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Lecture I Life in The Icu
Lecture I Life in The Icu
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SOUND OF PNEUMATIC DRILLING: 50 DECIBELS
SOUNDS IN
THE ICU:
60-80
DECIBELS
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Types of patients that can
benefit from ICU admission
Facilit
Involve ate a
patient
proper
and
family day
Provide night
in plan suitable
of care rhyth
means of
communicatio
m
ns for the
patient
Communication:
Alternative Ways
o Mouthing words
o Writing
o Pointing to pictures
or letters
o Use of tablets/
laptops
Needs patience,
dedication, and
creativity
VI. UNDERSTANDING THE LIMITS
OF CRITICAL CARE
o Limitations as physicians
o Critical illness have high morbidity
and mortality
o Ethical and legal : determination of
brain death, patient autonomy,
consent of care, advance directives,
surrogate decision makers
o Alternative to ICU care reviewed
periodically
FOCUS: FAST HUG
Vincent JL. Give your
patient a fast hug (at
least) once a day.
Crit Care Med. 2005
Jun 33(6):1225-9.
Give your patient fast hug (at
least) once a day
F Feeding
A Analgesia
S Sedation
T Thromboembolic
prevention
H Head of bed
elevated
U Ulcer (stress)
prophylaxis
Pain Scoring System
FASTHUG MAIDENS
FOCUS: PROBLEM BASED
MEDICAL HISTORY
Basic Components
o Data base:
Name, History, PE, Labs
o Complete problem list
o Initial Plans
o Daily Progress Notes
o Final Progress Notes or Discharge
Summary
General Data
o Religion
o General survey
o Anthropometric
measurements
o Vital signs
HR, RR, Temp
BP
o Informant: %
reliability
In Pediatrics,
o Birth rank
add:
o Prenatal , Natal history, Post-
natal history
o Feeding history
o Developmental milestones
o Immunization history
Physical Examination
In the chest
oObservation
oPalpation
oPercussion
oAuscultation
In the chest
oObservation
oPalpation
oPercussion Chest: Barrel chested,
equal chest expansion,
oAuscultation hyperresonance on
percussion, (+)
wheezing
all over lung fields
Problem List
o May be a :
1) diagnosis
2) non-diagnosis
> symptom or a sign
> abnormal laboratory result
> presence of catheters and
date of
insertion
A.B. , 25 days old, male, Roman Catholic
Chief complaint: Difficulty in breathing
HPI:
PE: RR= 70/min HR= 170/min Temp=
37C
Chest: (+) intercostal retraction,
palpation and percussion not done, (+)
rales both lung fields
CBC: WBC= 35, 000 Segmenters: 80%
Proble Date Problem Problem
m no. Entered List Resolved
1 11/3
Tachypnea
2 11/5
Tachycardi
a
3 11/4
Retraction
s
Proble Date Problem Proble
m no. Enter List m
ed Resolve
d
1 11/5 Neonatal
pneumoni
a
After the Problem List
oThen give your
Assessment
oFinally, give your Initial
Plans
Progress Notes
o S : subjective complaints
o O : objective findings (e.g. physical
exam)
o A : assessment
o P : plan
> diagnostic
> therapeutic
> supportive
> plan for discharge
11/24/2015
S : Patient no longer complains of difficulty in
breathing, cough not as frequent and is now
productive, appetite is improving
O:
V/S: RR= 30/min HR= 90/min Temp= 36.5
Chest: No more retractions, bilateral equal vocal
fremitus, occasional wheezing, (-) rales
A: Acute asthma attack- improving
Pneumonia - resolving
P: Therapeutic-- cont meds, refer for pulmonary
toileting
Diagnostic for repeat chest xray
Basic Components
o Data base:
Name, History, PE, Labs
o Complete problem list
o Initial Plans
o Daily Progress Notes
o Final Progress Notes or Discharge
Summary
is not written,
did not happen!