ICU Handbook

2017
 ICU Equipment
Term Page #
Arterial Line 3
Artic Sun Device 3
Central Venous Catheter 3
Chest Tubes 4
Chole Drain 4
Epidural Pump 5
External Pacemaker 5
Extracorporeal Membrane Oxygenation (ECMO) 5
Femoral Vein Line 6
Foley Catheter 6
Intra-Aortic Balloon Pump (IABP) 6
Impella Device 7
Implantable Cardioverter Defibrillator (ICD) 7
Internal Jugular Vein (IJV) Line 8
Jejunal Tubes 8
JP Drain 8
Nasogastric Tube 9
Oxygen Humidifier 9
Patient-Controlled Analgesia (PCA) Pump 9
Percutaneous Endoscopic Gastrostomy (PEG) Tube 10
Peripherally Inserted Central Catheter (PICC) 10
Peripheral Intravenous Line 10
Pigtail Catheter 11
Rectal Tube 11
Stents 11
Supplemental Oxygen Devices
• Nasal Cannula 12
• Closed Face Mask 12
• Face Tent 12
• Tracheostomy Collar 13
• Non-Rebreather Mask 13
• BiPAP 13
• T-Tube 14
Swan Ganz Line 14
Temporary Pacer 14
Total Parenteral Nutrition (TPN) 15
Trach Tubes 15-16
Vital Signs Monitor 16
Watchman Device 17
Water Seal Chest Tube 18
Wound Vac 18
Yankauer Suction 19
Zoll Pads 19

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 2

 Arterial Line (A-Line)
Function:
• To directly and continuously record systolic,
diastolic blood pressures and MAP. Access for ABG
Clinical Implications:
• If A line is displaced, patient can lose significant amounts
of blood
• Pressure transducer should be kept level with heart for
accurate readings
• If transducer is above heart, false low BP reading occurs
• If transducer is below heart, false high BP reading occurs
• If femoral arterial line, patients usually seen bedside, and
hip flexion over 60-80* is avoided.
• After removal of A-line, patient is usually on strict bed rest for 60-90 minutes unless
otherwise specified by nursing.

Arctic Sun Device:

Function:
• Non-invasive temperature management device.
Conductive pads connect to the patient to administer
treatment. Can control a patient's temperature between
89.6 and 101.3 degrees

Central Venous Catheter

Purpose:
• Measures right atrial pressure, giving information regarding cardiac function and
intravascular fluid status.
• Also provides access for short or long term (days to months) nutrition administration,
repeated blood sampling, administration of medication, or initiation of transvenous
cardiac pacing.
Location:
• Catheter inserted through subclavian, internal jugular vein, into superior vena cava
Clinical Implications:
• Do not use a blood pressure cuff on the side with the catheter.
• If subclavian line: no activity restrictions

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 3

 Chest Tubes
Purpose:
• Removes and prevents the reentry of air or fluid from the pleural or mediastinal space
and provides negative intrapleural pressure.
Indications:
• After cardiac surgery and opening of mediastinum
• Pleural effusion, pneumothorax, hemothorax, chylothorax
Types of Chest Tubes
• Mediastinal tubes: in post-op 12-24 hours. Into mediastinal space around heart. Exits
under sternum.
• Pleural Tubes: removing fluid from pleural spaces, in 1-3 days. Exit lateral/posterior
chest wall.

• For pneumothorax: end of the tube is directed anterior and superior in pleural space near
apex of the lung, at level of 2nd or 3rd intercostal space.
• To drain hemothorax or pleural effusion, tube is positioned inferior and posterior in
pleural space. Tube is placed in mid-axillary line at 7th or 8th intercostal level.
PT Implications
• See if patients can be taken off wall suction for activity. If not, use portable suction
machine to allow for mobility.
• Keep drain below the level of the chest tube to facilitate gravity drainage

Chole Drain/Tube
Function:
• Drain that is inserted into gallbladder to drain fluid (procedure called Cholecystostomy)
Indications:
• When outlet of the gallbladder is blocked by a tumor or gallstone.
Gallbladder will need to be drained to reduce swelling and infection.
PT Implications:
• Ensure proper placement with functional mobility so drain remains
in place.

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 4

 Epidural Pump:
Function:
• Small catheter placed into epidural space at a predetermined sensory level.
• Used to block pain transmission at predetermined sensory level.
Indicated for use with thoracic, abdominal, vascular and
large orthopedic surgeries
PT Implications
• Check sensation prior to mobility.
• Avoid dislodging line, make sure enough slack is on line before
movement
• Patients can receive a “rescue dose” by nursing prior to session,
but vitals will need to be monitored closely.

External Pacemaker
Function:
• To maintain normal sinus rhythm, and prevent
arrhythmias.
PT Implications:
• Monitor heart rate/rhythm with mobility. No
mobility restrictions unless specified by
nursing/MD.

Extracorporeal membrane oxygenation (ECMO)

Function:
• Device that bypasses heart and lungs, and takes over their functions to allow both organs
to rest
PT Implications:
• No mobility when on this device.

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 5

 Femoral Vein Line
Indications:
• Central venous pressure monitoring, urgent hemodialysis access,
Contraindications:
• Venous injury, thrombosis, ambulatory patient
Function:
• Allows for access to central veins for hemodynamic monitoring
PT Implications:
• No functional mobility if femoral vein line present in patient

Foley Catheter
Purpose:
• To drain urine from the bladder.
PT Implications:
• Keep collection bag below bladder level to allow for gravity assisted drainage.
• Secure tab to patient’s leg or clothing before ambulation to avoid tripping on tube

Intra-Aortic Balloon Pump (IABP)

Purpose:
• Device to increase coronary perfusion in the event of cardiogenic
shock, heart failure, acute heart attack, support during high risk
heart surgeries, failure to wean from cardiopulmonary bypass.
Location/Mechanism of Action:
• A balloon mounted to a catheter, is inserted into the aorta through
the femoral artery. Balloon guided to descending aorta.
• During diastole, the balloon inflates, which increases coronary
perfusion by keeping vessels open
• At the beginning of systole, the balloon deflates as blood is
ejected from LV, which increases space in the aorta and can increase cardiac output by as
much as 40%.
PT Implications:
• Patients not allowed out of bed, PT only for positioning needs. Involved hip immobilized

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 6

 Impella Device:
Purpose:
• Left ventricular assist device, mimics LV function allowing heart to rest
• Indicated for patients experiencing: cardiogenic shock, advanced
heart failure. Short term use (4-6 days)
Location:
• Inserted through femoral artery through standard catheterization
procedure.
Mechanism of Action
• Pulls blood from left ventricle, and expels it through aorta,
mimicking LV function, allowing the heart to rest.
PT Implications:
• No functional mobility when on this device

Implantable Cardioverter Defibrillator (ICD)

Function:
• An ICD is a battery-powered device placed under the skin that keeps track of heart rate.
Thin wires connect the ICD to the heart.
• If an abnormal heart rhythm is detected (tachycardic) the device will deliver an electric
shock to restore a normal heartbeat
• If ICD has a pacemaker feature when heartbeat is too slow, it works as a pacemaker and
sends tiny electric signals to the heart.
Placement
• Wires or leads run from the pulse generator to positions on the surface of or inside the
heart and can be installed through blood vessels, eliminating the need for open-chest
surgery.
PT Implications
• Monitor vital signs. No mobility restrictions

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 7

 Internal Jugular Vein (IJV) Line
Function:
• Another central venous access line for critically ill patients
• For access to superior vena cava, access to
pulmonary artery via right ventricle for passage
of Swan-Ganz catheter
PT Implications:
• No mobility restrictions, check with nursing prior
• No shoulder ROM on side of IJV line
• Watch for dislodgement of line, even though line is usually
secured with sutures and/or tape

Jejunal (J) Tubes

Function:
• Provides nourishment directly to jejunum for patients unable to take nourishment orally.
Location
• Directly to jejunum through abdominal wall.
PT Implications:
• Do not dislodge with functional mobility
• Pain at insertion site after placement.

Closed Suction Drain with Bulb (JP Drain)

Function:
• Used to remove fluids that build up in areas of body after
surgery or infection
Placement
• One end of rubber tube placed where fluid builds up. The
other end of the tube comes out through a small incision,
and a small bulb is attached to outer end.
PT Implications:
• Pin drain to gown prior to functional mobility.
• Assess for any leaks, lack of suction.

