Critical Care Unit | ICU

Critical care is for hospital patients with serious health problems who need intensive medical care and
monitoring from life support equipment and medication in order to ensure normal bodily functions.

Patients in intensive care units, also called ICUs, are cared for by a team of providers that may include:

Specially trained nurses

Physicians
Respiratory therapists
Care managers
Physical and occupational therapists
Other providers
What is critical care?
Critical care also is called intensive care.

Critical care treatment takes place in an intensive care unit (ICU) in a hospital. Patients may have a
serious illness or injury.

In the ICU, patients get round-the-clock care by a specially trained team.

Who needs critical care?

Critical care is appropriate for hospital patients of every age who are severely ill.

Patients may go to the ICU from the Emergency Department, or may move there from the general
hospital ward if they become critically ill.

Examples of patients who need critical care includes those who undergo very invasive surgery or who
have poor outcomes after surgery, those who are severely injured in an accident, people with serious
infections, or people who have trouble breathing on their own and require a ventilator to breathe for
them.

Here are some common conditions that require critical care:

Heart problems
Lung problems
Organ failure
Brain trauma
Blood infections (sepsis)
Drug-resistant infections
Serious injury (car crash, burns)

What happens after critical care?

Patients may be moved to the hospital ward or a rehabilitation facility, after making improvements
during a stay in ICU.
This does not mean that the need for medical care is gone; it means that the patient has improved
beyond critical and is in stable condition.

Patients who have suffered critical illness often need significant time and a lot of rehabilitation and
therapy to continue to get well.

ICU equipments

Intensive care unit equipment includes patient monitoring, life support and emergency resuscitation
devices, and diagnostic devices.

1. Patient monitoring equipment

Patient monitoring equipment includes the following:

Acute care physiologic monitoring system—comprehensive patient monitoring systems that can be
configured to continuously measure and display a number of parameters via electrodes and sensors that
are connected to the patient. These may include the electrical activity of the heart via an EKG,
respiration rate (breathing), blood pressure, body temperature, cardiac output, and amount of oxygen
and carbon dioxide in the blood. Each patient bed in an ICU has a physiologic monitor that measure
these body activities. All monitors are networked to a central nurses' station.

Pulse oximeter—monitors the arterial hemoglobin oxygen saturation (oxygen level) of the patient's
blood with a sensor clipped over the finger or toe.

Intracranial pressure monitor—measures the pressure of fluid in the brain in patients with head trauma
or other conditions affecting the brain (such as tumors, edema, or hemorrhage). These devices warn of
elevated pressure and record or display pressure trends. Intracranial pressure monitoring may be a
capability included in a physiologic monitor.

Apnea monitor—continuously monitors breathing via electrodes or sensors placed on the patient. An
apnea monitor detects cessation of breathing in infants and adults at risk of respiratory failure, displays
respiration parameters, and triggers an alarm if a certain amount of time passes without a patient's
breath being detected. Apnea monitoring may be a capability included in a physiologic monitor.

2. Life support and emergency resuscitative equipment

Intensive care equipment for life support and emergency resuscitation includes the following:

Ventilator (also called a respirator)—assists with or controls pulmonary ventilation in patients who
cannot breathe on their own. Ventilators consist of a flexible breathing circuit, gas supply,
heating/humidification mechanism, monitors, and alarms. They are microprocessor-controlled and
programmable, and regulate the volume, pressure, and flow of patient respiration. Ventilator monitors
and alarms may interface with a central monitoring system or information system.

Infusion pump—device that delivers fluids intravenously or epidurally through a catheter. Infusion
pumps employ automatic, programmable pumping mechanisms to deliver continuous anesthesia, drugs,
and blood infusions to the patient. The pump is hung on an intravenous pole placed next to the patient's
bed.

Crash cart—also called a resuscitation or code cart. This is a portable cart containing emergency
resuscitation equipment for patients who are "coding." That is, their vital signs are in a dangerous range.
The emergency equipment includes a defibrillator, airway intubation devices, a resuscitation bag/mask,
and medication box. Crash carts are strategically located in the ICU for immediate availability for when a
patient experiences cardiorespiratory failure.

Intraaortic balloon pump—a device that helps reduce the heart's workload and helps blood flow to the
coronary arteries for patients with unstable angina, myocardial infarction (heart attack), or patients
awaiting organ transplants. Intraaortic balloon pumps use a balloon placed in the patient's aorta. The
balloon is on the end of a catheter that is connected to the pump's console, which displays heart rate,
pressure, and electrocardiogram (ECG) readings. The patient's ECG is used to time the inflation and
deflation of the balloon.

3. Diagnostic equipment

The use of diagnostic equipment is also required in the ICU. Mobile x-ray units are used for bedside
radiography, particularly of the chest. Mobile x-ray units use a battery-operated generator that powers
an x-ray tube. Handheld, portable clinical laboratory devices, or point-of-care analyzers, are used for
blood analysis at the bedside. A small amount of whole blood is required, and blood chemistry
parameters can be provided much faster than if samples were sent to the central laboratory.

