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I. THE ICU TEAM
Many different health care professionals provide care in the ICU. The members of the ICU Care Team are dedicated to providing the care required in order to achieve the best possible outcomes for critically ill and injured patients.
MEMBERS OF THE ICU CARE TEAM
Physicians The Most Responsible Physician (MRP) is
the physician in charge of the patient’s care during the current hospitalization.
He or she communicates with other members of the team on a daily basis. The MRP may also consult with other physicians who are specialists in particular areas of medicine or surgery (such as heart, kidney, or lung specialists).
Pharmacists Pharmacists consult with the physician in selecting
the right medicines at the correct dose for patients and also in monitoring drug levels in the body. Pharmacists also help to decrease medication side effects and provide valuable information to the team members.
Physical Therapists Physical Therapists are involved in the care of
critically ill patients early on in their ICU stay. They help prevent disabilities and facilitate rehabilitation as soon as possible.
Dietitians Dietitians calculate the nutritional
needs of the critically ill patient and consult with the physician to provide the patient with the best possible diet, whether orally or through a feeding tube.
Nurses Intensive Care nurses are the minute-
to-minute critical care providers. They not only help to provide, but also coordinate most aspects of care delivery. They have received specializedtraining in caring for critically ill patients.
Respiratory Therapists Respiratory therapists have special training
and experience in caring for patients with breathing problems.
They work closely with the physician to develop a plan to support a patient’s breathing.
They set up, monitor and maintain the breathing machines (mechanical ventilators), and they adjust these machines minute by minute and hour by hour to best meet the patient's needs.
They also give breathing treatments, suction secretions from the breathing tubes and setup and maintain oxygen delivery devices and many other pieces of breathing equipment
Medical Radiation and laboratoryTechnologist
Technologists specially trained in taking X-ray pictures and in obtaining blood samples for laboratory tests are often found in the ICU.
Social Worker Social workers provide professional assistance with the needs of patients and families. They can help to assess and determine what resources patients and families might be lacking, providing them with information on agencies to assist with various needs and generally assisting with other family difficulties.
II. (ICU) EQUIPMENT
Intensive care unit (ICU) equipment includes patient monitoring, respiratory and cardiac support, painmanagement, emergency resuscitation devices, and other life support equipment designed to care for patients who are seriously injured, have a critical or life-threatening illness, or have undergone a major surgical procedure, thereby requiring 24-hour care and monitoring
A. PATIENT MONITORING EQUIPMENT
Aims of using monitoring system in the ICU:
-Establish the indications and contraindications of cardiopulmonary physiotherapy.
-Define treatment intensity, duration and frequency for optimal treatment outcome.
-Establish whether the patient is responding negatively to treatment and whether treatment should be continued or modified.
COMMON MEASUREMENTS IN MONITORING INSIDE ICU:
1. Blood gas analysisBlood gas analysis is crucial to the
assessment of problems related to acid-base balance, ventilation and oxygenation.
The generally accepted normal ranges (±2 SD) for arterial blood gas values.
pH PCO2 PO2 HCO3- %Sat
Normal value
Normal range
7.40
7.33-7.45
40
35-45
97
>80
24
22-28
--
>95%
2. Arterial oxygen saturation: Pulse oximetery provides a continuous feedback
on arterial oxygen saturation. A probe on the ear, finger, toe or nose sends beams of light through perfused tissue, the degree of light absorption depending on the level of oxyhaemoglobin.
Values below 95% in black people and 92% in white people indicate oxygen desatruation. Results are unreliable in conditions of pour perfusion such as hypotension, hypovolaemia or peripheral vascular disease
The monitor should be observed regularly during treatment, specially during and after position or suctioning. It provides reassurance, guidance and biofeedback of both the patient and the physiotherapist.
3-HAEMODYNAMIC MONITORING:
A) Arterial blood pressure: An arterial catheter measures systemic blood pressure more accurately than a standard blood pressure cuff. The arterial line is commonly found in the radial artery but may also be placed in the femoral artery. This measurement may be altered by the patient's position; for example, when the line is in the radial artery it gives an accurate reading with the wrist in an extended position. Relative or absolute flexion of the wrist produces an erroneous reading. Extension or hyperextension of the wrist should restore accurate reading.
B) Central venous pressure (CVP): The central venous catheter is
inserted most commonly through the subclavian, internal jugular, or femoral veins. The central venous line measures right atrial pressures .
CVP line does allow the administration of potent drugs and hypertonic solutions relatively safe.
C)Pulmonary artery pressure:
A pulmonary artery catheter, provides an immediate profile of cardiac function by measuring the pulmonary artery pressures.
4. Pulsemeter: Electronic pulsemeter use
sensor to detect the pulse pulemeters have gained expanded use in ICU because they produce a practical, accurate method of continual pulse monitoring.
5.Temperature: It is important to known
the patients temperature as part of the general assessment. Skin temperature as well as central or core temperature is measured. It is continuously monitored by means of an oesophageal or rectal probe.
6.Blood glucose meter (glucometer) :
Glucometer offers easy and convenient measurement of blood glucose.
7. Electrocardiography (ECG): ECG is a record of potential
changes generated by the heart during each cycle and transmitted to the surface of the body. These potential changes can be recorded from the surface of the body by surface electrodes.
8. SPIROMETER:
Spirometry is a simple method for studying pulmonary ventilation. Pulmonary function test provide the clinician with information about the integrity of the airways, the function of the respiratory musculature and the condition of the lung tissues themselves. A through evaluation of pulmonary function involves several tests that measure lung volumes and capacities, gas flow rates and gas diffusion.
B. LIFE SUPPORT AND EMERGENCY RESUSCITATIVE EQUIPMENT
1-Ventilator (also called a respirator): Assists or controls pulmonary ventilation in patients who cannot breathe on their own. Ventilators consist of : a-A flexible breathing circuit, b-gas supply c-heating/humidification mechanism, d-monitors, and alarms. They regulate the volume, pressure, and flow of patient respiration.
2-Infusion Pump:-Device that delivers fluids intravenously or epidurally through a catheter. -Infusion pumps employ automatic, programmable pumping mechanisms to deliver continuous anesthesia, drugs, and blood infusions to the patient.
3-Crash cart—also called a resuscitation or code cart.
- This is a portable cart containing emergency resuscitation equipment for patients who are "coding." That is, their vital signs are in a dangerous range. - The emergency equipment includes a defibrillator, airway intubation devices, a resuscitation bag/mask, and medication box. - Crash carts are strategically located in the ICU for immediate availability for when a patient experiences cardiorespiratory failure.
C. DIAGNOSTIC EQUIPMENT
The use of diagnostic equipment is also required in the ICU.
Mobile x-ray units are used for bedside radiography, particularly of the chest.
Handheld, portable clinical laboratory devices, or point-of-care analyzers, are used for blood analysis at the bedside.
D. OTHER ICU EQUIPMENT
1- Urinary (Foley) catheters.
2-catheters used for arterial and central venous lines.
3-Swan-Ganz catheters.4-Endotracheal tubes.
5-Gastrointestinal and nasogastric feeding tubes,
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