The document discusses the principles of intensive care unit (ICU) care for surgical patients. Key points include: ICUs provide specialized care for critically ill surgical patients; admission criteria focus on patients with potentially reversible conditions; monitoring and specific/supportive treatments aim to address physiological abnormalities and organ dysfunction; discharge depends on clinical improvement and meeting criteria for step-down care. Managing ICU resources and prioritizing patients based on prognosis is also important due to limited bed availability.
Central Venous Access and Catheters. Their indications and contraindications, Different types of central catheters and their advantages and disadvantages, Technique of insertion, and Complications related to central venous lines.
This slide share includes definition,indications,dehydration status,types of fluids,when to administer which fluid,how to calculate the fluid to be administered and how to monitor fluid therapy.Hope its helpful.
Postoperative care & management after sui operationsWafaa Benjamin
Surgeries for SUI are not without hazards.
Proper preoperative assessment, patient counseling, meticulous postoperative care& early discovery of complications are the mainstays of management.
Voiding difficulty after anti-incontinence surgeries can become persistent and have a significant impact on quality of life.
Supra-pubic catheter & CISC should be added to our practice.
Careful surgical technique with avoidance of over-elevation might play a role in prevention of VD.
Central Venous Access and Catheters. Their indications and contraindications, Different types of central catheters and their advantages and disadvantages, Technique of insertion, and Complications related to central venous lines.
This slide share includes definition,indications,dehydration status,types of fluids,when to administer which fluid,how to calculate the fluid to be administered and how to monitor fluid therapy.Hope its helpful.
Postoperative care & management after sui operationsWafaa Benjamin
Surgeries for SUI are not without hazards.
Proper preoperative assessment, patient counseling, meticulous postoperative care& early discovery of complications are the mainstays of management.
Voiding difficulty after anti-incontinence surgeries can become persistent and have a significant impact on quality of life.
Supra-pubic catheter & CISC should be added to our practice.
Careful surgical technique with avoidance of over-elevation might play a role in prevention of VD.
An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensive treatment medicine.
The CVP catheter is an important tool used to assess right ventricular function and systemic fluid status. Normal CVP is 2-6 mm Hg. CVP is elevated by : overhydration which increases venous return.
An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensive treatment medicine.
The CVP catheter is an important tool used to assess right ventricular function and systemic fluid status. Normal CVP is 2-6 mm Hg. CVP is elevated by : overhydration which increases venous return.
Implementing American Heart Association Practice Standards for Inpatient ECG ...Allina Health
Implementing American Heart Association Practice Standards for Inpatient ECG Monitoring: An Interventional Study at Abbott Northwestern Hospital presented by Kristin Sandau, PhD, RN
Presentations and Management of Intracranial Abscess.pptxCHIZOWA EZEAKU
summary on intracranial abscess with emphasis on aetiology, pathogenesis, pathology, forms of presentations , investigations and treatment options of brain abscess.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Discuss the principles of intensive care unit in surgery
1. DISCUSS THE PRINCIPLES OF
INTENSIVE CARE UNIT IN
SURGICAL PRACTICE
PRESENTER:
EZEAKU, CHIZOWA OKWUCHUKWU
7/13/2021 1
2. Outline
• Introduction
• Classification
• Admission Criteria
• Triage
• Principles of care
– Resuscitation and diagnosis
– Patient stratification
– Monitoring
– Specific and supportive care
– Discharge criteria
– Follow-up/Outcome
• Challenges/ Ethical issues
• Recommendations
• Conclusion
7/13/2021 2
3. Introduction
• Intensive care unit [ICU]: is a specially dedicated hospital unit
well equipped and staffed, to cater for critically ill patient with
potential reversible cause.
• It is a low volume, high cost care unit for vital target organ[s]
support, critical monitoring and some invasive intervention in
a functional and user friendly environment.
• Word wide, critically ill surgical patient accounts for 60-70% of
the workload of the general intensive care units.
7/13/2021 3
4. Introduction
• In UBTH, Nigeria, surgical patients constitute 58.4% of
patients admitted in the ICU, with NSU and general surgery
accounting for 23.8% and 21.5% respectively.