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 8

 Nasogastric (NG) Tube:
Purpose:
• Keeps the stomach empty after surgery, and rests the bowel by
preventing gastric contents from passing through bowels. Some NG
tubes allow access to stomach for medications or tube feedings.
PT Implications:
• Review orders to see if tube can be temporarily disconnected from
suction. When disconnected, the open end should be capped and
monitored.

O2 Bubbler (humidifier)
Function:
• Used to humidify supplemental oxygen. Provides long
lasting moisture for patients during oxygen therapy.
PT Implications:
• Not able to place on humidified air with functional
mobility if using portable O2.
• Make sure to place back on humidified oxygen after
session to increase patient comfort

Patient-Controlled Analgesia (PCA) Pump

Function
• Pain management device that allows patient to
control when a dose of medication is
administered. Handheld button given to
patient that, when pressed, administered one
dose of a pain medication that is selected by
doctor.
• There is a certain time that must pass in
between doses, and a maximum number of
doses that are allowed within a certain time
frame to prevent overdose.
PT Implications
• Time doses with treatment, have patient press button before session if in pain.
• Make sure button for PCA pump is within reach after treatment session.

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 9

 Percutaneous Endoscopic Gastrostomy (PEG) Tube
Function
• Flexible feeding tube placed through abdominal wall into
stomach, allowing nutrition or medications to be put directly
into stomach, bypassing mouth and esophagus
• Can remain in place for months or years, but can become
clogged
Location
• Into stomach through abdominal wall.

Peripherally Inserted Central Catheter (PICC)

Function:
• To provide IV access for long term administration of
medications, fluid, blood products or chemotherapy.
useful for patients having head/neck surgery
Clinical Implications:
• Wait for x-ray to confirm proper placement before
mobilization.
• Do not use a BP cuff on involved extremity, but do
encourage mobility of that extremity.
• Use of axillary crutches may be contraindicated,
especially if the PICC line is inserted in the
basilic vein.
• No activity restrictions

Peripheral Intravenous (IV) Line:

Function:
• Provides temporary access for delivery of medications, fluids, electrolytes, nutrients, or
blood product transfusions.
Clinical Implications:
• Avoid using BP cuff on extremity with IV line.
• Monitor positioning as not to occlude line
• Check to see if any lines can be disconnected prior to mobility

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 10

 Pigtail Catheter
Function
• Used to drain fluids/air from pleural space. The
coil end helps hold the pigtail catheter in place,
and to slow the flow of injected fluids. Used in
critical conditions where a surgery cannot be
done.
PT Implications
• Do not dislodge with functional mobility
• Do not roll to side of pigtail catheter

Rectal Tube
Function:
• Collects bowel drainage and protects fragile skin from
contact with feces
PT Implications:
• Can be dislodged easily.
• Use a draw sheet when moving patient in bed.
• Keep collection bag below level of insertion

Stents
Function
• To hold open valves that are narrowed due to plaque build-up, allowing improved blood
flow through the vessel.
Types
• Drug Eluting Stent (DES)
o A stent saturated with medication to reduce rate of re-narrowing
• Bare Metal Stent (BMS)
o A stent with no medication, holds vessel open

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 11

 Supplemental Oxygen Devices

Nasal Cannula (FiO2: 24-44%)

• Functions
o Delivers supplemental oxygen mixed with room air
about 1-6 L/min
• PT Implications:
o Ensure proper length of O2 tubing and prevent kinks in
tubing during session.

Closed Face Mask (FiO2: 40-60%)

• Functions:
o Delivers supplemental oxygen mixed with room
air. Allows for collection of O2 about the nose and
mouth
• PT Implications:
o Closed mask interferes with coughing, talking,
eating, drinking so patients may try and remove
mask for these reasons.

Face Tent (FiO2: 28-100%)

Function:
• To provide humidification and oxygenation, however it is
not possible to control oxygen concentration.
• Mask is partially open over nose
PT Implications:
• More difficult to mobilize patient compared to nasal cannula
• Moisture may collect within tubing requiring drainage

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 12

 Tracheostomy Collar (FiO2: 28-100%)
Function:
• Provides supplemental humidified oxygen or air at
tracheostomy site
PT Implications:
• Mask can be easily shifted, make sure it is in proper
place. Gently pull mask away for secretion
management.
• Moisture may build up, drain before mobility to prevent
aspiration

Non-Rebreather Mask (FiO2 60-80%)

Function:
• Provides highest concentration of supplemental oxygen
via face mask.
• One way valve between mask and bag, which allows
oxygen to be taken in from bag, and expired air to escape
from mask through vents on either side.
PT Implications:
• Interventions generally deferred if patient requires this
device to maintain oxygenation.

Bilateral Positive Airway Pressure (BiPAP) (FiO2 21-100%)

Function:
• Mask fitted to patient face, fit over nose and mouth
delivering oxygen
• Provides positive inspiratory and end expiratory
pressure to decrease work of breathing by reducing
airway pressure necessary to generate inspiration.
• May deliver supplemental oxygen at a specific
concentration or room air.
• May be used to avoid intubation
PT Implications
• May be able to switch to other methods of oxygen
therapy for treatment.
• Patient may feel claustrophobic while wearing device,
difficult to communicate with

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 13

 T-Tube (FiO2 50-80%)
Function:
• Provides specific concentration of supplemental
oxygen to intubated patient who is spontaneously
breathing, while weaning from ventilator
PT Implications:
• Patient may tire more easily since weaning from
ventilator. Check with provider to determine
appropriateness of interventions.

Swan Ganz Line

Function:
• Monitors left sided heart pressures and cardiac output
• Specific measurements include:
Pulmonary Artery Systolic Pressure (PAS)
Pulmonary Artery Pressure (PAP)
Left atrial pressure (LAP)
Right atrial pressure (RAP)
Central venous pressure
Core body temperature
Cardiac output..
PT Implications:
• Mobility is not contraindicated, just requires increased caution
• Avoid neck and head (for subclavian access) or extremity movements that could disrupt
the PA line at the insertion

Temporary Pacing Wires

Function
• Maintain normal sinus rhythm (NSR) and
prevent arrhythmias
Locations:
• Epicardial Leads: directly to surface of
right atrium/ventricle and exits chest from
small subxiphoid incision. Usually placed
during cardiac surgery
• Endocardial Leads: In right atrium or
ventricle via subclavian, internal jugular or
cephalic veins.
PT Implications:
• No ROM assessment or therex on ipsilateral side for endocardial leads.
• No mobility precautions unless otherwise dictated by MD or nursing.

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 14

 Total Parenteral Nutrition (TPN) or Intravenous Nutrition
Function:
• Method of feeding that bypasses the gastrointestinal
tract.
• Fluids given intravenously, contains proteins, carbs,
fats, vitamins and minerals.
• Method is used when patient cannot/should not receive
feedings/fluids by mouth
• Long term use can lead to liver problems
PT Implications:
• No mobility restrictions
• Cannot be disconnected for functional mobility

Trach Tubes:
Function
• To assist with breathing, decreases the length of airway for patients with decreased
respiratory capabilities
• Balloon cuff can be used to completely block airway, patient unable to speak
• Progress by deflating to open up airway, increase length of airway

Cuffed Trach tube with reusable inner cannula

• Used to obtain a closed circuit for ventilation
• Cuff should be inflated just enough to allow minimal air leak
• Cannula can be reused after cleaning

Cuffless Tube with Disposable Inner Cannula

• Used with patients who are ready for decannulation
• Patients may be able to eat, and may talk without speaking
valve

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 15

 Fenestrated Cuffed Tracheostomy Tube:
• Used for patients who are on vent, but cannot tolerate
a speaking valve to speak
• Higher risk for aspirating secretions

Vital Signs Monitor

Green: Heart Rate

Red: Real time blood pressure from arterial line
Yellow: Pulmonary pressure from Swan Ganz line
Blue: SpO2 reading
White: Respiratory rate
Purple: Last blood pressure taken

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 16

 Watchman Device
Function:
• Left Atrial Appendage Closure Device, seals off left atrial appendage to prevent
formation of blood clots.
Procedure of Implantation:
o Insert catheter through body (femoral artery) to right atrium. Hole cut between
atrial septum to access left atrium. Watchman device then pushed through
delivery catheter and implanted into left atrial appendage. Device opens like
an umbrella.
o After 45 days, a layer of tissue grows over device sealing off left atrial appendage.
After 45 days, 9/10 of patients no longer need to take warfarin to reduce stroke
risk. Doctors will take imaging of heart to monitor progress. Plavix may be
prescribed, and an aspirin regimen may remain in place.
Indications:
• Used in patients with atrial fibrillation not related to heart valve disease. During a-fib
most blood clots develop in the left atrial appendage
PT Implications:
• No mobility restrictions.

