NMS. Surgery

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Part I ♦ Foundations

THE INTENSIVE CARE UNIT Specialized Intensive Care Unit Care and Monitoring I. Management specific to the ICU: Provides critically ill patients with specific care and monitoring not typically available in other hospital units. Quick Cuts • If the gut works, use it. • Post-pyloric feedings do not decrease aspiration risk. • TPN has mechanical complications (central line placement), infectious complications, and metabolic complications (electrolyte and trace mineral imbalances). TRUSTED SOURCE Society of Critical Care Medicine Guidelines. Available at: sccm.org/Clinical- Resources/Guidelines/Guidelines A. Airway control (endotracheal intubation): Placement of an artificial airway to prevent airway obstruction or to provide mechanical ventilation. 1. Placement: Artificial airways can be placed orotracheally, nasotracheally, or directly into the trachea by an incision in the lower anterior neck ( tracheostomy ). 2. Cricothyroidotomy: Emergent airway access. 3. Assessment for intubation: The decision to intubate a patient by whichever route is a critical decision with serious consequences if performed too late. a. Respiratory rate (RR): Most simple to assess. (1) The normal RR is 12–16 breaths per minute (bpm). (2) If a patient’s RR is greater than 40 bpm, then intubate. (3) If a patient is breathing 30–40 bpm, initiate therapy to get RR less than 30 bpm, or the patient will tire and go into respiratory failure. (4) Low RRs are almost always caused by a neurologic disorder (e.g., alcohol, drugs, head injury). respiratory muscles, having difficulty speaking in full sentences, forcibly exhaling, or uncomfortably inhaling) typically need intubation. (2) If left to progress without intervention, these patients become overly tired with progressive hypoventilation and potential respiratory arrest. c. Hypoxia: Can be an indication for intubation but also manageable by noninvasive increased oxygen concentrations. Intubation b. Respiratory effort: Represents the work of breathing. (1) Patients exerting a significant effort (i.e., using accessory