• The provision of intensive care has led to increasing
complexity of modern surgery in patients with high levels of
physiological compromise and significant co-morbidities.
• However, Singer etal, noted that it costs twice as much to
die in ICU as it does to survive, thus, it is vital that patients
are carefully selected for ICU care.
7/13/2021 4
8. Admission criteria
• Hallmarks of admission:
– Have potential for recovery.
– The pathological state should have potential for
reversibility.
– According to clear criteria to identify at risk patients.
– Undertaken at senior level using appropriate transfer
equipment or modality.
7/13/2021 8
9. Admission criteria
• Surgical patients are admitted to ICU:
– Preoperatively
– Post operatively
– Stepping up:
• cared for on a standard ward ,but now require an
increased level of monitoring or support, or who are at
risk of deterioration.
7/13/2021 9
10. When Should the Critically ill Surgical Patient be Admitted
Preoperatively to ICU?
It has been suggested that
pre-operative admission to
ICU and cardiovascular
optimization may reduce
post-operative mortality.
In a large-scale study, only
5% of surgical patients were
admitted to ICU pre-
operatively, and this was
thought to be due, in part, to
pressure on ICU beds.
Shoemaker et al and Boyd et
al demonstrated a significant
reduction in mortality
following preoperative supra-
optimization of surgical
patients in the ICU.
Effects:
1. increase the ICU beds
usage
2. increase in cost of ICU care
Benefits:
1. reduced hospital stays
2. avoidance of the
extremely high cost from late
ICU admissions, reduce the
total hospital costs and
possibly the total ICU costs
for this large group of surgical
patients.
11. Br J Surg. 1998 Jul;85(7):956-61.
Ward versus intensive care management of high-risk
surgical patients.
Curran JE1, Grounds RM.
RESULTS: Medical staff allocated patients appropriately. There
was a lower mortality rate than predicted from individual
POSSUM scores. Patients who were admitted to the ITU before
operation had the highest ASA scores, admission criteria and
POSSUM scores; they also had significantly lower mortality and
morbidity rates than predicted by the POSSUM scoring system.
CONCLUSION: Patients with the greatest reduction in
mortality and morbidity rates were admitted to the ITU
before operation and had cardiovascular physiology
'optimized' before surgery.
12. Criteria for Preoperative high risk
patients (Shoemaker)
7/13/2021 12
Previous severe cardio-respiratory illness (acute myocardial
infarction, stroke, COAD)
Extensive ablative surgery planned for carcinoma (ie
oesophagectomy, gastrectomy, prolonged surgery)
Severe multi-trauma (ie> 2 organs or 3 systems, or opening 2
body cavities)
Massive acute blood loss (> 8 units), blood volume < 1.5 l/ m2,
haematocrit < 0.2
Age > 70 or evidence of limited physiological reserve of one of
more organs
Septicaemia, positive blood cultures or septic focus, WCC >13
000/ml, spiking fever to > 38.3oC for 48 hours
14. Other candidates for preoperative
admission
• Burns –TBSA>50%
• Electrical injuries with physiologic, metabolic, acid-base
imbalance.
• Late stage vascular disease involving aortic disease
• Dissecting aortic aneurysm etc
7/13/2021 14
15. Candidates for Post operative
admission
Elective admission into ICU:
Cardiac surgeries
Major neurosurgeries
Post organ transplant(renal, liver)
ELCS for major placenta praevia
ELCS on parturient with heart failure
7/13/2021 15
16. Candidates for Post operative
admission
Emergency admission to the ICU:
Intraoperative cardiac arrest
Severe hemorrhage with shock
Complicated thyroidectomy
Post surgical patient requiring inotropic support
Prolonged surgery (>4-6 hrs.)
– Especially when associated with complicated
intraoperative event or prolonged post op recovery.
