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How to admit a patient in medical icu


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admission in ICU especially medical is a critical decision because of work load in MICU. We also can not ignore critically ill patients.

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How to admit a patient in medical icu

  1. 1. How to admit a patient in Medical ICU Fakhir Raza
  2. 2. Background • How many patients die of mistakes by doctors in USA – Up to 440,000 Patients May Die Each Year in US – – The number of patients dying in NHS hospitals from prescription errors and adverse side-effects of their medicines has soared by 500% in the last decade, new Audit Commission figures revealed yesterday. –
  3. 3. Admission Criteria • Severe illness • Reversible illness – patients needing mechanical ventilation – patients needing intensive monitoring and closely guarded therapy in any acute illness or in multi- organ failure. – respiratory illness needing more than 40% oxygen to maintain oxygen saturation
  4. 4. Important to Remember • Make sure patient is not DNR, not for terminal care • Discuss with family and convince them for DNR in case of advance metastatic disease and conditions which are equivalent to this.
  5. 5. Word of caution • Accept patient only after ER has done their job as described in next slide
  6. 6. Resuscitation in ER • Airway • Breathing • Circulation • Making diagnosis, scans, investigations • Central line • A-line • Foley’s • NG Tube • Treatment for acute problems like arrythmias, DKA, dialysis, thrombolysis, others
  7. 7. What you do • You accept the patient. • Write diagnosis • Write plan – Airway: size and position of tube after confirmation in X-ray – Ventilator setting: Mode, R/R, TV, PEEP, FiO2 – Order for remaining jobs by ER like lines, catheter – Feeding orders cont…
  8. 8. What you do – Vital charting: BP, TPR, I/O, SatO2 monitoring – GCS monitoring – Septic work up, blood, urine, ETT samples, procalcitonin, lactic acid, ABG, VBG, CXR, ECHO, FAST – Anemic work up, CBC, Iron, TIBC, Ferritin, peripheral smear, B12, Folic acid coomb’s, hemolysis workup etc
  9. 9. What you do – Radiology work up: X-ray, CT, Ultrasound – Referrals to Cardiology, Nephrology, Gastroenteology for respective jobs, specific. – Fluids to be started – Ionotropes needed, dose, route, tapering – Sedation and analgesia orders, dose, route, titration – Antibiotic orders
  10. 10. What you do – GI and DVT prophylaxis – Head of bed position – Ulcer prophylaxis – Diabetic management – Sepsis management
  11. 11. Other important things • Check home medications – Continue or hold these medicines • Need for toxicology studies – Follow and give antidote or act accordingly • Lumber puncture – Check CT head or fundoscopy as required and follow results and act accordingly
  12. 12. Other important things • Pregnancy test – Don’t miss even in Unmarried women in case of suspicion • Screening for Hep B, C, HIV, MRSA screening • Any epidemic screening like corona virus etc • Ventilator, central line bundles – Use specific sheet for this
  13. 13. Other important things • Always care for infection control • Self care • Transfer the patient to ICU as soon as possible • Follow all the labs you have sent and act accordingly. • Always mention date, time, signature and stamp the orders, prescriptions, notes.
  14. 14. TIPS for Care • Pulse pressure • Lactic acid • ScvO2 • Pro BNP for heart failure • Compare with old X-rays and labs • de-escalate the therapies, ionotropes, antibiotics • Head to toe examination, any scars, jaundice, anomalies, heart sounds, fundoscopy. • Procedure related problems in X-rays
  15. 15. Do it your way • You should not omit important things. • You should try not to over treat. • Ask for help if not sure
  16. 16. Do not Forget • Relatives are waiting to listen from you. • Discuss the facts. • Make them realize the severity of disease. • Tell them your plan. • Document the counseling in notes, with name and relation of person.
  17. 17. Always take care of… • Always take care of the dignity of human being. • Give importance to the wish of patient and family. • Act ethically and follow the policies of hospital.
  18. 18. Keep a book or reference • Keep a book or ready reference in pocket for doses, and work up.
  19. 19. Thank you May Allah keep patient safe from our mistakes.