The document discusses admission and discharge policies and procedures for intensive care units (ICUs). It defines ICUs and other critical care levels. Admission depends on likelihood of benefit from intensive care and availability of beds. Scoring systems like APACHE II are used to predict outcomes but not for individual patients. Discharge occurs when intensive care is no longer needed or further treatment is deemed futile. Senior staff involvement, documentation, and family agreement are important for difficult discharge decisions.
DAY-CARE SURGERY IN CHILDREN [Autosaved].pptxgauthampatel
DAY-CARE SURGERY IN CHILDREN
Children are excellent candidates for day care management as they are usually healthy and predominantly require minor or intermediate surgery of short duration.
The document provides an overview of critical care nursing. It discusses the history of critical care units emerging in the 1950s to provide one-to-one nursing care to very ill patients. It defines critical care nursing as dealing with human responses to life-threatening problems. Critical care nurses work in intensive care units and other areas where critically ill patients require complex care and monitoring. The document outlines the roles, skills, and responsibilities of critical care nurses in advocating for and providing specialized care to critically ill patients.
The document defines critical care units and intensive care units as specialized hospital sections that provide comprehensive care for critically ill patients. It discusses the goals, organization, staffing, and principles of critical care nursing. The levels of ICU are described from level 1 to level 3 with increasing complexity of care. Ethical principles like beneficence, non-maleficence, autonomy and justice govern critical care. Staffing includes intensive care doctors, resident doctors, intensive care nurses, and allied health professionals like respiratory therapists and physiotherapists.
The document discusses concepts related to critical care, including:
- Critical care involves an intensive care team including doctors, nurses, and other specialists caring for patients with life-threatening illnesses.
- Critical care nursing deals with human responses to life-threatening problems. Key aspects of critical care include compassion, communication, comfort, and ensuring optimal care for critically ill patients.
- An intensive care unit is a specially designed facility equipped to provide intensive monitoring and life support to dependent patients with critical illnesses or injuries requiring 24-hour care.
The document discusses the concept of critical care including the intensive care team, critical care nursing, the seven Cs of critical care nursing, the roles of critical care nurses and units. It describes the organization, staffing, equipment and facilities required for an intensive care unit. It discusses ICU admission and discharge criteria including prioritization models based on patient stability and likelihood of benefit, as well as diagnosis-based models. The goal is to provide intensive treatment and monitoring to critically ill patients who can benefit from care that can't be delivered elsewhere.
Emerging Trends in ICU Management was presented by Prof. Vijayreddy Vandali. There are three main trends emerging in ICU management: 1) Caring for children in adult ICUs and adjusting protocols accordingly, 2) Using manual hyperinflation to clear secretions which requires more research, and 3) Using innovative new equipment that improves safety and quality of care like the Marvelous Stopcock. Critical care nursing will continue to evolve with new technologies and treatments requiring nurses to constantly update their knowledge and skills.
The document discusses critical care nursing and the organization and design of intensive care units (ICUs). It defines critical care nursing and its roles/responsibilities. It describes the evolution of ICUs and different levels of ICUs. It discusses the organization of ICUs including staffing, equipment, patient areas, central nursing station, and other therapeutic and support areas. The principles of critical care nursing are also outlined.
UNIT-9 NURSING MANAGEMENT OF PATIENT IN CRITICAL CARE.pptxNirmal Vaghela
Nursing management of patients in critical care involves monitoring vital signs, administering medications, managing ventilator support, providing wound care, ensuring infection control, and offering emotional support to both patients and their families. Nurses play a crucial role in coordinating care and advocating for the best possible outcomes for patients in critical condition.
DAY-CARE SURGERY IN CHILDREN [Autosaved].pptxgauthampatel
DAY-CARE SURGERY IN CHILDREN
Children are excellent candidates for day care management as they are usually healthy and predominantly require minor or intermediate surgery of short duration.
The document provides an overview of critical care nursing. It discusses the history of critical care units emerging in the 1950s to provide one-to-one nursing care to very ill patients. It defines critical care nursing as dealing with human responses to life-threatening problems. Critical care nurses work in intensive care units and other areas where critically ill patients require complex care and monitoring. The document outlines the roles, skills, and responsibilities of critical care nurses in advocating for and providing specialized care to critically ill patients.
The document defines critical care units and intensive care units as specialized hospital sections that provide comprehensive care for critically ill patients. It discusses the goals, organization, staffing, and principles of critical care nursing. The levels of ICU are described from level 1 to level 3 with increasing complexity of care. Ethical principles like beneficence, non-maleficence, autonomy and justice govern critical care. Staffing includes intensive care doctors, resident doctors, intensive care nurses, and allied health professionals like respiratory therapists and physiotherapists.
The document discusses concepts related to critical care, including:
- Critical care involves an intensive care team including doctors, nurses, and other specialists caring for patients with life-threatening illnesses.
- Critical care nursing deals with human responses to life-threatening problems. Key aspects of critical care include compassion, communication, comfort, and ensuring optimal care for critically ill patients.
- An intensive care unit is a specially designed facility equipped to provide intensive monitoring and life support to dependent patients with critical illnesses or injuries requiring 24-hour care.
The document discusses the concept of critical care including the intensive care team, critical care nursing, the seven Cs of critical care nursing, the roles of critical care nurses and units. It describes the organization, staffing, equipment and facilities required for an intensive care unit. It discusses ICU admission and discharge criteria including prioritization models based on patient stability and likelihood of benefit, as well as diagnosis-based models. The goal is to provide intensive treatment and monitoring to critically ill patients who can benefit from care that can't be delivered elsewhere.
Emerging Trends in ICU Management was presented by Prof. Vijayreddy Vandali. There are three main trends emerging in ICU management: 1) Caring for children in adult ICUs and adjusting protocols accordingly, 2) Using manual hyperinflation to clear secretions which requires more research, and 3) Using innovative new equipment that improves safety and quality of care like the Marvelous Stopcock. Critical care nursing will continue to evolve with new technologies and treatments requiring nurses to constantly update their knowledge and skills.
The document discusses critical care nursing and the organization and design of intensive care units (ICUs). It defines critical care nursing and its roles/responsibilities. It describes the evolution of ICUs and different levels of ICUs. It discusses the organization of ICUs including staffing, equipment, patient areas, central nursing station, and other therapeutic and support areas. The principles of critical care nursing are also outlined.