7/13/2021 16
17. Candidates for “Step up” ICU
admission
• The objective parameter model is handy here:
– Potentially reversible pathology
– RR<8, >35 cycles/min
– PR< 40, ≥150 beats/min
– GCS ≤ 8
– Sudden fall in the level of GCS
– SPO2 <90% on 100% O2
7/13/2021 17
19. Other models Of ICU admission
decision
• Diagnosis model
– Based on specific disease condition determines ICU
admission appropriateness.
• Prioritization model
– Defines those who will benefit (Priority1) from those who
will not benefit (Priority 4)
7/13/2021 19
21. Triage
• Due to limited bed space, factors taking into account:
– Diagnosis
– Severity of illness
– Age and functional status
– Co-morbid disease
– Physiological reserve
– Prognosis
– Availability of suitable treatment
– Response of treatment to date
– Recent cardiopulmonary arrest
– Anticipated quality of life
7/13/2021 21
22. Exclusion criteria for ICU admission
• Terminally ill patients from metastatic cancer, unresponsive to
available management options.
• Patients with living wills:
– DNR
– DNAR
• Irreversible brain damage/death who are non organ donor.
• Non traumatic coma leading to PVS.
7/13/2021 22
23. Principles of care
• Resuscitation and diagnosis
• Patient stratification
• Monitoring
• Specific and supportive care
• Discharge criteria
7/13/2021 23
24. Resuscitation
• Initiation of ATLS protocol, where indicated.
• Timely activation of the basic life support and advanced
cardiac life support.
• Brief history from relatives ,primary team members, case
notes, anesthetic note especially for the preoperative or step
up patient.
7/13/2021 24
25. History (postop)
• Accurate, structured and timely handover of patient care.
• Pertinent points in the post operative patient:
– Age, Highlights of the medical and surgical history
– Nature, details of surgery and anesthesia
– Use of drains, vascular access points etc
– Medication history, adjuncts eg pacemakers, prosthesis.
7/13/2021 25
26. Examination and investigations
• Head to toe , and systemic
• Surgical wound site
• Proper placement of adjuncts eg Endotracheal tube, ECG
electrodes, NG tube, Surgical drains etc.
• Vital signs
• Appropriate investigation guided by prevailing clinical
condition.
7/13/2021 26
27. Patient Stratification
• Scoring system to predict severity, outcome and prognosis.
Include:
– APACHE II
– qSOFA
– MPM
– SAPS
– ASA
– POSSUM
7/13/2021 27
28. Monitoring
• Aid in decision marking, diagnosis and detecting early sign of
deterioration or improvement.
• May be invasive or non invasive
• Attention is paid to trend not a single one time
measurement.
7/13/2021 28
31. Specific Treatment
• Specific treatment could be medical, surgical or combined.
• It varies from patient to patient depending on the diagnosis
and patient’s physiologic needs.
7/13/2021 31
32. Role of family meeting
7/13/2021 32
Conclusion:
It is worrisome that majority of family members of
critically ill patients were neither carried along in the
management of their patients nor were they informed of
likely outcome.
A timely, well-planned and regular family meeting is
therefore advocated in the management of critically ill
patients.
34. Cardiovascular support
• Aim is to restore end organ perfusion and oxygenation.
• Appropriate fluid and blood where indicated.
• Inotropes/vasoactive agents eg dobutamine, dopamine,
norepinephrine, epinephrine.
• Pacemakers
• Mechanical assist devices eg intra aortic balloon
7/13/2021 34
35. Renal support
• Fluid balance
• Avoid nephrotoxic agent or adjust dose when necessary.
• Timely use of diuretics
• Prompt renal replacement therapy , when indicated.
7/13/2021 35
36. Neurological support
• Aim: Prevent secondary brain injury, ensure adequate
cerebral perfusion and normalized ICP.
• Sedation +/- paralysis
• Controlled hyperventilation to PCO2(30-35mmHg)
• Barbiturate coma
• Hypothermia
7/13/2021 36
37. General supportive measures
• Good nursing care:
– General, oral and ocular hygiene
– Prevention of pressure ulcers
• Role of physiotherapy
• Adequate sedation and analgesia
• Nutritional support
• DVT prophylaxis
• Psychological support
7/13/2021 37
39. Discharge criteria
• When a patients physiological status has stabilized and the
need for ICU care and monitoring no longer necessary, or
• Deteriorated and becomes irreversible and active
intervention is no longer beneficial, withdrawal of care done
in the ICU .