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 17

 Water Seal Chest Tube Drainage
Function:
• Provides separate functions of fluid collection, water seal
(1-way valve) and suction control
Chambers of Water Seal Unit
• Fluid Collection
o Collects fluid from chest tube. Nurses will record
amounts of fluid in chamber in schedules intervals
• Water Seal
o Allows air to pass down and bubble out through
bottom of water seal, while not allowing air to
pass back to the patient.
o Example: cup of water and straw. If you blow into
the straw, air bubbles through the water. However,
if you want to draw air through the straw, you
only get water.
• Suction Control
o Atmospherically vented section of device, containing water. By adding or
removing water in the suction control chamber, chest drain controls the amount of
suction imposed on the patient.
o Lower water content equals lower suction, higher water content equals higher
suction.
PT Implications:
• Patients can sometimes be unhooked from water seal suction for functional mobility
• Keep collection chambers below level of tubing to allow gravity assisted drainage
• Do not knock collection chamber open, if you do, contact nursing.

Wound Vac
Function:
• Helps wounds to close.
• Device decreases air pressure on the wound,
accelerating healing.
• Can pull fluid from wound to reduce swelling and
remove bacteria, also pulls wound edges together.
PT Implications:
• Dressing is changed every 24-72 hours.
• During therapy, portable pump will accompany
patient, meaning shorter lengths of stay in hospital.
• No mobility restrictions

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 18

 Yankauer Suction
Function:
• Handheld suction device to manage secretions
PT Implications:
• If excessive secretions, use suction prior to functional mobility

Zoll Pads (Stat pads)

Function:
• Pad attached to patient if risk for coding during surgical intervention to allow for quicker
defibrillation.
PT Implications:
• Check with nursing in ICU if pads can be removed once in upright sitting posture
• No mobility restrictions

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 19

 Procedures and Surgical Interventions
Term Page #

Acid Fast Bacillus (AFB) Test 21

Aortic Aneurysm Repair 21
Aortic Valve Replacement (AVR) 22
Arterial Blood Gasses (ABG) 22
Bronchoscopy 22
Cardiac Catheterization 23
Cardioversion 23
Coronary Artery Bypass Graft (CABG) 23
Continuous Veno-Venous Hemofiltration (CVVH) 23
Dialysis 23
Echocardiogram 24
Enema 24
Kidney, Ureters, Bladder x-ray (KUB) 24
Lumbar Puncture 24
Mitral Valve Replacement (MVR) 25
Paracentesis 25
Percutaneous Coronary Intervention 25
Thoracentesis 25
Tracheostomy 25
Transcatheter Aortic Valve Replacement (TAVR) 26

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 20

Acid Fast Bacillus
(ABF) Test
Purpose:
• To test a patient
for TB
• Results come
within a few
hours.
• Performed in
conjunction
with NAAT test, which is more sensitive

Aortic Aneurysm Repair

• Open Heart Approach
o Sternal incision made, 7-10",
o The repair involves replacing the
damaged portion of aorta with a
graft made of a durable artificial
material such as Dacron, which is
sutured, or sewn, into place.
o During complex operations
involving replacement of a portion
of the aorta, patients may be put
into hypothermic circulatory arrest
o A heart-lung bypass machine takes over heart function and maintain circulation
• Endovascular Approach
o Incision into blood vessels in femoral artery,
catheters guided up to the point where aneurysm
is located. Using X-ray guidance and long, thin
instruments threaded through the catheters to place
a stent graft inside the affected portion of the vessel
o Endovascular surgery can sometimes be done with
the patient under local rather than general anesthesia;
in addition, it usually does not require hypothermic
circulatory arrest or use of a heart-lung bypass machine
• Valve Sparing Surgery
o This procedure involves replacement just of the damaged portion of the vessel,
not of the aortic valve as well
o The alternative is known as a composite graft, and it involves not only replacing
the affected portion of the aorta but also replacing the aortic valve with a
mechanical valve.
o Only if patient's aortic valve is intact, would this surgery be indicated.
• Prognosis
o Overwhelmingly positive. Most patients able to return home, some require
inpatient rehabilitation upon discharge.
o Hospital Stay: 7-10 days generally

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 21

Aortic Valve Replacement (AVR)
• Replacement valve wedged inside of existing valve
• Incision made in chest to reach aortic valve
• The heart is stopped, during which time the
blood pressure and oxygen levels are maintained
with a heart-lung machine (cardiopulmonary bypass).
The aorta is opened and the diseased valve removed.
It is then replaced with an artificial valve (prosthesis).
• Types of Replacement:
o Metal: durable, do not wear out, but blood
tends to clot, so need to take anticoagulants
o Biological Tissue: Generally from animals:
less durable, will wear out eventually, but
less risk of clotting.
• Sternal precautions afterward
• Hospital stay: generally under 1 week

Arterial Blood Gasses (ABG)

• Measures the acidity (pH) and levels of oxygen and carbon dioxide in the blood. This
serves to test how well lungs can move oxygen into blood and remove carbon dioxide
from blood
• Measures of ABG:
o Partial Pressure of Oxygen (PaO2) Pressure of oxygen dissolves into blood, and
how well oxygen moves from lungs into blood
o Partial Pressure of Carbon Dioxide (PaCO2) Pressure of carbon dioxide dissolved
in blood and how well carbon dioxide is being removed from the body
o pH: Measures hydrogen ions in blood.
o Bicarbonate (HCO3) chemical buffer that keeps pH neutral
o SpO2: Measures how much of the hemoglobin in RBCs are carrying oxygen
• Taken from a blood sample in an artery (radial, brachial, of femoral)

Bronchoscopy
• Test to view airways and diagnose lung disease. It can also be used during treatment of
some lung conditions.
• Numbing agent applied to mouth and throat if entering through mouth, numbing jelly
placed in nostril if tube enters through nose. Bronchoscope is passed through mouth or
nose through trachea into lungs. If entering through nose looks at upper airways.
• Saline solution sent through tube to wash lungs, allows provider to collect samples.
• Imaging performed with bronchoscope, ultrasound can be utilized as well
• Patients not allowed to eat/drink until cough reflex returns.

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 22

Cardiac Catheterization
• Catheter inserted into heart through veins/arteries to assess cardiac anatomy and function
• Right Heart Catheterization
o Involves a catheter insertion into the venous system (usually femoral or basilic
vein) passed into the right atria, right ventricle and pulmonary artery
o Used to
▪ Determine RA, RV, PA pressures
▪ Sample blood from RV to evaluate shunts
▪ Measure cardiac output
▪ Assess LV function in patients with atrial/ventricular septal defect
• Left Heart Catheterization
o Involves insertion of catheter into arteries (usually femoral or brachial)
o Catheter passed up through aorta to coronary arteries or left ventricle
o Used to
▪ Evaluate mitral and aortic valve disease
▪ Assess regional and global LV function
▪ Measure LV and aortic pressures
Cardioversion
• Medical procedure done to restore a normal heart rhythm for those with arrhythmia
• DC current used to correct rhythm, can also be done medically.

Coronary Artery Bypass Graft (CABG)

• Indications: Coronary Artery Disease
(CAD) plaque buildup inside arteries,
blocking blood flow.
• Vessels Used: Mammary artery, saphenous
vein.
• Incision made through chest, through
sternum to access heart
• A heart-lung bypass machine takes over
heart's function and maintains circulation
• Surgeon will sew one end of a vein over a small opening made in the aorta, and the other
end over a small opening made in the coronary artery, just below the blockage. This re-
routes the blood flow around the blockage.

Continuous Veno-Venous Hemofiltration (CVVH)

• Short term treatment used in ICU patients with acute or chronic renal failure. For patients
who cannot tolerate hemodialysis.
Dialysis
• For patients in end stage renal disease (ESRD) losing about 85-90% of kidney function
• Dialysis keeps body in balance by removing waste, salt, and extra water to prevent
buildup in body.
• Typically lasts about 4 hours, done 3 times per week
• PT Implications: patients can experience increased fatigue or decreased blood pressure
after dialysis. Attempt to see patients before dialysis if possible.