UNIT-9 NURSING MANAGEMENT OF PATIENT IN CRITICAL CARE.pptxNirmal Vaghela
Nursing management of patients in critical care involves monitoring vital signs, administering medications, managing ventilator support, providing wound care, ensuring infection control, and offering emotional support to both patients and their families. Nurses play a crucial role in coordinating care and advocating for the best possible outcomes for patients in critical condition.
This document provides an overview of critical care, including definitions, teams, units, equipment, and design considerations. It discusses that critical care involves an intensive care team including doctors, nurses, and other specialists caring for critically ill patients. Key aspects of intensive care units are specialized equipment for monitoring and life support, as well as design elements to support patient privacy, reduce noise and stress, and allow observation of all patients. The document also outlines recommended staffing and resources for intensive care units.
A C S0105 Postoperative Management Of The Hospitalized Patientmedbookonline
This document discusses postoperative management of surgical patients. It describes the different levels of postoperative care including same-day surgery, the surgical floor, telemetry ward, and intensive care unit. Factors determining a patient's disposition include their preoperative health, procedure performed, and postoperative clinical status. The document also discusses common postoperative orders related to tubes, drains, oxygen therapy, and wound care to guide nursing staff.
The document provides guidelines for the use of vasoactive agents in the management of acute circulatory failure, noting that noradrenaline is usually the first choice for septic shock while adrenaline is preferred for anaphylactic shock. It emphasizes starting vasopressors promptly in severe hypotension after optimizing fluid status, titrating the dose to achieve perfusion targets, and considering adding other agents or inotropes if the first agent is not effective alone. The type of shock should be identified to guide choice of vasoactive medication based on the underlying pathophysiology in each case.
The document provides guidelines for the use of vasoactive agents in the management of acute circulatory failure, noting that noradrenaline is usually the first choice for septic shock while adrenaline is preferred for anaphylactic shock. It emphasizes starting vasoactive drugs promptly in severe hypotension after optimizing fluid status, titrating to target blood pressure and monitoring for complications. The type of shock should be identified to guide choice of vasoactive agent based on the underlying pathophysiology.
The document provides an overview of intensive care units (ICUs) and their role in modern healthcare. It discusses how ICUs are specialized hospital units equipped to provide round-the-clock intensive treatment and monitoring to critically ill patients. ICUs are staffed by medical professionals trained to care for patients with severe illnesses or injuries who require close attention. The document also outlines different types of ICUs that are organized based on medical specialty or patient condition.
Dr David Maltz: The challenge of length of stayNuffield Trust
In this slideshow, Dr David Maltz, of The Oak Group, explores the challenge of length of stay and opportunities for improvement.
Dr Maltz spoke at the Nuffield Trust ‘Reducing the length of stay’ event in September 2014.
The document provides information about intensive care units (ICUs). It discusses how ICUs differ from other hospital units through close observation and specialized equipment. The document outlines the types of staff that work in ICUs and the reasons why patients are admitted. It also describes different types of ICUs like neonatal ICUs, pediatric ICUs, and cardiac ICUs. The document discusses ICU design, planning, equipment, and staffing needs. It provides details on the costs associated with operating an ICU and challenges with ICU care in India.
This document describes an ethical dilemma faced in an ICU with limited beds. A 65-year-old diabetic man with an amputated leg requiring ICU care was to be transferred to the surgical ward to make room for a newly admitted 25-year-old man with chest trauma. The family refused transfer due to the older patient's critical condition. However, full information and prognosis were not provided to the family. This raises ethical issues of respecting patient autonomy, non-maleficence by avoiding increased risk, and fair allocation of limited resources between the two critical patients.
Day surgery offers advantages for both patients and healthcare providers by reducing disruption and costs compared to overnight stays. Success requires efficient coordination across admission, the procedure itself, recovery, and safe discharge within 12 hours. Selection criteria evaluate medical fitness, social support, and whether the planned procedure is suitable for day surgery. Preoperative assessment optimizes patient health while clear discharge standards ensure recovery before leaving. Common day surgery procedures involve areas like abdominal, breast, orthopedic, and vascular operations. Emergency minor cases can also sometimes be managed with same-day admission and discharge.
Day surgery, also known as ambulatory surgery, involves performing surgical procedures on patients who are admitted and discharged within 12 hours without an overnight hospital stay. Day surgery offers advantages for both patients and healthcare systems by reducing disruption to patients' lives and providing significant cost savings. A variety of medical, social, and surgical criteria are used to determine patient eligibility for day surgery to minimize risks and ensure safe recovery at home. Successful day surgery requires thorough preoperative patient assessment, optimized anesthesia and postoperative pain management, and monitoring to prevent complications.
Barking, Havering and Redbridge University Hospitals NHS Trust- Holistic appr...RuthEvansPEN
The document describes initiatives at a large acute care provider to improve the patient experience in critical care. It discusses improvements to admission times, introducing patient diaries and family overnight facilities, timely discharge, end-of-life care withdrawn at home, bespoke patient satisfaction surveys showing high satisfaction, and post-ICU follow up clinics. The overall goal is to improve every step of the critically ill patient's journey through sustainable long-term projects now embedded in daily practice.
1. Maternal mortality is a major issue in developing countries, where 99% of maternal deaths occur. The leading causes are direct obstetric complications and indirect medical conditions exacerbated by pregnancy.
2. Emergency obstetric care (EmOC) provides life-saving interventions for direct obstetric complications and must be available 24/7. International goals aim to increase access to and quality of EmOC.
3. Ensuring basic and comprehensive EmOC requires essential equipment, skilled birth attendants, clinical protocols, financial access, and emergency transport systems between facilities.
This document provides an overview of ICU design, organization, and operation. It discusses that ICUs concentrate care for critically ill patients, are staffed by multidisciplinary teams, and have equipment for multi-organ support. It describes the layout and levels of ICUs from basic to tertiary care facilities. Level I ICUs provide short-term care, level II provide higher standards of care, and level III provide all aspects of intensive care. The organization, staffing, equipment needs, and economics of ICUs are also outlined.
