Lines & Tubes
I am extra shiny, you can see real time results because of me and this is the line you do NOT want to pull on - it's messy!
What is the Arterial Line?
- Artery not a vein
- Very positional and it is not always accurate!!
- attached is a pressurized IV bag and cord attaching it to the monitor (grey)
- Insertion Site: Wrist vs. Groin
Patients who are ventilated need rest and shouldn't get out of bed
What is False
Improve Alertness
Ventilated does not mean sedated
Airway Clearance & Respiratory function
RASS -5
Sodium 115 mmol/L, Potassium 2.1 mmol/L
Vasopressin 0.04 unit/min
Norepinephrine (levophed) 20mcg/min
BP 90/60
What is ..NOPE
- Comatose, critical lab values & hypotensive with 2 types of Vasopressors
FiO2
Fraction of inspired O2 - concentration of O2 patient is receiving.
You are rolling a patient in bed, they don't have any wounds but they unexpectedly pooped..
Who is the ICU care-aid
I feed patients, but sometimes empty their stomach.
What is a Nasogastric tube?
- Suction: typical after abdominal surgery for bowel rest.
- Feeding: Attached to tube feed
- Watch the nose!!
- This tube is uncomfortable!
The ICU is the safest place to work
What is true.. okay that may be a personal opinion
Intubated and ventilated x 50 days. Tracheostomy on day 30
Heavily sedated and occasional paralytic requirements used for 48 days. Now awake for the last 2 days
Grade 1 strength to fingers and left elbow, Grade 2 strength to right hip.
What is.. YES! Hello early rehab candidate
Treatment ideas?
ABG
What is Arterial Blood Gas - proportion of O2 and CO2 in the blood which is used to determine the level of respiratory support needed of if they are appropriate to extubate
Able to mobilize but stuck on a ventilator, they are depressed and have been stuck in 309 for the last 45 days- its the perfect sunny day out if you can get out of the room
Who is the RT (*and the physician)
I am used for nutrition support, volume resuscitation, emergency long lasting venous access and allow for caustic meds (ie. vasopressors). I'm typically sutured in place and I'm not a PICC line
What is a central line.
Nothing scary just like a regular IV with sometimes multiple lines attaching into it that makes it heavy.. if its hanging add some tape or ask the nurse to reinforce it!
ICU patients are too sick, they can be left alone until they are feeling better and on regular wards
What is False
- for everyday in the ICU it takes 3-5 to recover - Prevention!
- sedation is the primary limitation for mobilization
- Treatment Ideas
Polytrauma MVA 2 weeks ago
Craniotomy with bone flap left out, minimally responsive, occasionally localizing with one arm, spontaneous movement to both legs
Multiple Broken ribs, right broken wrist, left tibial plateau fracture in a zimmer (NWB), pelvis fracture (WBAT)
Tracheostomy on 7th day in ICU
Vitals and medications: Stable
No head control
What is definitely try!
- Treatment Ideas
VSS
What is Vital Signs Stable
Hands are stiff with no active movement, edematous, sweaty & fingernails are starting to dig into skin
Who is the OT
I provide a type of anesthetic that numbs a specific area, I am used for pain control that blocks spinal nerves to prevent pain signals reaching the brain - I typically have fewer side effects and provide longer lasting pain relief
What is an epidural
- sometimes sensation/motor function can be affected, typically not but just a heads up before you move someone!
Feeding tubes need to be stopped if the Head of Bed is lower than 30 otherwise a patient will aspirate
What is False
There is a much greater risk in turning feeds off briefly for boosts/repositioning as the pt is denied nutrition (potentially for longer as it often does not immediately get turned back on).
Current research indicates there is no risk of aspiration
Ventilator via Tracheostomy on PSV, FiO2 0.30%
Awake and cooperative
Stable Levophed dose
Tolerating upright positioning - dangle
What is YES (with the help of an RT - you can walk them)
- What is PSV
- Treatment Ideas?
PEEP
What is Positive End Expiratory Pressure - how much pressure is needed at the end of exhalation to keep the lungs inflated.
Patient is not responding to your treatment plans, they seem to continue to lose function despite your best efforts, you are out of ideas
Who are your co-workers
I need a laser level to be positioned, the patient cannot be moved until I'm clamped - I typically drain clear fluid
What is an Extra Ventricular drain
- Activity Parameters
- Uses: post-op craniotomy, drain excess CSF, measure ICP
The nurse said no so I can't see the patient
What is false
- Communicate & advocate
Guillian-Barre Syndrome, onset 5 weeks ago, they have reached a plateau with their deficits
Only active movement: Partially able to open left eyelid, eye movements intact
Tracheostomy - volume control setting, fiO2 50%
What is yes - movement would need to be scaled down to meet the patients activity tolerance - watching for fatigue or a change in vitals
- What is Volume Control?
- Treatment Ideas??
NAFNE
What is Nurses Are Friends Not Enemies :)
Mechanically lifting patient into a Broda with the help of an RA - they are ventilated via ETT and have tube feed running through their NG tube
Who is the nurse