE BODY’S NATURAL PACEMAKER
IN THE SINOATRIAL NODE OF THE HEART IS ABLE
TO RE-ESTABLISH NORMAL SINUS RHYTHM.

37. DEFIBRILLATOR

38. PRESSURE MONITOR
• BLOOD PRESSURE
MEASUREMENT IS INTEGRAL
TO THE INTENSIVE CARE
PATIENT’S VITAL SIGNS AND
IS USED TO SCREEN FOR
HYPERTENSION, ESTIMATE
CARDIOVASCULAR RISK, AND
DIAGNOSE, MANAGE, AND
TREAT ACUTE AND CHRONIC
MEDICAL CONDITION.
• THE BLOOD PRESSURE
DEVICE MOST COMMONLY
USED IN THE ICU IS THE
SPHYGMOMANOMETER.

39. BED SIDE ULTRASOUND
• A BEDSIDE ULTRASOUND
EXAMINATION IS A VERY
SPECIFIC ULTRASOUND SCAN
THAT IS PERFORMED WHILST
YOU ARE IN YOUR BED IN THE
EMERGENCY DEPARTMENT.

40. ECHOCARDIOGRAM
• ECHOCARDIOGRAM IS A TOOL
THAT SUPPORT DIAGNOSIS,
MONITORING, MANAGEMENT
AND CLINICAL PROGRESS OF
CRITICALLY-ILL PATIENTS, IN
ADDITION IT WORKS AS
THERAPEUTIC
INTERVENTIONS.

41. INTRA-AORTIC BALLOON
PUMP
[IABP]
• THE INTRA-AORTIC BALLOON PUMP IS
A MECHANICAL DEVICE THAT
INCREASES MYOCARDIAL OXYGEN
PERFUSION AND INDIRECTLY
INCREASES CARDIAC OUTPUT
THROUGH AFTER LOAD REDUCTION.
• IT CONSISTS OF A CYLINDRICAL
POLYURETHANE BALLOON THAT SITS
IN THE AORTA, APPROXIMATELY 2
CENTIMETERS FROM THE LEFT SUB
CLAVIAN ARTERY.

42. EXTRACORPOREAL MEMBRANE
OXYGENATION
[ECMO]
• EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO), ALSO
KNOWN AS EXTRACORPOREAL LIFE SUPPORT (ECLS), IS AN
EXTRACORPOREAL TECHNIQUE OF PROVIDING PROLONGED
CARDIAC AND RESPIRATORY SUPPORT TO PERSONS WHOSE
HEART AND LUNGS ARE UNABLE TO PROVIDE AN ADEQUATE
AMOUNT OF GAS EXCHANGE OR PERFUSION TO SUSTAIN LIFE.
• THE TECHNOLOGY FOR ECMO IS LARGELY DERIVED FROM
CARDIOPULMONARY BYPASS, WHICH PROVIDES SHORTER-TERM
SUPPORT WITH ARRESTED NATIVE CIRCULATION.

44. MODIFIED HEART- LUNG
MACHINE
• THIS MACHINE IS ALSO CALLED A CARDIOPULMONARY
BYPASS MACHINE. IT PUMPS BLOOD WHILE YOUR HEART IS
STOPPED AND ADDS OXYGEN TO THE BLOOD BEFORE IT IS
PUMPED THROUGHOUT THE BODY.
• USE OF MODIFIED HEART-LUNG MACHINE LIFE SUPPORT
SYSTEM IS A LIFE-SAVING MEASURE FOR SOME PATIENTS.
THE ECLS SYSTEM USES A MODIFIED HEART-LUNG
MACHINE TO PROVIDE CONTINUOUS CIRCULATION OF
BLOOD TO PROVIDE GAS EXCHANGE AND PERFUSION.

45. HEART-LUNG MACHINE

49. REFERENCES:
• BRUNNER & SUDDARTH’S, “TEXTBOOK OF MEDICAL
SURGICAL NURSING," VOLUME-II, SOUTH ASIAN EDITION;
PUBLISHED BY WOLTERS KULVER, PAGE NO:2146- 2147.
• HTTPS://WWW.SLIDESHARE.NET/KULDEEPVYAS370/ICU-
EQUIPMENT-232228257
• HTTPS://CPR.HEART.ORG/EN/COURSES/BASIC-LIFE-
SUPPORT-COURSE-OPTIONS