Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

How to admit a patient in medical icu

1,072 views

Published on

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

Published in: Health & Medicine, Business
  • Be the first to comment

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 – http://suzannecgordon.com/up-to-440000-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. – http://www.dailymail.co.uk/news/article-90471/More-patients-dying-medical-blunders.html#ixzz2gXd8jzrK
  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.

×