Surgery Resident clinical seminar on day case surgery presented to the department of surgery, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State
Cardiac transplantation involves surgically transplanting a donor heart into a recipient with end-stage heart failure. It has significantly improved survival rates compared to conventional treatments, with one-year survival rates over 80%. Both donors and recipients undergo extensive evaluation and selection criteria to ensure transplant success and survival. Post-transplant, recipients progress through three phases of cardiac rehabilitation - initial recovery in the hospital (Phase I), monitored exercise at a rehabilitation facility (Phase II), and long-term independent exercise maintenance (Phase III) - in order to promote heart health and maximize the benefits of their transplant.
This presentation discusses intensive care delivered at home as an alternative to hospital ICU care. It begins with learning objectives about challenges in hospital ICUs, consequences of delayed discharge, criteria for home ICU eligibility, and requirements for home ICU setup. Key terms are defined, such as tele-nursing, remote patient monitoring, and care packages. Care packages including critical, step-down and supportive options are outlined. The care delivery process from hospital transfer to monitoring is explained. Finally, methods, advantages and disadvantages of tele-nursing are reviewed.
The document outlines a project to reduce unplanned extubations (UPE) in the pediatric intensive care unit (PICU) at a hospital. The project aims to reduce UPE from 0.19 per 100 ventilator days to zero for avoidable cases. Strategies proposed include developing protocols for patient movement during procedures, stratifying high-risk patients and periods, and standardizing procedures like x-ray imaging. The document analyzes past UPE data and root causes to identify areas for improvement such as ensuring two clinicians are present for high-risk activities and standardizing high-risk procedures like diaper changes. Communication protocols and checklists are also proposed to reduce UPE incidents.
Critical care nursing or intensive care nursing, is a specialty focused on the care of unstable, chronically ill or post surgical patients and those at risk from life threatening diseases and injuries.
This document provides an overview of critical care, including definitions, teams, units, equipment, and design considerations. It discusses that critical care involves an intensive care team including doctors, nurses, and other specialists caring for critically ill patients. Key aspects of intensive care units are specialized equipment for monitoring and life support, as well as design elements to support patient privacy, reduce noise and stress, and allow observation of all patients. The document also outlines recommended staffing and resources for intensive care units.
A C S0105 Postoperative Management Of The Hospitalized Patientmedbookonline
This document discusses postoperative management of surgical patients. It describes the different levels of postoperative care including same-day surgery, the surgical floor, telemetry ward, and intensive care unit. Factors determining a patient's disposition include their preoperative health, procedure performed, and postoperative clinical status. The document also discusses common postoperative orders related to tubes, drains, oxygen therapy, and wound care to guide nursing staff.
The document provides guidelines for the use of vasoactive agents in the management of acute circulatory failure, noting that noradrenaline is usually the first choice for septic shock while adrenaline is preferred for anaphylactic shock. It emphasizes starting vasopressors promptly in severe hypotension after optimizing fluid status, titrating the dose to achieve perfusion targets, and considering adding other agents or inotropes if the first agent is not effective alone. The type of shock should be identified to guide choice of vasoactive medication based on the underlying pathophysiology in each case.
The document provides guidelines for the use of vasoactive agents in the management of acute circulatory failure, noting that noradrenaline is usually the first choice for septic shock while adrenaline is preferred for anaphylactic shock. It emphasizes starting vasoactive drugs promptly in severe hypotension after optimizing fluid status, titrating to target blood pressure and monitoring for complications. The type of shock should be identified to guide choice of vasoactive agent based on the underlying pathophysiology.
The document provides an overview of intensive care units (ICUs) and their role in modern healthcare. It discusses how ICUs are specialized hospital units equipped to provide round-the-clock intensive treatment and monitoring to critically ill patients. ICUs are staffed by medical professionals trained to care for patients with severe illnesses or injuries who require close attention. The document also outlines different types of ICUs that are organized based on medical specialty or patient condition.
Dr David Maltz: The challenge of length of stayNuffield Trust
In this slideshow, Dr David Maltz, of The Oak Group, explores the challenge of length of stay and opportunities for improvement.
Dr Maltz spoke at the Nuffield Trust ‘Reducing the length of stay’ event in September 2014.
The document provides information about intensive care units (ICUs). It discusses how ICUs differ from other hospital units through close observation and specialized equipment. The document outlines the types of staff that work in ICUs and the reasons why patients are admitted. It also describes different types of ICUs like neonatal ICUs, pediatric ICUs, and cardiac ICUs. The document discusses ICU design, planning, equipment, and staffing needs. It provides details on the costs associated with operating an ICU and challenges with ICU care in India.
This document describes an ethical dilemma faced in an ICU with limited beds. A 65-year-old diabetic man with an amputated leg requiring ICU care was to be transferred to the surgical ward to make room for a newly admitted 25-year-old man with chest trauma. The family refused transfer due to the older patient's critical condition. However, full information and prognosis were not provided to the family. This raises ethical issues of respecting patient autonomy, non-maleficence by avoiding increased risk, and fair allocation of limited resources between the two critical patients.
Day surgery offers advantages for both patients and healthcare providers by reducing disruption and costs compared to overnight stays. Success requires efficient coordination across admission, the procedure itself, recovery, and safe discharge within 12 hours. Selection criteria evaluate medical fitness, social support, and whether the planned procedure is suitable for day surgery. Preoperative assessment optimizes patient health while clear discharge standards ensure recovery before leaving. Common day surgery procedures involve areas like abdominal, breast, orthopedic, and vascular operations. Emergency minor cases can also sometimes be managed with same-day admission and discharge.
Day surgery, also known as ambulatory surgery, involves performing surgical procedures on patients who are admitted and discharged within 12 hours without an overnight hospital stay. Day surgery offers advantages for both patients and healthcare systems by reducing disruption to patients' lives and providing significant cost savings. A variety of medical, social, and surgical criteria are used to determine patient eligibility for day surgery to minimize risks and ensure safe recovery at home. Successful day surgery requires thorough preoperative patient assessment, optimized anesthesia and postoperative pain management, and monitoring to prevent complications.
Barking, Havering and Redbridge University Hospitals NHS Trust- Holistic appr...RuthEvansPEN
The document describes initiatives at a large acute care provider to improve the patient experience in critical care. It discusses improvements to admission times, introducing patient diaries and family overnight facilities, timely discharge, end-of-life care withdrawn at home, bespoke patient satisfaction surveys showing high satisfaction, and post-ICU follow up clinics. The overall goal is to improve every step of the critically ill patient's journey through sustainable long-term projects now embedded in daily practice.