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 23

Echocardiogram
• Uses of Echocardiogram: To determine overall heart function, integrity of valves, check
for any stenosis
• Types of Echocardiograms:
o Transthoracic echocardiogram (TTE). Standard, noninvasive echocardiogram.
Gel applied to chest and transducer used to record the sound wave echoes from
heart. A computer converts the echoes into moving images on a monitor.
Transesophageal echocardiogram (TEE) If it's difficult to get a clear picture of
the heart with a standard echocardiogram or if there is reason to see the heart and
valves in more detail, this procedure is indicated. Flexible tube containing a
transducer is guided down throat and into the esophagus. From there, the
transducer can be positioned to obtain more-detailed images of the heart.
o Doppler echocardiogram. Doppler techniques are used in most transthoracic
and transesophageal echocardiograms, and they can be used to check blood flow
problems and blood pressures in the arteries of the heart that traditional ultrasound
might not detect.
o Stress echocardiogram. Ultrasound images of heart are taken before and
immediately after walking on a treadmill or riding a stationary bike
Enema "Fleet Enema"
• Procedure used to promote evacuation of bowels. Generally administered prior to
colonoscopy, or to treat constipation. Generally, bowel movements occur within 1 hour
of administration of fluids.
• Fluid is a combination of water and another substance designed to loosen stool. Sodium
phosphate is the substance of the strongest enema.

KUB: Kidneys, Ureters and Bladder x-ray

• Used to assess abdominal area for causes of abdominal pain, or to assess structures of
urinary and/or GI system.
• May be the first diagnostic procedure to assess urinary system
• Can be used to evaluate urinary tract before other diagnostic procedures are performed.
Lumbar Puncture
• Procedure in which a sample of cerebrospinal fluid is taken for
examination. Needle is inserted into lumbar spine in order to
obtain sample.
• Performed in order to rule out diseases and conditions such as
meningitis (most common) or Guillain-Barre and multiple
sclerosis
• Patient positioned with in flexion to increase the space between
vertebrae. Needle inserted into lumbar spine to collect CSF
fluid. Needle then removed, and bandage placed over puncture
site

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 24

Mitral Valve Repair/Replacement (MVR)
• Indications: calcified or loose mitral valve
• Procedure: Patient hooked up to heart and lung support during surgery. Sternal incision
made to gain access to heart. Incision made to left side of heart to access mitral valve.
• Options
o Repair:
▪ Ring Annuloplasty: surgeon will tighten the valve by sewing a ring of
cloth, metal or tissue around the valve
▪ Valve Repair: the valve is trimmed, or rebuilt to restore function.
o Replacement
▪ Mechanical valve: made of titanium or carbon. More durable, last longer,
but will need to take anticoagulants for the rest of your life.
▪ Biological: made of human or animal tissue. Valves last 10-15 years, but
less likely to require anticoagulant therapy for life.
• Precautions
o Sternal precautions
Paracentesis
• Procedure to remove fluid within the abdomen (ascites)
• Local anesthetic applied to stomach, test performed in x-ray department.
• Needle inserted to reach area of fluid.
• Procedure takes approximately 20-30 minutes, vitals are monitored closely for approx. 1
hour after procedure is completed.

Percutaneous Coronary Intervention (PCI)/Coronary Angioplasty

• Non-surgical procedure to improve blood flow to heart
• Requires cardiac catheterization, through wrist or groin
• Contrast dye injected once catheter is in heart to highlight where blocked arteries are
• Balloon catheter brought along guide wire to impacted artery, and inflated/deflated
several times to gradually widen vessel.
• Second balloon artery with a stent is then brought in, balloon inflated, and stent placed.
Sometimes drug eluting stents are used as well.

Thoracentesis:
• Removal of fluid/air from pleural space.
• Needle inserted into pleural space between lungs and chest to remove excess fluid to ease
breathing

Tracheostomy:
• Surgical hole into trachea. Trach tube placed
• through hole directly into trachea to help patient breathe.
• May be used for patients who are anticipated to
be on a ventilator for more than a couple weeks

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 25

Transcatheter Aortic Valve Replacement (TAVR)
• Replacement valve wedged inside of existing valve
• 2 most common insertion sites are transfemoral
and transapical (ribs)
• Balloon catheter with replacement valve inserted
through site, and guided to aorta
• Balloon catheter inflates to expand replacement
valve into place.
• Hospital stay of roughly 3-5 days.
• No sternal precautions
• Usually go home without home PT services

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 26

 Medical Conditions
Term Page #

Acute Coronary Syndrome 28

Acute Respiratory Distress Syndrome (ARDS) 28
Aneurysm 28
Cardiac Tamponade 29
Cardiogenic Shock 29
Cardiomyopathy 29
Chronic Obstructive Pulmonary Disease (COPD) 30
Congestive Heart Failure (CHF) 30
Coronary Artery Disease (CAD) 30
Cystic Fibrosis 31
Emphysema 31
Graves Disease 31
Hemothorax 31
Hypercapnia 32
Ileus 32
Myocardial Infarction 32
Pleural Effusion 32
Pneumonia 33
Pneumothorax 33
Pulmonary Embolism 33
Pulmonary Hypertension 34
Rhabdomyolysis 35
Scleroderma 35
Subdural Hematoma 36
Tombstoning ST Elevation 36
Venous Thrombosis 37

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 27

Acute Coronary Syndrome
• When myocardial oxygen demand is higher that oxygen supply
• Can lead to ischemia and infarction.
• Causes: coronary artery disease (CAD) impaired coronary artery supply,
• Symptoms: Stable angina (angina occurring with exertion and relieved with rest or
nitroglycerin) unstable angina (angina occurring at rest, does not respond well to
nitroglycerin)
• Treatment: Nitroglycerin, surgical intervention for revascularization.

Acute Respiratory Distress Syndrome (ARDS)

• Acute inflammation of lungs associated with aspiration, drug toxicity, pulmonary trauma.
• Fluid buildup in alveoli in lungs. Fluid prevents lungs from filling fully, meaning less
oxygen to body.
• Causes: Sepsis, severe pneumonia, head/chest injuries.
• Symptoms: severe SOB, labored breathing, low blood pressure, confusion, extreme
fatigue
• Diagnosis: chest x-ray, CT scan
• Treatment: supplemental oxygen/mechanical ventilation,

Aneurysm
• Localized bulging of vessel wall that results from vessel wall degeneration weakening of
vessel wall. Defined as 50% increase in normal diameter of vessel, involving weakening
of all 3 layers of arterial wall.
• Most commonly occur in abdominal aorta and iliac artery.
• Causes: Exact mechanism unknown. Genetic, aging, atherosclerotic damage to elastin
and collagen.
• Diagnosis: Abdominal ultrasound, CT scan, MRI
• Treatment: Surgical intervention

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 28

Cardiac Tamponade
• Sudden accumulation of fluid in pericardial sac.
• Causes: heart surgery, heart attack, kidney failure, heart failure, injury to heart,
• Symptoms: anxiety, sharp chest pain, chest pain that worsens with deep inhalation,
breathing problems, lightheadedness, swelling of legs or abdomen, palpitations. rapid
breathing.
• Diagnosis: chest CT scan, chest x-ray, right heart catheterization, ECG
• Treatment: incision through pericardium (pericardiectomy) supplemental oxygen,
Cardiogenic Shock
• Heart has been damaged to the extent that it is unable to supply enough blood to the body
and its organs.
• Causes - heart attack, arrhythmias such as V-tach, V-Fib, Supraventricular Tachycardia,
fluid buildup around heart, tear/rupture of valves, bradycardia, heart block
• Symptoms: Chest pain, coma, decreased urination, fast breathing, tachycardia, sweating,
lightheadedness, confusion, loss of ability to concentrate, shortness of breath, weak pulse,
cool skin.
• Diagnosis: Cardiac catheterization, chest x-ray, coronary angiography, echocardiogram,
electrocardiogram
• Treatment - medications to increase blood pressure and improve heart function,
cardioversion, pacemaker, IABP, Impella device.

