Editors: Chawla, Rajesh, Todi, Subhash (Eds.) The book describes step-wise management of clinical emergencies seen every day in Intensive care units (ICUs. Targeted readers are intensivists, critical care specialists, and residents involved in the care of patients admitted in ICUs. ICU Protocols: A stepwise approach: Medicine & Health Science Books @ Editorial Reviews. Review. From the reviews: “This is a multiauthored set of summaries of download ICU Protocols: A stepwise approach: Read 1 Books Reviews -

Icu Protocol Book

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Dear All,. The ICU Protocol a stepwise approach book edited by Dr Rajesh Chawla and Dr SubhashTodi can be downloadd from ISCCM Mumbai head office or. The book describes step-wise management of clinical emergencies seen every day in Intensive care units (ICUs. As a practical guide. A Book for Residents, Fellows,Critical care practitioners and Allied health care professionals, with comprehensive and current stepwise algorithm for the.

A severe brain injury often affects the ability of the body to function. Often a patient will need to breathe. An ET endotracheal tube may be put through the nose or mouth into the lungs and hooked up to a ventilator, a machine that assists breathing. If the ventilator is needed for more than two weeks, a tracheostomy may be performed. A small cut is made in the windpipe, or trachea, directly above the "Adam's Apple.

The ventilator is then hooked up to the trach, similar to the ET tube. Usually a patient on a ventilator will have wrist restraints to prevent him from pulling out the ET tube.

Extra fluids and medications may be needed to regulate the amount of water, salt and potassium in the body. Blood pressure, if too high or too low, may also need to be regulated with medications.

An IV inserted into the upper chest called a Swan Ganz catheter will be monitoring how effective the heart is beating and the amount of fluid in the body. Blood pressure is monitored by another catheter placed in an artery called an Arterial Line or A Line , usually placed in the wrist or foot. The arterial line is used so that the doctors and nurses can tell what the blood pressure is at all times.

It is likely the patient will be hooked up to a heart monitor, and will have EKG electrodes taped to the chest to monitor the heart rate rhythm. The patient may need medications to keep the heart beating normally. The patient usually is not alert enough to eat, and so he may be getting nutrients through a feeding tube.

Other IVs may also be run through pumps, so there may be several around the bed. Since the stomach may produce too much gastric juice, there may be a tube that goes into the stomach called a nasogastric, or NG, tube.

This tube may be hooked up to a suction bottle to remove these gastric juices. The stress of a brain injury may make some individuals prone to some bleeding from the stomach.

Airway Management in ICU Settings

This bleeding is called a stress ulcer. The patient may be treated with medications to prevent these stress ulcers from forming. Medications may also be given to help combat any infections in the bloodstream.

A catheter may be placed in the bladder to drain urine. By now it may seem that everything can go wrong. The important thing to remember is that the nurses and doctors will be monitoring the patient very closely, so they can treat all these problems as soon as they occur.

If the patient was in an accident, there might be other injuries beside the brain injury that require treatment. Often, patients have broken bones, therefore may have splints or casts, or may be placed in traction. A broken rib can puncture a lung.


If this happens, the patient may have a chest tube to drain off blood or fluid from around the lungs. The patient may have internal bleeding and need medications or surgery to stop that bleeding.

The patient's family and friends will be allowed to see him or her, but because he or she is so sick, visiting hours will be limited and there will be rules about how many people can come at one time. These rules ensure that the nurses can provide the patient with the best care.

Intensive and Critical Care Nursing

Family and friends are usually directed to wait in a nearby lounge between the times for visiting. The times for visiting are usually posted on a sign outside the ICU, in special circumstances, it may be possible to visit at times other than those posted times. This must be arranged with a person at an information desk outside the ICU.

Most patients with a severe brain injury will initially appear to be in a deep sleep.

They may not be able to move or open their eyes or talk. The nurses and physicians monitor the ability of the patient to respond using a scale, called the Glasgow Coma Scale GCS. See the page in the reference section of this book. After testing the patient's eye, motor and verbal response, the patient is assigned a score that best describes the nature of the response.

The patient may respond in a strange way, arms and legs may spasm into strange positions. He or she may say strange things. Tracheoarterial fistulas are due to erosion from the tube tip or cuff into the anterior wall of the trachea resulting in a fistulous communication with the innominate artery as it passes anteriorly across the trachea. Diagnosis is dependent upon a high index of suspicion, and when suspected, immediate action should be undertaken to stop the bleeding since diagnostic modalities such as angiography or bronchoscopy may lead to delay and death.

The following temporizing maneuvers may be performed while waiting for definitive therapy, which is surgical repair [ 22 ]. In an attempt to compress the innominate artery, the tracheostomy or endotracheal tube cuff may be overinflated.

If the above fails, an ETT may be placed orally, the tracheostomy removed, and the cuff inflated distal to the tracheostomy site.

Intensive and Critical Care Nursing

Pressure should be maintained during transport to the operating room. Reduced phonation: Following tracheostomy, many patients experience a reduction in or loss of phonation, the duration of which may be prolonged or indefinite, and the effect of which can be devastating to some patients. Preliminary data suggest that early phonation is feasible and may be beneficial when instituted during mechanical ventilation in tracheostomized patients.

Others: Tracheoesophageal fistula is more commonly encountered with prolonged endotracheal intubation and is discussed separately. Changing a tracheostomy tube: There are no universally accepted indications for changing a tracheostomy tube. Therefore, the following indications are based on clinical experience rather than on empirical evidence: Routine changes: Tracheostomy tubes are routinely changed from 7 to 14 days after initial insertion and then every 60 to 90 days. Observational data suggest that changing the tracheostomy tube before 7 days may be associated with earlier use of a speaking valve and earlier ability to tolerate oral intake.

A consensus statement recommends changing the tracheostomy tube at 3—7 days if inserted operatively but 10—14 days if placed via the percutaneous dilatational method. Patient discomfort: Patient discomfort may respond to a reduction in the size of the tracheostomy tube.

Malposition: Tracheostomy tube malposition may respond to a change in the length or size of the tracheostomy tube. Cuff leak: A cuff leak may be due to malposition of the tracheostomy tube particularly in the setting of tracheomalacia and may respond to changing the tube.

Fracture: Fracture of the tracheostomy tube or flange is an indication for a new tracheostomy tube. Bronchoscopy: Flexible bronchoscopy generally requires a tracheostomy tube with an inner diameter of at least 7. Decannulation: Appropriate candidates for tracheal decannulation after weaning from mechanical ventilation include patients who fulfill all the following criteria: No upper airway obstruction, ability to clear secretions that are neither too copious nor too thick, and presence of an effective cough.

The value of this measurement in patients without neuromuscular disease is unknown.

Failed decannulation has been associated with age, greater severity of illness, the presence of renal failure, and a shorter duration of spontaneous breathing prior to decannulation or the insertion of a tracheostomy plug. Extubation in ICU 7. ICU Protocols: A stepwise approach: As a practical guide.

The Critical Care Reviews Book seeks to summarise, critique and put in context The pdf is available as a free download at the Critical. ICU Protocols. This listing is a new book, a title currently in-print which we order directly and immediately. You can read this book with Apple Books on your iPhone, iPad. As a practical guide, clinicians can refer to it on.Central venous lines: Indications, placement and management. Attention must also be given to the status of any chest tubes to assure proper functioning in order to avoid a pneumothorax and be aware of any ongoing bleeding.

Intubated patients must have their endotracheal tube evaluated for patency, security, and position. Best For. Nonsteroidal antiinflammatory drugs.

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