Who Needs Critical Care?
Patients come to ICU either from the emergency ward to recover post-surgery or if they become critically ill. Patients with life-threatening injuries and illnesses need intensive care. These include:
- Heart Attack
- Heart Failure
- Severe Bleeding
- Serious Infections
- Severe Burns
- Kidney Failure
- People Recovering after Surgeries
- Serious Injuries
- Respiratory Failure
- Multi-organ Failure
Manipal Hospitals Gurgaon being the top icu hospital in gurgaon offers 24-hour ambulance services so that the patient does not have to wait for primary medical aid in an emergency.
What Happens in a Critical Care Unit?
Intensive care units have several diagnostic, monitoring, and treatment-providing machines and equipment, which help doctors and nurses give medicine and treatment to reduce morbidity and mortality. Different machines and equipment used in ICUs are:
- Dialysis machines (for patients with kidney failure)
- Feeding tubes- to provide nutritional support
- Catheters- These are the flexible tubes that help the doctors to give in or take out fluids and medicines
- Intravenous Tubes
- Machines with monitors to check the vital stats of the patients
- Oxygen therapy to aid in breathing
- Tracheostomy Tubes
- Ventilators (for patients with respiratory failure).
POINT-OF-CARE IMAGING PROCEDURES
Management of patients in intensive care units is incomprehensible without continuous and sophisticated diagnostic procedures like bedside ultrasound and portable chest radiography to reduce morbidity and mortality.
Patients undergo advanced hemodynamic monitoring around the clock in an ICU. Hemodynamic monitoring includes the physical and static examination of vital signs like temperature, respiratory rate, heart rate, arterial haemoglobin oxygen, and means arterial pressure. Commonly used hemodynamic monitors are central venous catheters, pulmonary artery catheters, and arterial pulse-wave analysis. Hemodynamic monitoring helps doctors take the desired course of action before worsening the condition.
This test is known as the Arterial Blood Gas (ABG) test. A blood gas test measures the amount of oxygen and carbon dioxide in the blood and assesses the acid-base status. It allows the doctors to evaluate the adequacy of the patient's ventilation.
Coagulation and Blood Management
Excessive bleeding and clotting are dangerous for critically ill patients. Doctors in the ICU regularly check for clotting with the help of blood coagulation monitoring. The test measures the blood's ability to clot and how long it takes to clot. It helps doctors to assess the risk of excessive bleeding or developing clots.
A lumbar puncture takes out the cerebrospinal fluid to determine central nervous system diseases. During the procedure, the doctors insert a needle into the space between the two lumbar bones (lower back) to remove the cerebrospinal fluid for testing. The test is also called a spinal tap.
Bronchoscopy is the endoscopic technique that allows doctors to view inside the air passages and lungs for diagnostic and therapeutic purposes. The procedure involves passing a tube through the nose or mouth via the throat and into the lungs.
Treatments and Procedures followed in a Critical Care Unit
Tracheostomy is a surgical procedure for critically ill patients to assist them in breathing. The surgeons make a hole into the trachea and insert a tracheostomy tube inside it. This procedure of creating an opening through the trachea is called a tracheostomy. The procedure is for patients whose usual breathing route gets blocked. The hole is surgically closed or allowed to heal on its own when it is no longer needed. The process is permanent for critically ill patients.
Central line insertion involves inserting a catheter in the patient's vein for long-term drug therapy or kidney dialysis. The catheter stays for as long as the patient needs drug treatment or dialysis. It saves the patient from the pain and botheration of getting pricked by needles every time they need treatment. The procedure involves the placement of a tiny catheter in the vein under the shoulder bone and threading it by creating a tunnel under the skin.
An arterial line insertion is a procedure of inserting a catheter in an artery in the wrist. Doctors use it to monitor continuous blood pressure readings in critically ill and injured patients or those with unstable blood pressure. It also helps in taking frequent blood samples for testing purposes and saves the patient from repeated needle punctures.
A temporary pacemaker is a device that helps to regulate the heartbeat to the correct pace if it goes out of rhythm temporarily. It is also called temporary cardiac pacing. The cardiologists insert wires through the chest's large groin or neck vein and connect them directly to the heart. On the outside, these wires connect to an external pacing box. It works by sending current to the heart to regulate the heartbeat. For continuous irregularity in the heartbeat, the doctors recommend a permanent pacemaker. The patients can use temporary pacemakers for days or weeks.
Chest tube thoracostomy involves draining the fluid, air, or blood from around the lungs. The doctors place a hollow plastic tube between the ribs and the patient's chest. It helps the patients to breathe easily. Doctors recommend thoracostomy to patients with pneumonia, cancer, pleural effusion, hemothorax, and pneumothorax.
A mechanical ventilator is also called a breathing machine. It works to move air in and out of the lungs. It is for patients with respiratory failure. The ventilator machine has a breathing mask or tube that the patient wears to get air into the lungs from the ventilator. The respiratory healthcare team decides the level of ventilator support for the patient and when to take the patient off the ventilator.
Pericardiocentesis is the procedure to remove the fluid built up in the pericardium. The doctors use a small catheter and a needle to aspirate the excess liquid. The procedure is also called pericardial tap.
RENAL REPLACEMENT THERAPY
Renal replacement therapy replaces the normal blood-filtration function of the kidneys. It involves solute removal using hemofiltration, hemodialysis, or hemodiafiltration. Renal replacement therapy is of two types:
- Continuous renal replacement therapy (CRRT)
- Intermittent renal replacement therapy (IRRT)
PERCUTANEOUS ENDOSCOPIC GASTRONOMY TUBE PLACEMENT
Percutaneous Endoscopic Gastronomy (PEG) is a procedure that helps to give nutrition, fluid, and medication directly to the stomach, bypassing the mouth and the oesophagus. The doctors place a flexible feeding tube through the abdominal wall and into the stomach.
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