Cardiomyopathy
• Abnormal myocardial structure and function
o Dilated Cardiomyopathy:
▪ Most common, characterized by cardiac enlargement, impaired systolic
function of one/both ventricles, and symptoms of congestive heart failure.
▪ Symptoms: Nocturnal dry cough, dyspnea initially on exertion, then at
rest, signs and symptoms of LV failure, chest pain on exertion, S3-4
sounds, atrial enlargement, possible LA and RA enlargement
o Hypertrophic Cardiomyopathy
▪ Characterized by a considerable, unexplained increase in cardiac mass,
either symmetrical or asymmetrical.
▪ Symptoms: Dyspnea, angina pectoris, fatigue and weakness, presyncope,
syncope, palpitations, S4 heart sound
o Restrictive Cardiomyopathy
▪ Characterized by diastolic dysfunction and associated reduction in
ventricular filling, caused by excessively rigid ventricular walls.
▪ Symptoms: Impaired exercise tolerance, dyspnea, S3, S4 heart sounds,
symptoms of CHF, arrhythmia.
o Stress Cardiomyopathy aka Takotsubo Cardiomyopathy
▪ Intense emotional or physical stress can cause rapid and severe heart
muscle weakness
▪ Symptoms: Chest pain, shortness of breath, sweating, dizziness, nausea,
vomiting, weakness, palpitations

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 29

Chronic Obstructive Pulmonary Disease (COPD)
• Includes chronic bronchitis, emphysema
• Causes: Smoking, alpha-1 deficiency.
• Symptoms: chronic cough, SOB with daily activities, frequent respiratory infections,
cyanosis, increased fatigue levels.
• Diagnosis: Spirometry: chest x-ray.
• Treatment: Medication, pulmonary rehabilitation, lung surgery. supplemental oxygen.

Congestive Heart Failure (CHF)

• Heart not able to pump enough blood to meet demands from the body.
• Kidneys receive less blood and filter less out of circulation into urine
• The extra fluid collects in the lungs, liver, around eyes, legs.
• Types
o Left sided heart failure: failure of left ventricle, resulting in backflow into lungs
o Right sided heart failure: failure of right side of heart, leading to back flow into
systemic venous system.
o High Output Failure: heart failure secondary to renal failure. More fluid placing
higher load on heart
o Low Output Failure: heart not able to pump minimal amount of blood to support
circulation
o Systolic Dysfunction: problem with strength of myocardial contraction
o Diastolic Dysfunction: problem with ventricular filling.
• Causes: Most patients have (or had) another heart condition first. Most commonly CAD,
HTN, and PMH of MI
• Diagnosis: Symptom reporting, chest x-ray, blood test, ECG, stress test, cardiac
catheterization, MRI.
• Symptoms: Shortness of breath, chronic coughing/wheezing, buildup of fluid (edema)
fatigue, increased heart rate, confusion, weight gain, jugular venous distention, sinus
tachycardia, cold, pale possible cyanotic extremities, decreased exercise tolerance.
• Treatment: Diuretics (Lasix) lifestyle changes,

Coronary Artery Disease (CAD)

• Disease of heart when coronary arteries become hardened and narrowed due to buildup of
cholesterol called atherosclerosis.
• Decreased blood flow to heart due to narrowing
• Causes: Smoking
• Symptoms: chest pain, jaw pain, shoulder pain, shortness of breath, heart attack, nausea.
• Diagnosis: Cardiac catheterization, stress test, electrocardiogram, echocardiogram.
• Treatment: Stenting, CABG

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 30

Cystic Fibrosis:
• Thick buildup of mucus in lungs, pancreas and other organs. In lungs, mucous clogs
airways, traps and can lead to infections, respiratory failure. In pancreas, mucous
prevents release of digestive enzymes that allow body to break down food and absorb
nutrients.
• Causes: Genetic mutation of CF gene.
• Symptoms: persistent coughing, phlegm, frequent lung infections, wheezing, SOB, poor
growth or weight gain despite good appetite (inability to absorb nutrients due to blocked
pancreas)
• Diagnosis: genetic testing
Treatment: Vibrating vest to loosen secretions, airway clearance, bronchodilators
(nebulizer) antibiotics, pancreatic enzyme supplement to improve absorption of vital
nutrients.
Emphysema
• A type of COPD damaging the alveoli in the lungs. Air becomes trapped upon expiration,
leaving no room for new oxygen-rich air to enter. Most people with emphysema also
have chronic bronchitis. Combination of these two conditions make up COPD.
• Causes - smoking.
• Symptoms - chronic cough, shortness of breath, trouble breathing with exertion.
• Diagnosis - spirometry, chest x-ray, CT scan,
• Treatment - medications, lung transplant, surgical intervention

Graves’ Disease:
• Autoimmune disorder that leads to overall hyperactivity of entire thyroid gland. Most
common cause of hyperthyroidism in the USA.
• Symptoms: racing heartbeat, hand tremors, trouble sleeping, weight loss, muscle
weakness, neuropsychiatric symptoms and heat intolerance.
• Only form of hyperthyroidism associated with inflammation of the eyes, swelling of the
tissues around the eyes and bulging of the eyes. Begin around 6 months before/after
diagnosis.
• Smoking cigarettes can make eye symptoms worse.
• Early signs of trouble might be red or inflamed eyes, a bulging of the eyes due to
inflammation of the tissues behind the eyeball or double vision. Diminished vision or
double vision are rare problems that usually occur later, if at all

Hemothorax
• Collection of blood in pleural cavity
• Symptoms Chest pain, low blood pressure,
rapid heart rate, rapid, shallow breathing, shortness of breath
• Causes Blood clotting defect, thoracic/heart surgery,
tear in blood vessel with central venous line placement.
• Diagnosis Chest x-ray, CT scan, thoracentesis.
• Treatment Chest tube placement with suction to
allow lung to re-expand

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 31

Hypercapnia
• Increased levels of carbon dioxide in bloodstream, generally caused by hypoventilation.
• Causes: COPD, obesity, smokers.
• Symptoms
o Mild Symptoms: Flushed skin, drowsiness, mild headaches, feeling disoriented or
dizzy, shortness of breath, being abnormally tired or exhausted
o Severe Symptoms: Unexplained confusion, abnormal feelings or paranoia or
depression, abnormal muscle twitching, irregular heartbeat, hyperventilation,
seizures, panic attacks, syncope.
• Diagnosis: Arterial blood gasses, chest x-ray, spirometry.
• Treatment: ventilation, medications, pulmonary rehabilitation, surgical interventions

Ileus
• Partial or complete blockage of bowel, blocking contents of intestines from passing
through
• Causes - bowel does not work properly, but no structural problem is causing dysfunction.
Paralytic ileus caused by virus//bacteria, abdominal surgery, decreased blood supply to
intestines, appendicitis, kidney/lung disease, use of narcotics
• Symptoms - abdominal swelling, pain and cramping, breath odor, constipation, diarrhea,
vomiting
• Diagnosis - Abdominal CT, Abdominal x-ray, barium enema
• Treatment - placing tube through nose into stomach/intestine to relieve abdominal
swelling.

Myocardial Infarction – Heart Attack

• Occurs when oxygen supply to a section of the heart is blocked off, causing that section
of heart muscle to die.
• Types
o STEMI - result of complete blockage of coronary artery. Carries greater risk of
death and disability.
o NSTEMI - partial blockage of coronary artery. less severe heart attack compared
to STEMI
• Causes: Coronary artery narrowing/blockage, smoking, increased stress.
• Symptoms: Chest pain, nausea, shortness of breath, pain in back/shoulders/jaw/neck.
• Diagnosis: Electrocardiogram, blood tests, coronary angiography, cardiac
catheterization,
• Treatment: Aspirin, nitroglycerin, oxygen therapy, percutaneous coronary intervention
(to open blocked or narrowed coronary arteries) CABG, diet/lifestyle alterations/cardiac
rehabilitation afterward.
Pleural Effusion
• Presence of fluid in pleural space
• Causes: congestive heart failure, PE, pericardial disease
• Symptoms: SOB, increased work of breathing with activity
• Diagnosis: Chest x-ray
• Treatment: Chest tubes to drain fluid

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 32

Pneumonia
• Infection in one or both lungs, caused by bacteria, virus, fungi.
• Causes: Virus, bacteria, fungi, inhaling liquid/chemical
• Symptoms: fever, chills, cough, SOB with daily activities, chest pain with
breathing/coughing, feel suddenly worse after a cold or the flu. Infection can be located
in single or multiple lobes either unilateral or bilateral.
• Diagnosis: Chest x-ray, blood tests, pleural fluid culture
• Treatment:
o If Bacterial: treated with antibiotics
o If Viral; Antiviral
o Supplemental oxygen,
• Types of Pneumonia
o Commonly acquired (CAP) hospital acquired (HAP) Ventilator associated (VAP)
atypical, aspiration