1. Maternal mortality is a major issue in developing countries, where 99% of maternal deaths occur. The leading causes are direct obstetric complications and indirect medical conditions exacerbated by pregnancy.
2. Emergency obstetric care (EmOC) provides life-saving interventions for direct obstetric complications and must be available 24/7. International goals aim to increase access to and quality of EmOC.
3. Ensuring basic and comprehensive EmOC requires essential equipment, skilled birth attendants, clinical protocols, financial access, and emergency transport systems between facilities.
This document provides an overview of ICU design, organization, and operation. It discusses that ICUs concentrate care for critically ill patients, are staffed by multidisciplinary teams, and have equipment for multi-organ support. It describes the layout and levels of ICUs from basic to tertiary care facilities. Level I ICUs provide short-term care, level II provide higher standards of care, and level III provide all aspects of intensive care. The organization, staffing, equipment needs, and economics of ICUs are also outlined.
Surgery Resident clinical seminar on day case surgery presented to the department of surgery, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State
Cardiac transplantation involves surgically transplanting a donor heart into a recipient with end-stage heart failure. It has significantly improved survival rates compared to conventional treatments, with one-year survival rates over 80%. Both donors and recipients undergo extensive evaluation and selection criteria to ensure transplant success and survival. Post-transplant, recipients progress through three phases of cardiac rehabilitation - initial recovery in the hospital (Phase I), monitored exercise at a rehabilitation facility (Phase II), and long-term independent exercise maintenance (Phase III) - in order to promote heart health and maximize the benefits of their transplant.
This presentation discusses intensive care delivered at home as an alternative to hospital ICU care. It begins with learning objectives about challenges in hospital ICUs, consequences of delayed discharge, criteria for home ICU eligibility, and requirements for home ICU setup. Key terms are defined, such as tele-nursing, remote patient monitoring, and care packages. Care packages including critical, step-down and supportive options are outlined. The care delivery process from hospital transfer to monitoring is explained. Finally, methods, advantages and disadvantages of tele-nursing are reviewed.
The document outlines a project to reduce unplanned extubations (UPE) in the pediatric intensive care unit (PICU) at a hospital. The project aims to reduce UPE from 0.19 per 100 ventilator days to zero for avoidable cases. Strategies proposed include developing protocols for patient movement during procedures, stratifying high-risk patients and periods, and standardizing procedures like x-ray imaging. The document analyzes past UPE data and root causes to identify areas for improvement such as ensuring two clinicians are present for high-risk activities and standardizing high-risk procedures like diaper changes. Communication protocols and checklists are also proposed to reduce UPE incidents.
Critical care nursing or intensive care nursing, is a specialty focused on the care of unstable, chronically ill or post surgical patients and those at risk from life threatening diseases and injuries.
Assessment and management of Airway for BSc Nuursing StudentsAme Mehadi
The document discusses airway assessment. It defines the upper and lower airways and describes components of each. It then defines a difficult airway and lists factors that can make mask ventilation and intubation difficult. The document outlines tools for assessing airway difficulty, including individual indices, group indices with or without scoring, laryngoscopy grading, tests of mandibular space, and advanced radiographic assessments. It emphasizes that a thorough airway assessment is critical for airway management and difficult intubations cannot always be predicted.
Principles of Anesthesia for Nursing StudentsAme Mehadi
This document provides an overview of anesthesia, including definitions, types, stages of general anesthesia, and mechanisms of action. It discusses local anesthesia, general anesthesia, and the routes of administering each. The stages of general anesthesia are induction, excitement, relaxation, and danger. Inhalational agents like nitrous oxide, halothane, and isoflurane as well as intravenous agents like thiopental sodium and ketamine are reviewed. The document aims to educate about the basics of anesthesia.
First Aid for management of Specific Injuries.pptxAme Mehadi
This document provides information on first aid for specific injuries written by Ame Mehadi. It covers injuries to the eyes, head, face, jaw, nose, neck, chest, abdomen and skin burns. For eye injuries, it describes treating foreign objects and blows to the eye. For head injuries, it discusses scalp wounds and signs of brain injury, advising to call for medical help. Face and jaw injuries can obstruct breathing, so the first aid is to maintain an open airway. Nosebleeds are also addressed. The document aims to inform first responders on appropriate first aid for different types of injuries.
Nursing Ethics for nurses in clinical settingAme Mehadi
The document outlines an agenda for a national training on nursing ethics conducted by the Federal Ministry of Health. The 7-session training covers topics such as the introduction to nursing ethics, ethical principles, nursing values, ethical dilemmas, ethical decision-making, legal aspects of nursing practice, and the nursing code of ethics. Session 1 defines nursing ethics and describes theories of ethics. Session 2 identifies ethical principles like beneficence, non-maleficence, respect for autonomy, and others. Session 3 explains ideal nursing competencies such as moral integrity, communication skills, and concern for patients. Session 4 discusses ethical dilemmas and moral distress in nursing.
pneumothorax for Emergency and critical care nursing studentsAme Mehadi
A tension pneumothorax occurs when air enters the chest cavity during breathing but cannot escape, causing the lung to collapse with each inhalation. This puts pressure on the heart and pushes the trachea away from the affected side, compressing the heart and potentially stopping breathing if not treated by releasing the trapped air.
WOUND CARE for Public health professionals .pptAme Mehadi
This document provides guidance on wound care, including differentiating between types of wounds and describing various wound healing processes. It outlines the objectives and equipment needed for cleaning and dressing clean wounds, septic wounds, and wounds with drainage tubes. Procedures are provided for dressing changes, wound irrigation, and ensuring aseptic technique is followed to prevent infection. The goal of wound care is to keep wounds clean and promote healing.
The document provides information about operating room organization and design. It discusses the objective of describing specific OR areas, equipment, environmental layout, personnel, and aseptic technique principles. It defines key terms like operating department, operating suite, and operating theater. It describes the major considerations for OR design which include doors, lighting, ventilation, humidity, and heating. The basic design principles are outlined, including having a simple cleanable design, separate clean and soiled instrument rooms, and sufficient space. Specific organizational areas in the OR are also detailed.