7/13/2021 39
40. Discharge criteria
• Stable hemodynamic parameters.
• Stable respiratory status, post extubation.
• No longer on inotropic support.
• Cardiac dysrhythmias are controlled.
• Oxygen requirement < 60%.
• Patient on chronic mechanical ventilation with resolution of
acute critical problems.
• Neurologic stability with control of seizures.
7/13/2021 40
41. Outcome/Follow up
• Number transferred to the ward, or discharge home with or
without deficits.
• Follow up on discharge, rehabilitation and re-integration back
into the society.
• Monitor of duration of survival, quality of life after discharge
and ability to return to normal daily activity of life.
7/13/2021 41
42. Challenges
• Patient factors:
– Infection control
– Care of unconscious patients
– Financial constraints
– Multiple comorbidities
– Psychological problems
7/13/2021 42
43. Challenges
• Institutional factors:
– Poor funding
– Inadequate man-power
– Poor infrastructural support
• Role of HDU
– Poor power supply
– Poor support services
– Social patient
7/13/2021 43
44. Ethical issues
• Discharging a recuperating patient to create space for a
gravely ill one.
• Conflicts over withholding or withdrawing life support.
• Admitting patient in ICU for organ support or harvest
• End of life issues
7/13/2021 44
45. Recommendations
• Role of high dependency unit
– The availability of HDU is one of the most important factors in determining the
availability of ICU beds. (Gallimore S C et al, Rowan KM et al.)
– The ability to discharge ICU patients to an appropriately equipped and staffed
HDU reduces the pressure on ICU beds and reduces the rate of ICU
readmission.
• The role of ICU in training of surgical staff
– Training: rotation of surgical residents through the unit.
– Advice: early consult and involvement of the ICU team.
– Ward round for patients not in ICU yet, by ICU team.
7/13/2021 45
46. Conclusion
• Adequate knowledge of surgical intensive care is
needed in selection of high risk patient, delivery of
high level critical care, for optimum outcome of the
surgical patient with life threatening condition.
7/13/2021 46
47. Reference
• Update in anaesthesia; vol 28; special edition on intensive
care medicine
• Worthley, L.I. “The ideal intensive care unit: ‘Open’, ‘Closed’ or
somewhere in between?”. Critical Care and Resuscitation 9.2
(2007): 219.
• The International Surgical Outcomes Study Group. Global
patient outcomes & after elective surgery: prospective cohort
study in 27 low-, middle-, and high income countries. Br J
Anaesth 2016; 117: 601-609.
• Weiser TG, Semel ME, Simon AE, et al. In-hospital death
following inpatient surgical procedures in the United States,
1996–2006. World J Surg 2011; 35:1950–1956.
7/13/2021 47
48. Reference
• Churchill Livingstone; Textbook of anaesthesia 4th edition;
ch 60; pg 722-738
• Goel A, Joshi R and Jain AP. Administrative effectiveness
and Organization In: ICU manual 3rd ed. Paras medical
publisher, Hyderabad, India. 2013: 1-5)
• Eskicioglu C, Forbes SS, Aarts MA, et al. Enhanced
recovery after surgery (ERAS) programs for patients
having colorectal surgery: a meta-analysis of randomized
trials. J Gastrointest Surg 2009; 13:2321–2329.
• Hilberman M. The evolution of intensive care units. Crit
Care Med 1975; 3: 159 – 163
7/13/2021 48
49. Reference
• Principles and practice of Intensive care management in
surgery- A seminar delivered by Dr Iromeh C
• Intensive care of the surgical Patient,-A lecture delivered by
Dr Utobi K
• Taskforce of the American College of Critical Care Medicine,
Crit Care Med 1999;27(3):633-638
• Petrovic MA, Etal: Implementing a perioperative handoff tool
to improve postprocedural patient transfers. Jt Comm J Qual
Patient Saf 2012;38(3):135-142.
7/13/2021 49