2. Surviving ITU Placements

3. INTRODUCTION TO ITU ITU: Ventilated or at risk of 2 or more organ failures. HDU: Self-ventilated or at risk of 1 organ failure. General wards: Self-ventilated with basic level of nursing care.

4. General thoughts of ITU Sick people Noisy/Busy People dying Smell Lots of machines Overwhelming Frightening Arrests frequently Blood Scared of making people worse Casualty/ER style!!

5. What ITU is actually like Calm Supportive Large presence of medical staff People who are critically ill Cleaners! (very clean) Demand for beds. Moved out ASAP Highly trained staff. Each person knows their job Friendly and approachable Infection control

6. MONITORING IN ITU Heart Rate Blood Pressure Temperature Central venous pressure Oxygen staturation Cardiac output

7. Head Injuries Inter cranial pressure Jugular oxygen saturation Cerebral perfusion pressure End tidal Carbon dioxide

8. Blood Gases P a O 2 P a CO 2 H + pH HCO 3 Base excess (BE)

9. Ventilator Setting Tidal volume Respiratory Rate Peak Airway Pressure Minute Volume Fraction of inspired O 2

10. MODES OF VENTILATION SIMV SIMV + PS CPAP + PS EXTERNAL CPAP BiPAP

11. Assessment in ITU Communicate with nurses Look at medical notes Look at nursing notes Look at last PT notes Look at chest X-rays

12. ASSESSMENT IN ITU Observation Palpation Auscultation Tape

13. Analysis IS THE PATIENT STABLE ENOUGH TO BE TREATED? If the pt is unstable will they deteriorate further without PT input? Will PT cause further instability? ?  WOB ? SPUTUM RETENTION ?  LUNG VOLUME

14. Treatment Ward fit  ITU Active treatment  passive treatment  WOB 1.Rest/sleep 2.Positioning 3.Pacing 4.Relaxation 5.Breathing re-education 6.BiPAP/CPAP 7.Ventilation *Intubating and ventilating a pt is a MDT decision with consultant having final say.

15. SPUTUM RETENTION Mobilising Deep breathing/ ACBT Re-hydration Positioning Postural drainage Flutter etc. Humidified Oxygen Bird Bagging Suctioning

16. LUNG VOLUME Mobilising Deep breathing Insentive spirometer Positioning Bird CPAP/ BiPAP Bagging

17. FINALLY……. Although ITU seems daunting, remember it is one of the safest environments to work in!

18. VASCULAR What it involves? Diabeties V.V Ischaemia-grafting Arterial and venous ulcers Aortic aneurysms Amputees post op

19. Typical patients 50+male Multiple problems Alcohol abuse Smoking-COPD

20. Physio input CHEST PHYSIO POST OP MOBILITY PHYSIO BEFORE D/C VV- in/out Aneurysms- aim 1 week. Amputees- awaiting wound heeling

21. Use M/D notes Work alongside O.T Transfering pt to suitable physio….D/C, outpatients, further rehab.