Felix, Irish Eunice A.

BSN – 3A

A. ICU Team roles and functions

Doctors in the ICU are also referred to as Intensivists. They are specialists who have completed
advanced training in intensive care medicine or a related speciality such as anaesthetics, cardiology or
emergency medicine. They are responsible for coordination of patient care in the ICU and will consult
with other specialists.

There is usually an ICU Consultant leading a team of doctors who normally examine patients on a daily
basis to assess their progress and decide all aspects of treatment and care.

Nurses in the ICU usually look after just one or two patients only. Many have special experience,
education and training in caring for critically ill and injured patients. They work with the doctors and
other healthcare professionals to ensure all the patient’s needs are met in terms of treatment, care and
comfort. Their role is to give the drugs and fluids prescribed by the doctors, monitor a patient’s blood
pressure, heart rate and oxygen levels, allowing for early identification of changes in a patient’s
condition. In addition, nurses are responsible for keeping the patient as comfortable as possible in
practical ways such as changing sheets, cleaning teeth, regularly washing and turning the patient, and
generally attending to their needs.

Physiotherapists attend to patients in ICU (often when they are asleep) to exercise muscles in their arms
and legs to prevent joints from becoming stiff and, sometimes to help strengthen the chest muscles and
lungs of patients who need help with breathing while in ICU. And they are there to help recovering
patients with exercises to aid their physical strength after a long period in bed, preparing them to
become mobile again.

Dieticians work out patients’ nutritional needs and how best they will be fed. Sometimes this can be
through a nasogastric tube (a tube that goes up the nose and down into the stomach) or through a drip
straight into the vein.

Speech therapists may also be involved, especially if a patient has a tracheostomy. (A tracheostomy is a
procedure to make a hole in the throat and insert a tube, which is connected to a ventilator or
ʻbreathing machineʼ.) Later, the speech therapist may recommend a speaking valve on the
tracheostomy.

Pharmacists attend ward rounds and assist doctors and nurses with advice regarding medications as
well as ensuring a supply of medication for patients.

Occupational therapists evaluate the ability of the patient to carry out everyday activities of daily living
and develop treatment plans to improve the patient’s abilities

Social Workers are available at most large hospitals. They provide invaluable support for families of
critically ill including counselling and assistance with financial matters such Centrelink.
B. Monitoring machines

There is a range of equipment available in ICU so it is difficult to be too specific.

Every patient in ICU, though, does have a monitor (a television-like screen) that collects information on
the patient’s heart rate and rhythm, blood pressure, temperature, breathing and many other things,
displaying them as a graph.

Most patients will have powerful drugs given to them continuously through intravenous infusions (‘I.V’
or ‘drip’).

Patients may also be assisted in their breathing by a machine (ventilator). They are attached to the
machine by a tube (ETT) inserted into the trachea (windpipe).

C. Indications for admission to ICU

A person is likely to be admitted to ICU if they are in a critical condition and need constant observation
and specialised care. This can happen: after major surgery. following an accident (e.condition reaches a
point from which recovery is impossible. Clear criteria may help to identify those at risk and to trigger a
call for help from intensive care staff. Early referral improves the chances of recovery, reduces the
potential for organ dysfunction (both extent and number), may reduce length of stay in intensive care
and hospital, and may reduce the costs of intensive care. Patients should be referred by the most senior
member of staff responsible for the patient—that is, a consultant. The decision should be delegated to
trainee doctors only if clear guidelines exist on admission. Once patients are stabilised they should be
transferred to the intensive care unit by experienced intensive care staff with appropriate transfer
equipment.

Criteria for calling intensive care staff to adult patients

(Adapted from McQuillan et al BMJ 1998;316:1853-8.)

 Threatened airway
 All respiratory arrests
 Respiratory rate ⩾40 or ⩽8 breaths/min
 Oxygen saturation <90% on ⩾50% oxygen
 All cardiac arrests
 Pulse rate <40 or >140 beats/min
 Systolic blood pressure <90 mm Hg
 Sudden fall in level of consciousness (fall in Glasgow coma score >2 points)
 Repeated or prolonged seizures
 Rising arterial carbon dioxide tension with respiratory acidosis
 Any patient giving cause for concern
D. Bedside procedures done at the ICU

Some of the most common examples of bedside procedures are:

 Thoracentesis
 Paracentesis
 Lumbar puncture
 Peripherally inserted central catheter (PICC) line insertion
 Insertion of a urinary catheter
 Cardioversion
 Incision and drainage procedures
 Negative pressure wound therapy
 Central line insertion and declotting procedures
 Pleurodesis
 Arthrocentesis and joint injections
 Echocardiograms
 Biopsies (e.g., bone marrow biopsy)
 Cardiopulmonary resuscitation (CPR)
 Chest tube insertion
 Endotracheal intubation
 Blood transfusions
 Drug administration services