The document provides an outline for a lecture on communicable disease control nursing. It covers several topics including the definition and features of communicable diseases, classification methods, and the chain of disease transmission. The chain of transmission involves an infectious agent, reservoir, portal of exit, mode of transmission, mode of entry, and successive host. Reservoirs can be humans, animals, vectors, or the environment. Five factors that play a role in fecal-oral disease transmission are also defined.
Surgical Conscience and Informed ConsentAme Mehadi
This document discusses informed consent and surgical conscience. It defines informed consent as permission obtained from a patient to perform a specific medical test or procedure. Surgical conscience is defined as surgical ethics, principles, or a sense of right and wrong. The document outlines the purposes of informed consent, circumstances requiring consent, essential elements of informed consent, and requisites for validity of informed consent such as obtaining written permission and signature without pressure or duress.
CASH Clean and Safe Health facilities Initiative_Ethiopia.pptAme Mehadi
The Clean and Safe Health Facilities Initiative (CASH) aims to make healthcare facilities clean, safe, and comfortable for patients, visitors, staff, and the community. It focuses on cleaning, safety, and infection prevention. The objectives are to increase awareness of cleaning and safety, engage all staff in cleaning activities, and create accountability. The scope includes clinical areas, utilities, buildings, and waste management. Principles emphasize that clean care is safer care and cleanliness is a shared responsibility. Strategies include governance structures, advocacy, collaboration, and recognition of best practices. Action points involve assessments, infrastructure improvements, campaigns, and monitoring/evaluation. Measures center on attitudes, standards implementation, satisfaction, and infection rates. Responsibilities
This document discusses proper hand hygiene techniques for healthcare workers. It covers the importance of hand hygiene in reducing infection spread, different hand hygiene methods like hand washing, hand antisepsis, antiseptic hand rubs and surgical hand scrubs. The techniques for each method are described in detail. Barriers to hand hygiene compliance and strategies to improve practices are also reviewed.
This document discusses personal protective equipment (PPE) used in healthcare settings. It covers various types of PPE like gloves, masks, gowns and drapes. It describes when each type should be used and how to correctly put on and remove PPE like gloves and masks. The key learning objectives are to list different PPE, describe their uses and limitations, and demonstrate proper donning and doffing of equipment.
This document discusses iron poisoning, including its stages, signs and symptoms, diagnostic tests, differential diagnosis, management, follow up, complications, and prognosis. Iron poisoning can cause gastrointestinal toxicity within 6 hours, then apparent improvement before systemic injury sets in from 12-48 hours with potential hepatic injury, hypoglycemia, bleeding, and other effects. Management involves supportive care, gastric emptying, whole bowel irrigation, and chelation therapy with deferoxamine. Complications can include hypotension, metabolic acidosis, hemorrhage, and organ failure. Prognosis depends on serum iron levels with higher levels carrying more risk.
This document discusses various types of bone injuries including fractures, sprains, strains, and muscle cramps. It provides details on closed and open fractures, as well as green stick and complicated fractures. Signs and symptoms of fractures are outlined. First aid principles for fractures include immobilization, splinting, controlling bleeding if open, and seeking immediate medical help. Specific fractures of the skull, face, shoulder blade, collarbone, upper arm, elbow, and forearm are also described with appropriate first aid treatments.
About this webinar: This talk will introduce what cancer rehabilitation is, where it fits into the cancer trajectory, and who can benefit from it. In addition, the current landscape of cancer rehabilitation in Canada will be discussed and the need for advocacy to increase access to this essential component of cancer care.
Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
Healthy Eating Habits:
Understanding Nutrition Labels: Teaches how to read and interpret food labels, focusing on serving sizes, calorie intake, and nutrients to limit or include.
Tips for Healthy Eating: Offers practical advice such as incorporating a variety of foods, practicing moderation, staying hydrated, and eating mindfully.
Benefits of Regular Exercise:
Physical Benefits: Discusses how exercise aids in weight management, muscle and bone health, cardiovascular health, and flexibility.
Mental Benefits: Explains the psychological advantages, including stress reduction, improved mood, and better sleep.
Tips for Staying Active:
Encourages consistency, variety in exercises, setting realistic goals, and finding enjoyable activities to maintain motivation.
Maintaining a Balanced Lifestyle:
Integrating Nutrition and Exercise: Suggests meal planning and incorporating physical activity into daily routines.
Monitoring Progress: Recommends tracking food intake and exercise, regular health check-ups, and provides tips for achieving balance, such as getting sufficient sleep, managing stress, and staying socially active.
Unlocking the Secrets to Safe Patient Handling.pdfLift Ability
Furthermore, the time constraints and workload in healthcare settings can make it challenging for caregivers to prioritise safe patient handling Australia practices, leading to shortcuts and increased risks.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - ...rightmanforbloodline
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
The best massage spa Ajman is Chandrima Spa Ajman, which was founded in 2023 and is exclusively for men 24 hours a day. As of right now, our parent firm has been providing massage services to over 50,000+ clients in Ajman for the past 10 years. It has about 8+ branches. This demonstrates that Chandrima Spa Ajman is among the most reasonably priced spas in Ajman and the ideal place to unwind and rejuvenate. We provide a wide range of Spa massage treatments, including Indian, Pakistani, Kerala, Malayali, and body-to-body massages. Numerous massage techniques are available, including deep tissue, Swedish, Thai, Russian, and hot stone massages. Our massage therapists produce genuinely unique treatments that generate a revitalized sense of inner serenely by fusing modern techniques, the cleanest natural substances, and traditional holistic therapists.
Comprehensive Rainy Season Advisory: Safety and Preparedness Tips.pdfDr Rachana Gujar
The "Comprehensive Rainy Season Advisory: Safety and Preparedness Tips" offers essential guidance for navigating rainy weather conditions. It covers strategies for staying safe during storms, flood prevention measures, and advice on preparing for inclement weather. This advisory aims to ensure individuals are equipped with the knowledge and resources to handle the challenges of the rainy season effectively, emphasizing safety, preparedness, and resilience.