4. Other ICU equipment

Disposable ICU equipment includes urinary (Foley) catheters, catheters used for arterial and central
venous lines, Swan-Ganz catheters, chest and endotracheal tubes, gastrointestinal and nasogastric
feeding tubes, and monitoring electrodes. Some patients may be wearing a posey vest, also called a
Houdini jacket for safety; the purpose is to keep the patient stationary. Spenco boots are padded
support devices made of lamb's wool to position the feet and ankles of the patient. Support hose may
also be placed on the patient's legs to support the leg muscles and aid circulation.

Crash Carts

The crash cart is the commonly used term to describe a self-contained, mobile unit that contains
virtually all of the materials, drugs, and devices necessary to perform a code. The configuration of crash
carts may vary, but most will be a waist high or chest high wheeled cart with many drawers. Many
hospitals will also keep a defibrillator and heart monitor on top of the crash cart since these devices are
also needed in most codes. Since the contents and organization of crash carts may vary, it is a good idea
for you to make yourself aware of the crash cart that you are most likely going to encounter during a
code.

What is in a crash cart?

The size, shape, and contents of a crash cart may be different between hospitals and between different
departments within the same hospital. For example, an adult crash cart is set up differently than a
pediatric crash cart or crash cart on the medical service may be different than the one on a surgical
service.

1. Medications

Medications are usually kept in the top drawer of most crash carts. These need to be accessed and
delivered as quickly as possible in emergent situations. Therefore, they need to be available to providers
very easily. The medications are usually provided in a way that makes them easy to measure and
dispense quickly.

The common set of first drawer medications might be:

Alcohol swabs
Amiodarone 150 mg/3ml vial
Atropine 1mg/10 ml syringe
Sodium bicarbonate 50mEq/50 ml syringe
Calcium chloride 1gm/10 ml syringe
Sodium chloride 0.9% 10 ml vial Inj. 20 ml vial
Dextrose 50% 0.5 mg/ml 50 ml syringe
Dopamine 400 mg/250 ml IV bag
Epinephrine 1 mg/10 ml (1:10,000) syringe
Sterile water
Lidocaine 100 mg 5ml syringes
Lidocaine 2 gm/250 ml IV bag
Povidone-Iodine swabstick
Vasopressin 20 units/ml 1 ml vial
If the crash cart also contains pediatric medications these may be contained in the second drawer. Often
these would include:

Atropine 0.5 mg/ 5 ml syringe

Sodium bicarbonate 10 mEq/10 ml syringe
Saline flush syringes
Sodium chloride 0.9% 10 ml flush syringe

The second drawer of the crash cart might also contain saline solution of various sizes like 100 mL or 1 L
bags. A crash cart in the surgery department may include Ringer’s lactate solution.

2. Intubation

Many crash carts will also include most of the materials necessary to perform intubation. These may be
contained in the third or fourth drawers depending on the setup of the particular crash cart.

The adult intubation drawer will contain:

Endotracheal tubes of various sizes

Nasopharyngeal and perhaps oropharyngeal airways
Laryngoscope handle and blades of different sizes
A flashlight with extra batteries
A syringe of sufficient size to inflate the cuff on it endotracheal tube
Stylets
Bite block
Tongue depressors
Newer setups may also include the materials needed to start quantitative waveform capnography like a
nasal filter line
Pediatric intubation materials may be in a separate cart or if they are included in the adult crash cart
they may occupy their own drawer. The pediatric intubation supply drawer may contain the following:

2.5 mm uncuffed endotracheal tube

3.0 mm – 5.5 mm microcuff endotracheal tubes
Pediatric Stylet (8 Fr)
Neonatal Stylet (6 Fr)
Nasopharyngeal and perhaps oropharyngeal airways,
Laryngoscope blades
Disposable Miller blades
Disposable Macintosh blades
Armboards of various sizes
Vacutainers for blood collection
Spinal needles
Suction catheters of various sizes
Bone marrow needles of various sizes
Feeding tubes
Umbilical vessel catheter
Disinfectants (swab sticks)
Pediatric IV kits

3. Intravenous lines

It is usually the case that the equipment necessarily to start an IV is in a separate drawer from materials
needed to maintain an IV, such as the fluids in the tubing. The IV drawer(s) usually contain the following:

IV Start Kit
Angiocatheters 14 Ga and/or 16 Ga
Disinfectants (Chloraprep, Betadine, povidone-iodine)
Luer lock syringes of various sizes
Tourniquet tubing
Insyte autoguards of various sizes
Vacutainers
Blue top
Purple top
Green top
Red top
Spinal needles of various sizes
Regular needles of various sizes
3-Way stopcock
Tape
Armboards
ABG syringes and sampling kits
Catheter tips
Tubing
IV solutions may also be kept in this drawer

4. Procedure drawer

The bottom drawer on crash carts is usually devoted to keeping prepackaged kits available for various
urgent and emergent procedures (or it is where the IV solutions are kept). In any case, the following kits
may be found in the procedure drawer:

ECG electrodes
Sterile gloves of various sizes
Sutures of various sizes and materials
Suction supplies
Salem pump
Cricothyroidotomy kit
Adult and pediatric cut down pack
Yankauer suction
Drapes to create a sterile field
Large bore needle and syringe (for tension pneumothorax)
Suction Cath Kit 14 Fr & 18 Fr
Lumbar puncture kit