Pneumothorax
• Buildup of air in pleural space, which could potentially
collapse lung. Usually unilateral.
• Types:
o Closed: Without air movement into pleural space
during inspiration/expiration (chest wall intact)
o Open: With air moving in and out of pleural space
during inspiration/expiration (pleural space in contact
with atmosphere)
o Tension: With air moving into pleural space during only
inspiration. Can cause result in collapsed lung, mediastinal
shift and cardiac tamponade.
• Symptoms: pain in one side, shortness of breath
• Causes: trauma, or damage from underlying lung disease
• Diagnosis: Chest x-ray
• Treatment: chest tube placement to drain air, allowing lungs to re-expand

Pulmonary Embolism
• Causes: Blood clot that blocks pulmonary artery, commonly originating from lower
extremities.
• Symptoms: shortness of breath, chest pain that worsens with deep breathing, coughing,
bending, cough. Less common symptoms include swelling, leg pain, fever, excessive
sweating, rapid/irregular heartbeat, lightheadedness/dizziness.
• Diagnosis: Ultrasound, CT scan, pulmonary angiography, blood tests, chest x-ray
• Treatment: Medications (anticoagulants) thrombolytic, compression stockings.

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 33

Pulmonary Hypertension:
• Hypertension affecting arteries on the R side of heart.
• Symptoms: Shortness of breath (dyspnea), initially while exercising and eventually
while at rest, fatigue, dizziness or fainting spells (syncope), chest pressure or pain
Swelling (edema) in ankles, legs and eventually in abdomen (ascites), cyanosis, racing
pulse or heart palpitations
o Groups of Pulmonary Hypertension:
▪ Group 1: Pulmonary arterial hypertension
• Cause unknown: referred to as idiopathic pulmonary arterial
hypertension
• A specific gene mutation that can cause pulmonary hypertension to
develop in families, also called heritable pulmonary arterial
hypertension
• Certain drugs — such as certain prescription diet drugs or illegal
drugs such as methamphetamines — or certain toxins
• Heart abnormalities present at birth (congenital heart disease)
• Other conditions, such as connective tissue disorders (scleroderma,
lupus, others), HIV infection or chronic liver disease (cirrhosis)
▪ Group 2: Pulmonary hypertension caused by left-sided heart disease
• Left-sided valvular heart disease, such as mitral valve or aortic
valve disease
• Failure of the lower left heart chamber (left ventricle)
▪ Group 3: Pulmonary hypertension caused by lung disease
• Chronic obstructive pulmonary disease, such as emphysema
• Lung disease such as pulmonary fibrosis, a condition that causes
scarring in the tissue between the lungs' air sacs (interstitium)
• Sleep apnea and other sleep disorders
• Long-term exposure to high altitudes in people who may be at
higher risk of pulmonary hypertension
▪ Group 4: Pulmonary hypertension caused by chronic blood clots
• Chronic blood clots in the lungs (pulmonary emboli)
▪ Group 5: Pulmonary hypertension associated with other conditions
that have unclear reasons why the pulmonary hypertension occurs
• Blood disorders
• Disorders that affect several organs in the body, such as
sarcoidosis
• Metabolic disorders, such as glycogen storage disease
• Tumors pressing against pulmonary arteries
• Risk Factors:
o Family history, obesity and obstructive sleep apnea, gender (2.5x more common
in women) pregnancy, higher altitude
• Diagnosis of Pulmonary Hypertension:
o Blood Tests, chest x-ray, ECG, echocardiogram, pulmonary function tests, six
minute walk test, V/Q scan, right heart catheterization, vasodilator study

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 34

Rhabdomyolysis
• Results from death of muscle fibers that release their contents into blood stream
• Can lead to kidney failure
• Occurs due to direct or indirect muscular injury
• Causes
o Traumatic: crush injury, long lasting muscular compression, electrical shock
o Non-Traumatic: extreme muscle strain, medications such as antipsychotics or
statins, heat stroke, viral infections, sepsis
• Signs and Symptoms
o Classic triad includes: muscle pain in shoulders, thighs or lower back, muscle
weakness or trouble moving arms and legs, and dark red urine (due to release of
myoglobin)
o Approximately 50% of people with this condition have no muscular related
symptoms.
o Other symptoms include abdominal pain, nausea, vomiting, fever, rapid heart rate,
confusion, dehydration, lack of consciousness.
• Treatment:
o IV fluids to help maintain urine production and prevent kidney failure
o Sometimes, dialysis may be needed to help kidneys filter while they are
recovering
o Management of electrolytes
o Fasciotomy to relieve tension or pressure and loss of circulation

Scleroderma
• “Hard skin" group of diseases that cause abnormal growth of connective tissue. Tissues
get hard or thick, causing swelling or pain in joints and muscles.
• Causes - No known cause, immune system may play a role. Most common in women.
Overproduction and accumulation of collagen in body tissues.
• Symptoms - Calcium deposits in connective tissue, Raynaud's phenomenon, swelling of
esophagus, tight, thick skin on fingers. Hardening/tight patches of skin, skin can appear
shiny. Problems absorbing nutrients if intestinal muscles aren't moving food properly.
Heart, lung, kidney function can be impacted as well.
• Diagnosis - blood testing, biopsy.
• Treatment - There is no cure. Medications can help control symptoms and prevent
complications. Physical therapy services to maintain mobility and independence with
ADLs. Surgical interventions such as amputation and lung transplants are last resort
interventions.

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 35

Subdural Hematoma
• Collection of blood between dura and surface of the brain. This blood compresses brain
tissue, and can lead to brain injury and sometimes death. Tiny veins between the surface
of brain and dura, allowing blood to collect. This injury can also happen spontaneously.
• Causes Head injury either mild or severe. Risk factors include: blood thinners, long term
alcohol use, repeated head injury,
• Symptoms: confused/slurred speech, problems with balance, headache, seizures, loss of
consciousness, nausea/vomiting, weakness and numbness, vision problems.
• Diagnosis: CT scan, MRI
• Treatment Surgical intervention to relieve pressure within the brain. Diuretics,
corticosteroids, anti-seizure drugs.

Tombstoning ST Elevation
• An STEMI characterized by tombstoning elevation of ST segment.
• This type of MI is associated with reduced LV function, extensive myocardial damage,
and poor prognosis
• Mortality is 26-38%
• Higher BNP values
• Criteria:
o Absent R wave or an R wave duration <0.04 s with minimal amplitude,
o convex upward ST segment merging with the descending R or the ascending
QS/QR
o The peak of the ST segment is higher than the R wave and
o The ST segment merges with the T wave.
Comparison: TOMB-STEMI compared to non-TOMB-STEMI
Coronary risk Similar
factors
Symptom Similar angina pectoris but less frequent pre-infarction angina
Laboratory Higher CK, higher BNP which means larger infarction area.
Echocardiography Lower left ventricle EF which means a heavier left ventricle dysfunction
Angiography Similar epicardial coronary anatomy or more extensive. Higher TIMI
frame count and lower TIMI myocardial perfusion grade which means
more severe ischemia
Complication More complications and poor prognosis
Reperfusion Less efficient reperfusion therapy

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 36

Venous Thrombosis
• Can occur in superficial or deep veins (DVT)
• Causes: venous stasis (from immobility)
• Signs and Symptoms: pain and swelling distal to thrombus, redness/warmth around
thrombus, fever, dull ache/tightness in area of thrombus.
• Diagnosis: Ultrasound
• Treatment: Anticoagulation, bedrest initially to prevent clot from dislodging and
becoming pulmonary embolism, ambulation once properly anticoagulated.
o Compression stockings, activity (preventative measures)

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 37

 Medications
Term Page #
Amiodarone 39
Amlodipine 39
Ativan 39
Bactrim 39
Carvedilol 39
Coumadin 39
Dextrose 39
Diltiazem 39
Duoneb 39
Eliquis 39
Fentanyl 39
Haldol 39
Heparin 39
Inotropes
• Dobutamine 39
• Epinephrine 39
• Dopamine 39
• Milrinone 40
Lactulose 40
Lasix 40
Lisinopril 40
Lopressor 40
Lovenox 40
Methadone 40
Metoprolol 40
Midazolam 40
Neo-Drip 40
Nitric Oxide 40
Nitroglycerin 40
Nitroprusside 40
Oxycodone 40
Plavix 40
Prednisone 40
Sotalol 40
Toradol 41
Vancomycin 41
Vasopressors
• Levophed (Norepinephrine) 41
• Vasopressin 41
Zofran 41