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardso...rightmanforbloodline
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
Gemma Wean- Nutritional solution for Artemiasmuskaan0008
GEMMA Wean is a high end larval co-feeding and weaning diet aimed at Artemia optimisation and is fortified with a high level of proteins and phospholipids. GEMMA Wean provides the early weaned juveniles with dedicated fish nutrition and is an ideal follow on from GEMMA Micro or Artemia.
GEMMA Wean has an optimised nutritional balance and physical quality so that it flows more freely and spreads readily on the water surface. The balance of phospholipid classes to- gether with the production technology based on a low temperature extrusion process improve the physical aspect of the pellets while still retaining the high phospholipid content.
GEMMA Wean is available in 0.1mm, 0.2mm and 0.3mm. There is also a 0.5mm micro-pellet, GEMMA Wean Diamond, which covers the early nursery stage from post-weaning to pre-growing.
MBC Support Group for Black Women – Insights in Genetic Testing.pdfbkling
Christina Spears, breast cancer genetic counselor at the Ohio State University Comprehensive Cancer Center, joined us for the MBC Support Group for Black Women to discuss the importance of genetic testing in communities of color and answer pressing questions.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
2. INTRODUCTION
• Modern intensive care originated during the
poliomyelitis epidemics of the 1950s, when tracheal
intubation and PPV were applied to polio victims,
resulting in a substantial improvement in survival.
• Pts were managed in a specific part of the hospital
and received one-to-one nursing care, features that
still largely define ICUs to this day.
• From these beginnings, there was a gradual dev’t
until the ICU was a recognizable component of most
general hospitals.
3. INTRODUCTION
• In the early days of intensive care, pts were often
young and previously fit, with only single organ
failure.
• If they survived, a full functional recovery could be
anticipated.
• Today, in keeping with the changing structure of
society, pts are often elderly and many have
complex pre-existing medical problems, which
predispose them to develop MOF during critical
illness.
• As a consequence, the prospects for survival from
critical illness are sometimes limited.
4. INTRODUCTION
• Cost approaching £ 2000 per day, has led to
debate about how intensive care should be
provided in the future.
• there is increasing focus on the complex
ethical issues that surround;
– admission, provision and discontinuation of
intensive care therapy.
5. INTRODUCTION
• Nevertheless, intensive care medicine has
become established and fundamental part of
modern health care.
• Critical illness may arise from a variety of disease
processes, but the pathophysiological changes
that result lead to common patterns of organ
dysfunction.
• By recognizing these patterns and understanding
the interactions b/n d/t organ systems, intensive
care teams can improve the outcome of critically
ill pts.
6. INTRODUCTION
• The role of intensive care includes:
– Resuscitation and stabilization
– Physiological optimization of pts to prevent organ
failure
– Facilitation of complex surgery
– Support of failing organ systems
– Recognition of futility.
7. DEFINITIONS
• Traditional definitions of ICUs and HDUs
attempt to separate the functions of each.
• Intensive care unit (ICU)
– An area for pts admitted for the treatment of
actual or impending organ failure, especially
those requiring assisted ventilation.
– There is usually at least one nurse per patient and
a doctor assigned solely to the intensive care unit
throughout the 24-h period.
8. DEFINITIONS
• High dependency unit (HDU)
– An area for pts who require more intensive observation
or intervention than can be provided on a general ward,
but who do not require assisted ventilation.
– Nurse-to-pt ratios are generally b/n those of an ICU and
a general ward.
– There is not usually dedicated medical cover.
– There are, however, difficulties with such definitions.
– In many smaller hospitals ICU, HDU and coronary care
unit (CCU) are often combined in one area, with nursing
and medical staff working flexibly as required.
9. DEFINITIONS
– PACUs or recovery rooms may be used to
ventilate pts when the ICU is full.
– Many pts with chronic respiratory disease are now
ventilated on respiratory wards, either via face/
nasal masks or by long-term tracheostomy.
– Therefore the level of medical and nursing care
received by individual pts should not be a function
of their physical location, in an ICU or on the
ward, but a function of their clinical condition.
– This has led to the classification of levels of care
for critically ill pts based solely on need.
10. Levels of critical care
• Level 0: Pts whose needs can be met by ward-based
care in an acute hospital.
• Level 1: Pts at risk of deteriorating (including those
recently moved from higher levels of care) whose
needs can be met on a normal ward with additional
advice or support from the critical care team.
• Level 2: Pts requiring more advanced levels of
observation or intervention than can be provided on
a normal ward, including support for a single failing
organ system.
11. Levels of critical care
• Level 3: Pts requiring advanced respiratory support
alone or basic respiratory support together with support
for at least two organ systems.
• Specialist care is recorded by attaching one of the
following letters as a suffix.
• N – neurosurgical, C – cardiac, T – thoracic, B – burns, S – spinal injury,
R – renal, L – liver, A – other specialist care.
12. ADMISSION POLICIES
• The aim of intensive care is to support patients while
they recover.
• It is not to prolong life when there is no hope of
recovery.
• Sometimes difficult decisions have to be made about
whether or not to admit a pt to ICU, as there is often a
shortage of ICU beds and a requirement to use the
available resources responsibly and equitably.
• To aid decision making, some units have written
admission policies.
• The difficulty with all admission policies, however, is
that it is impossible to predict with complete accuracy
which individual pts stand to benefit from admission to
ICU.
14. Admission policy
1. Requests for admission
– Pts will be admitted to ICU who in the opinion of the ICU
consultant are likely to benefit from a period of intensive
care.
– Pts in whom further treatment is considered futile will
not normally be admitted.
– Requests for admission should be made by contacting the
ICU consultant on call.
– Requests should normally come from a consultant who
has seen the pt immediately prior to making a referral.
– In the case of elective surgery where the admission of the
pt can be foreseen a request should be made at least 24
hours prior to surgery.
– The bed should be confirmed immediately prior to
commencement of anesthesia.
15. Admission policy
2. Bed management issues
– All problems related to availability of beds will be dealt
with initially by the ICU consultant on call, who is in a
position to make decisions about the potential admission
and the needs of the pts already in the ICU.
– If there are no beds immediately available, the continued
provision of care at an appropriate level to the pt remains
the responsibility of the staff in attendance.
– Where no ICU bed is available, the ICU consultant may be
able to give advice as to the location of other available
ICU beds;
– however, their prime responsibility is to pts already in the
ICU.