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 38

Amiodarone
• Used to keep heart beating in normal sinus rhythm. Treats ventricular
tachycardia/fibrillation
Amlodipine
• Calcium channel blocker that dilates blood vessels. Used to treat chest pain and other
conditions caused by coronary artery disease. Also used to treat high blood pressure.
Ativan:
• Used to treat anxiety.
Bactrim
• Used to treat infections.
Carvedilol
• Beta blocker used to treat heart failure and hypertension.
Coumadin (Warfarin)
• Anticoagulant to reduce formation of blood clots. Used to reduce risk of stroke or heart
attack
Dextrose
• Sterile solution injected via IV, to provide fluids with sugar in patients who cannot drink
enough liquids.
Diltiazem
• Indications: to treat high blood pressure, control angina
• Method of Action: relaxing blood vessels, to reduce work of heart. Also increases supply
of blood/oxygen to heart
Duoneb
• Used for treatment of bronchospasm associated with COPD
Eliquis
• Used to lower risk of stroke for patients with atrial fibrillation. Blocks activity of certain
clotting substances in the blood.
Fentanyl
• Opioid medication for treatment of pain. Used as part of anesthesia or to treat pain after
surgery.
Haldol
• Antipsychotic. Used to treat schizophrenia and Tourette's
Heparin
• Fast acting anticoagulant. Prevents clots in arterial and heart surgeries, treatment of
venous thrombosis.
Inotropes: increase contractility of heart and heart rate/cardiac output.
• Dobutamine:
o Indications: treatment of decompensation due to depressed heart contractility after
surgery
• Epinephrine:
o Purpose: Increases coronary blood pressure, thus increased coronary artery blood
flow.
• Dopamine:
o Used to treat hypotension, low cardiac output and reduced perfusion.

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 39

 • Milrinone (Primacor IV):
o Indications: patients with acute decompensated heart failure, increases myocardial
contractility.
Lactulose:
• Lowers ammonia levels by drawing it out of blood into colon where it is removed from
the body.
Lasix
• Diuretic, which prevents body from absorbing too much salt. Used to treat fluid retention
in people with congestive heart failure, and to treat hypertension.
Lisinopril
• Used to treat high blood pressure
Lopressor
• Used to treat high blood pressure, and long term treatment of chest pain.
Lovenox
• Anticoagulant to help prevent formation of clots. Administered IV or via injection.
Methadone
• Opioid medication used for pain relief.
Metoprolol
• Beta blocker used to treat chest pain and hypertension.
Midazolam
• Used to lessen anxiety and relax muscles or make a patient drowsy before a procedure.
Neo-Drip
• Neo-Synephrine: used to maintain blood pressure in acute low blood pressure situations.
Is a vasopressor, works by constricting blood vessels to raise blood pressure.
Nitric Oxide:
• Selective pulmonary vasodilator
Nitroglycerin
• Vasodilator used for treating high blood pressure during surgery, controlling congestive
heart failure associated with heart attack, treating chest pain in certain patients
Nitroprusside
• Vasodilator used to treat congestive heart failure and high blood pressure. Used to keep
blood pressure low during surgery.
Oxycodone
• Opioid medication used to treat pain.
Plavix
• Prevents platelets from sticking together and forming a clot. Used to prevent blood clots
after a recent heart attack or stroke.
Prednisone
• Corticosteroid, anti-inflammatory. Also suppresses immune system.
Propofol
• Slows activity of brain and nervous system. Used to sedate a patient who is under critical
care and needs a mechanical ventilator.
Sotalol
• Used to maintain a normal heart beat in patients in atrial fibrillation or atrial flutter. Is an
antiarrhythmic medication

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 40

Toradol:
• NSAID used for pain relief. Short term only, use no longer than 5 days.
Vancomycin
• Antibiotic used to treat infections. If taken orally, this medication only works in
intestines. If injected, will treat infections in other places in the body.
Vasopressors: increase vasoconstriction, which increases BP
• Levophed (Norepinephrine):
o Purpose: for blood pressure control in acute hypotensive states
• Vasopressin:
o Purpose: helps prevent loss of water from body, as well as facilitating
vasoconstriction
Zofran
• Used to prevent nausea and vomiting that may be caused by surgery, or chemotherapy

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 41

 Pulmonary Therapies
Term Page #
Expiratory Positive Airway Pressure (EPAP) 43
Inspiratory Positive Airway Pressure (IPAP) 43
Modes of Mechanical Ventilation
• Airway Pressure Release Ventilation (APRV) 43
• Assist Control Ventilation (ACV) 43
• Controlled Mechanical Ventilation 43
• Pressure Controlled Ventilation 43
• Pressure Support Ventilation 43
• Synchronized Intermittent Mandatory Ventilation (SIMV) 43
Non-Invasive Positive Pressure Ventilation 44
• Bilateral Positive Airway Pressure (BiPAP) 44
• Continuous Positive Airway Pressure (CPAP) 44
Positive End Expiratory Pressure (PEEP) 44

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 42

Expiratory Positive Airway Pressure (EPAP)
• Pressure created during exhalation keeping airway open and free from obstruction

Inspiratory Positive Airway Pressure (IPAP)

• Controls the peak inspiratory pressure during inspiration.
• Machine senses when inspiratory effort is being made, and delivers a flow to the preset
pressure. Flow stops when pressure is reached.

Modes of Mechanical Ventilation

Airway Pressure Release Ventilation (APRV)

• Releases pressure temporarily on exhalation.
• Patients able to spontaneously ventilate at both low and higher pressures
• Generally requires increased sedation.
Assist-Control Ventilation (ACV)
• Each breath is either an assist or control breath, but all are of the same volume.
• In this mode, each inspiratory effort beyond the set sensitivity threshold triggers delivery
of the fixed tidal volume. If the patient does not trigger the ventilator frequently enough,
the ventilator initiates a breath, ensuring the desired minimum respiratory rate.
• Particularly indicated for patients who are tachypneic.
Controlled Mechanical Ventilation
• Ventilator does all the work of breathing at parameters preset
• No response to patient effort
• For patients who are not spontaneously breathing, no ability to breathe.
Pressure Controlled Ventilation (PCV)
• Does not allow for patient-initiated breaths, which improves gas exchange.
• No guarantees for volume however
• Preferred for patients with neuromuscular disease, but otherwise normal lungs
Pressure Support Ventilation (PSV)
• Allows patient to determine inflation volume and respiratory frequency, only used to
augment spontaneous breathing
• Can be delivered through specialized face masks
Synchronized Intermittent-Mandatory Ventilation (SIMV)
• Guarantees a certain number of breaths, but patient breaths are partially on their own.
• In contrast to V/C, patient efforts above the set respiratory rate are unassisted, although
the intake valve opens to allow the breath
• Breaths are synchronized to coincide with spontaneous respirations of patient.
• Has been shown to decrease cardiac output in patients with left ventricular dysfunction
• Tend to use AVC if patient has respiratory muscle weakness or left ventricular
dysfunction
• Tend to use SIMV for patients with are breathing rapidly on ACV

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 43

Noninvasive Positive Pressure Ventilation (NIPPV)
• Delivery of positive pressure ventilation via a tight-fitting mask covering nose, or nose
and mouth
• Primarily applied as a form of PSV, or to deliver end-expiratory pressure. Volume
control possible as well, just less frequent.
• Modes of NIPPV
o Bilevel Positive Airway Pressure (BiPAP)
▪ Helps push air into lungs.
▪ Patient wears a mask, or nasal plugs that are connected to ventilator.
Machine supplies pressurized air into airways.
▪ Positive pressure because the device helps open lungs with this air
pressure.
▪ Receive positive air pressure when you breathe in and out, but you receive
higher air pressure when you breathe out.
▪ Indications: COPD, obstructive sleep apnea, pneumonia, poor breathing
after operation.
▪ Contraindications: reduced consciousness, trouble swallowing, very poor
breathing, unstable hemodynamics.
▪ Usually a patient moving off a ventilator will trial BiPAP as a weaning
progression.
▪ End expiratory positive airway pressure (EPAP) and end inspiratory
positive airway pressure (IPAP) are both set in this mode.
o Continuous Positive Airway Pressure (CPAP)
▪ Positive pressure given throughout the cycle, for both inspiration and
expiration to decrease work of breathing. x
▪ Delivered through a mask
▪ Used in obstructive sleep apnea, or to treat acute exacerbations of COPD