16. Admission policy
3. Joint responsibility
– All pts will be admitted under the care of a named
ICU consultant and the ICU team will assume
responsibility for the patients care.
– Responsibility may be shared jointly with the
admitting team.
4. Discharge
– Will be arranged by the ICU staff in conjunction
with the responsible consultant.
– In cases of emergency, however, pts may be
discharged by the consultant on-call for the ICU.
17. Admission policy
• In practice, the decision to admit or not is usually
based on the outcome of multidisciplinary
discussion and clinical expertise.
• Instantaneous judgments regarding the
continuation or withdrawal of Rx from pts in the
OR, resuscitation room or on the wards are often
difficult and increasingly, lawyers, pt advocates,
independent mental capacity advocates (IMCAs)
and clinical ethicists are being involved in the
most difficult decisions.
18. Admission policy
• Senior staff should be involved early on.
• In many cases, unless the outlook is truly
hopeless, pts will be admitted for a trial of Rx
to see whether they will stabilize and improve
over time.
• Additionally , pts with little or no prospect of
survival may occasionally be admitted to ICU.
19. Admission policy
• For example, pts from the resuscitation room, or those
who have suffered catastrophic cxns during surgery,
may be admitted even though they are likely to die.
• This is to facilitate more appropriate terminal care, or
to allow the relatives time to visit and the bereavement
process to be better managed.
• This is a justifiable and appropriate use of a critical care
facility.
• Admission policies need, therefore, to be sufficiently
flexible to allow the admission of what may seem, on
occasion, like inappropriate cases.
20. PREDICTION OF OUTCOME
• The difficulties outlined above have led to a
wealth of work, using scoring systems, to predict
the outcome of patients treated in intensive care.
• This generally involves the collection of a large
amount of data from many pts, stratification of
the data to produce a risk score, prospective
validation of the score, and its subsequent
application to clinical decision making in specific
cases.
21. PREDICTION OF OUTCOME
• There are, however, major difficulties with this
approach:
– There is, as yet, no satisfactory diagnostic
categorization for intensive care pts.
– Often the problems relating to intensive care
admission bear little relation to the original
presenting complaint or diagnostic category.
22. PREDICTION OF OUTCOME
• Although pts may survive to leave the ICU, there
is a significant mortality:
– on the wards, and later at home, after leaving
intensive care.
• Many studies use 28-day mortality as an end
point.
• It has been suggested that 6-month or 1-year
outcomes of mortality and measures of morbidity
(quality of life measures) are better end points.
• Scoring systems may accurately predict
population outcomes, but are unreliable for
prediction in individual cases.
23. PREDICTION OF OUTCOME
• The APACHE II score, for example which is arguably the
best known outcome score, takes into account both
acute physiological disturbance and individual pre-
existing co-morbidity, and correlates well with the risk of
death for the intensive care population as a whole, but
does not accurately predict individual mortality.
• Attempts have been made using computer modeling to
improve the accuracy of outcome prediction models in
individual pts.
• The Riyadh Intensive Care Program, for example, uses
daily scores as a basis on which to predict those pts in
which further Rx is futile.
24. PREDICTION OF OUTCOME
• This approach has, however, failed to gain widespread
support.
• Severity of illness scoring systems therefore cannot be
used to predict individual pt outcomes.
• Their value lies in the ability to predict accurately the
overall mortality expected in a particular ICU based on
the local ‘ case mix ’ .
• The ratio of the actual mortality to the predicted case
mix adjusted mortality provides a measure
(standardized mortality ratio (SMR)) by which
individual units can be compared for audit purposes.
25. PREDICTION OF OUTCOME
• SMR less than 1 implies better than predicted
outcomes, whilst a SMR greater than 1 implies a
worse than predicted outcome.
• In the UK, a scoring system that predicts critical
illness outcomes more accurately in a British pt
population has been developed by the Intensive
Care National Audit and Research Centre
(ICNARC).
• Continuous ongoing data collection will enable
the score to be further refined and improved.
26. APACHE II SEVERITY OF ILLNESS SCORE
• The APACHE II (acute physiological and chronic health
evaluation) tool is the most widely used severity of
illness scoring system in intensive care.
– now somewhat dated and
– originally related to an index population in the U.S.,
– remains widely used because it is well known, reasonably
well validated and internationally accepted as a ‘case mix
adjustment tool ’.
• A score is assigned to each patient on the basis of:
– worst physiological derangement, occurring in the
first 24 hrs of admission (Table 1.4 )
– age (Table 1.5 )
– chronic health status (Box 1.2 ).
27.
28.
29. Notes on completing APACHE II scores
• In many ICUs, APACHE data are collected by audit
clerks and entered into electronic databases often
as part of a much larger data set.
• You may, however, be expected to calculate scores
on your patients and you should understand the
process:
– APACHE II score = acute physiology score (A) + age
score (B) + chronic health score (C).
• Score the worst value for each parameter in the
first 24 hrs
• Where results are not available, score as zero.
• This does not mean that you do not have to try to
fi nd the result fi rst!
30. • Serum HCO 3
– Only use bicarbonate when there are no blood gases available.
– Otherwise score the arterial pH.
• Glasgow Coma Scale (GCS)
– A number of approaches to this are adopted in different units.
– Either (a) assign the assumed GCS patient would have had if
– not artifi cially sedated, or (b) as patients who are ventilated,
– paralysed and sedated will have a GCS of 3, score as 15 3 12
– (see below). Ask what is the usual practice in your unit.
• Chronic health points
– This can provide a signifi cant loading to an APACHE score.
– Apply only according to the criteria on the scoring chart that
– imply established organ system impairment.
31. Problems with APACHE II
• There are a number of problems with the
APACHE II score:
– Patients with an APACHE II score 35 are unlikely to
survive.
• However, the score is a statistical tool based on the
population, and scores for individuals cannot be used to
predict outcome.
• Some patients, for example those with diabetic
ketoacidosis, may have marked physiological
abnormalities, but generally get better quickly.
– The score is based on historical data, and as new
interventions are developed, the data become
obsolete.
32. Problems with APACHE II
– Lead-time bias results from the stabilization of
patients in the referring hospital prior to transfer.
• This artificially lowers the score for the patient arriving at
the referral centre.