Positive End Expiratory Pressure (PEEP)

• Can be applied to any ventilator setting
• Increases end-expired lung volume and reduces airspace closure at end of expiration.
• Does not allow alveolar pressure to equal atmospheric pressure, which prevents alveolar
collapse with expiration
• Low levels of PEEP dangerous especially with hypovolemia or cardiac dysfunction.
• Indicated for: low volume ventilation cycles, FiO2 requirements, obstructive lung
disease.
• Normal physiologic PEEP = 5 cm H2O

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 44

 Lab Values
Term Page #
Albumin 46
Ammonia 46
aPTT 46
BNP 46
BUN 46
CK-MB 46
Creatine 46
Glucose 47
HbA1C 47
Hematocrit 47
Hemoglobin 47
INR 48
Magnesium 48
Myoglobin 48
Platelets 48
Potassium 48
Prothrombin Time 49
Red Blood Cells (RBC) 49
Sodium 49
Troponin 49
White Blood Cells (WBC) 49

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 45

 Lab Value Normal Ranges S/S if Abnormal PT Implications
Albumin 3.5-5.5 g/cl Decreased in liver Affects wound
damage, burns, healing
Crohn’s disease.
Decreased levels may
see weeping
extremities
Ammonia 15-45 mcg/dL Confusion, lethargy, Liver failure patients.
coma
aPTT 30-40 seconds Increased clotting
60-85 seconds: time, fall prevention,
heparin therapy safety
Used to monitor
effectiveness of
heparin
BNP < 100 does not Helps support
support CHF diagnosis, but
100-250: borderline standalone, cannot
CHF diagnose
250-400 supports
CHF
Over 400: strongly
supports CHF
➢
BUN 10-20 See implications Rises with decreased
kidney function
May be a decrease in
mental status
associated with
abnormal BUN levels
Patients with renal
disease may have
anemia, hypertension,
decreased endurance
CK-MB < 3 is normal Increased: MI, Heart attack versus
May take 1-2 days to cardiac contusion, chest pain
indicate MI cardiac trauma, CHF
without MI, CAD
Creatine .5-1.2 mg/dl See implications If there is a rise in
creatine, represents a
decline in kidney
function
Increased levels may
indicate muscle
wasting

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 46

 Lab Value Normal Ranges S/S if Abnormal PT Implications
Glucose 70-110 mg/dl < 70: Hypoglycemia: Do NOT exercise
headache, weakness, patients with blood
irritability, lack of glucose of 70 or
muscular below.
coordination,
apprehension,
inability to respond to
verbal commands
HbA1c Good Control: 2.5- Hypo/hyperglycemia Educate about
5.9% possible. glucose monitoring
Fair Control: 6.-7.0% and glucose control
Poor Control: > 7.0%
Hematocrit 36-49% Decreased: anemia Exercise tolerance,
Percentage of whole cause by blood loss, fatigue rate
blood occupied by nutritional deficit,
RBC hyperthyroidism,
decreased exercise
tolerance, increased
fatigue, tachycardia
Increased: severe
dehydration, shock,
cor pulmonale
Hemoglobin 12-18 g/dl Decreased: Exercise tolerance,
Measures oxygen pregnancy, fatigue rate
carrying capacity of hyperthyroidism, If values have been
RBC burns, bleeding trending low due to
Increased: COPD, chronic illness, okay
CHF, dehydration to treat
If values spiked low,
defer
If values are low and
patient being worked
up for GIB, defer
If values are low and
patient has blood
transfusion
scheduled, defer

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 47

 Lab Value Normal Ranges S/S if Abnormal PT Implications
INR .9-1.1 Over 1.1: longer time May need physician
Therapeutic range for blood to clot approval, if levels are
2.0-3.0 if on Warfarin Over 5.0 can mean high
therapy spontaneous bleeding
2.5-3.5 for 3.5 or greater: need May not work with
mechanical heart physician approval patient if levels are
valves before proceeding too high
Used to monitor with PT
effectiveness of
warfarin/Coumadin
therapy
Magnesium 1.5-2.5 mEq/L Low magnesium Monitor ECG,
results in palpate HR before,
arrhythmias, during and after
weakness, muscle intervention. Monitor
spasms, numbness for weakness and
muscle spasm
Myoglobin 50-120 ug/ml Increased: acute MI,
skeletal muscle
inflammation,
ischemia, trauma,
surgery.
Platelets 150,000-400,000 Decreased: anemia, Stratify the risk
infection, cancer versus benefit in
chemo, bone marrow regards to fall.
involvement
Increased: Low platelet levels =
inflammation, more conservative
infection, cancer, RA, treatment approach
heart disease,
recovery from bone
marrow suppression

Potassium 3.5-5.0 Hypokalemia (< 3.2): Treat as indicated.

Possible arrhythmia,
tetany
Hyperkalemia (>
5.1): irritability,
dizziness, muscle
cramping, numbness,
instability.

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 48

 Lab Value Normal Ranges S/S if Abnormal PT Implications
PT (Prothrombin 12-15 seconds Increased in liver How long it takes
Time) damage, salicylate blood to clot
intoxication, intake of
anticoagulants
RBC 4.1-5.3 x10^6/mm^3 Decreased: anemia, Correlates with a
blood loss, dietary person’s endurance
insufficiency of iron, and orthostatic
chemotherapy, tolerance
Increased:
dehydration, severe
diarrhea, poisoning,
pulmonary fibrosis,
chronic heart disease
Sodium 135-145 Confusion, impaired Monitor cognition
cognition (advanced cognition
may be impaired if
sodium levels are
low), behavior and
affect
Troponin Troponin I < .6 ng/ml Slight elevations are Serial troponin levels
Troponin T < .1 indicative of unstable taken every 8 hours
ng.ml angina or MI x3. Make sure
troponin peaks and
falls before initiating
treatment
WBC 4500-11,000 Decreased: bone Follow facilities
marrow suppression, policy RE: decreased
AIDS, alcoholism, WBC’s; gown, glove,
diabetes mask due to risk of
Increased: infection, nosocomial infection.
inflammation, tissue
necrosis, leukemia,
tissue trauma,
dehydration

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 49

 Miscellaneous ICU Information
Term Page #
CAM-ICU 51
Precautions
• Pacemaker 52
• Spinal 52
• Sternal 52
Richmond Agitation and Sedation Scale (RASS) 52

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 50

 Confusion Assessment Method for the ICU (CAM-ICU)
• Function:
o To assess confusion for patients in the intensive care unit (ICU)
• Test Administration

• Interpreting Results
o If feature 1 AND 2 are
positive as well as
feature 3 OR 4 are
positive, patient is
CAM-ICU positive,
indicated delirium is
present
o If the above criteria is
not met, patient is not
CAM-ICU positive.

• PT Implications
o If delirium is present,
patient may not be
appropriate for physical therapy.

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 51

 Precautions
Sternal Precautions
• 4-6 weeks (until d/c’ed by MD)
• No pushing, pulling with UE
• No lifting greater than 8-10 pounds
• No driving
Pacemaker Precautions
• 4-6 weeks
• No overhead motions or extreme reaching behind body.
• No pushing, pulling, supporting body weight with upper extremities
• No lifting greater than 10 pounds.
Spinal Precautions
• Specific to injury and situation, will be specifically outlined within medical record
• Generally include: no lifting, bending or twisting. May or may not be required to wear
cervical collar or Vista brace.
• If patient required to wear a Vista brace, precautions should specify what position patient
needs to assume while donning brace (supine, 30* 60* 90* of sitting)

Richmond Agitation and Sedation Scale (RASS)

Function:
• To assess a patient’s level of consciousness within the hospital setting
Test Administration and Interpretation

PT Implications:
• If patient is unable to be aroused, or is combative, they will not be appropriate for
physical therapy interventions.
• Check with nursing prior to entering room to determine patient appropriateness for
treatment session

DARTMOUTH HITCHCOCK MEDICAL CENTER ICU TERM LIST 52