– The GCS component is difficult to assess in patients
receiving sedative or neuromuscular blocking
agents.
• There is an important difference b/n a GCS 3 due to head
injury and due to the effects of drugs.
– The physiological components are based on adults.
• They do not translate to paediatrics. For children the ‘ Pim
’ (paediatric index of mortality) or ‘ Prism ’ (paediatric risk
of mortality) score is usually used instead.
33. ALTERNATIVE SEVERITY OF ILLNESS
SCORING SYSTEMS
• APACHE III score
– The APACHE II score has now been superseded by
an updated APACHE III score.
– Five new variables have been added (urine
output, serum albumin, urea, bilirubin and
glucose), while two variables (potassium and
bicarbonate) have been removed.
– In addition, the GCS and acid – base balance
components have been altered.
– A complex matrix grid scoring system is used with
a max score of 299.
34. ALTERNATIVE SEVERITY OF ILLNESS
SCORING
• Simplified Acute Physiology Score (SAPS)
– is similar to APACHE, and is used more commonly
in mainland Europe.
– It utilizes 12 physiological variables assigned a
score according to the degree of derangement.
35. ALTERNATIVE SEVERITY OF ILLNESS
SCORING
• Therapeutic Intervention Score System (TISS)
– assigns a value to each procedure performed in the ICU.
– The implication is that the more procedures that are
performed on a pt, the sicker they are.
– It is dependent on the physician and unit, however,
since d/t hospitals will have varying thresholds for
carrying out many procedures.
– The score is therefore:
• not good for comparing outcome b/n pts or b/n d/t units,
• is useful as a general guide to the type of care and resources
likely to be needed by pts on an individual unit.
36. ALTERNATIVE SEVERITY OF ILLNESS
SCORING
• Sequential Organ Failure Assessment (SOFA) score
– tracks changes in the pt’s condition over time.
– It comprises scores assigned to each of six components:
• respiratory, cardiovascular, hepatic, neurological,
coagulation and renal.
– These are summed to produce an overall score.
– A score higher than 11, or b/n 8 and 11 and not
improving, is generally associated with an adverse
outcome.
37. DISCHARGE POLICIES
• Discharge policies are just as hard to define as
admission policies (above).
• Pts may be discharged in the following
circumstances:
– Either: the pt’s condition has improved to the
extent that intensive care is no longer required.
– Or: the pt’s condition is not improving and the
underlying problems are such that continued
intensive care is considered futile by staff on the
ICU.
38. DISCHARGE POLICIES
– In the second of these situations, the pt may
either die on the ICU or be transferred back to the
ward in anticipation that they will not be
resuscitated or readmitted to the ICU if their
condition deteriorates further.
– It is imperative that the referring staff, the pt’s
family and, where possible, the pt, agree that
such decisions are appropriate and that decisions
are clearly documented.
39. DISCHARGE POLICIES
• For pts whose condition is improving and for whom
discharge is considered, two questions should be
asked, as follows.
1. When are patients fit to be discharged?
– In simple terms, pts are fit for discharge from ICU
when they no longer require the specialist skills
and monitoring available on the ICU.
– This generally means that;
• they have no life-threatening organ failure
• their underlying disease process is stable or improving.
40. DISCHARGE POLICIES
2. Where is the patient to be sent?
– This will depend at least in part on the pt’s;
• underlying diagnosis,
• current condition, and
• where the pt came from in the first place.
– Some pts, esp elective post-op surgical pts, may be
fit enough to go straight back to a general ward.
– Others may, because of continuing organ
dysfunction or other problems, require closer
monitoring, supervision and nursing care and may
go back to an HDU.
42. DISCHARGE POLICIES
• Increasingly pts with chronic respiratory disease or
those who are slow to wean from a ventilator may
be transferred to a respiratory HDU capable of
providing CPAP and non-invasive forms of
ventilation.
• Some centres are developing specific long term
weaning units for this purpose and for caring for
pts with tracheostomies.
• Pts who have been transferred from another ICU
for specialist Rx or because of lack of beds may be
discharged back to the referring hospital.
43. DISCHARGE POLICIES
• In general, pts should be returned to their
referring hospital as soon as possible, if only
for the sake of relatives who may find
travelling difficult.
• Wherever possible, pts should only be
discharged during normal daytime hours.
44. DISCHARGE POLICIES
• Indeed, the time of day at which pts are
discharged is taken as a ‘quality indicator’ for
ICU in the UK.
• pts who are discharged from ICU outside the
normal working day are at greater risk of
subsequent deterioration and readmission
(evidenced).
45. DISCHARGE POLICIES
• The causes of this are probably multifactorial, but
may include:
– pts being discharged prematurely to facilitate the
admission of another pt, and
– reduced levels of out of hrs supervision on the wards
• Occasionally, pts may either self-discharge or be fit
for discharge home prior to a ward bed becoming
available (e.g. after over dosage of sedative drugs).
• In such cases the pt’s family or friends may be able
to attend to take them home direct from ICU.
46. DISCHARGE POLICIES
• In general, it is helpful prior to discharge to document
explicit decisions regarding circumstances under which
Rx should be re-escalated,
– whether or not readmission to intensive care is
appropriate, and
– whether or not to attempt resuscitation in the event of
acute deterioration.
• Such decisions should not be ‘written on tablets of
stone’, however, and should be revisited on a regular
basis, in full consultation with the pt or their advocate.
47. Criteria for discharge from ICU
1. Airway
– Adequate airway and cough to clear secretions (if
inadequate, tracheostomy and suction)
2. Breathing
– Adequate respiratory effort and blood gases
– May be on oxygen (e.g. from face mask)
– Not requiring CPAP or non-invasive ventilation (unless
discharged to HDU or respiratory unit).
3. Circulation
– Stable, no inotropes
48. Criteria for discharge from ICU
4. Neurological function
– Adequate conscious level
– Adequate cough and gag reflexes (if inadequate, e.g.
bulbar palsy or brain injury may need tracheostomy to
make airway safe and allow suction)
5. Renal function
– Renal function stable or improving
– Not requiring renal support unless discharged to a
unit which performs dialysis.
6. Analgesia
– Adequate pain control
Editor's Notes
Futility: Uselessness as a consequence of having no practical result
Unusefulness
uselessness