Critical care

The ICU patient: mechanical ventilation, haemodynamic monitoring, shock and sepsis, sedation and delirium, intracranial pressure, trauma, burns and the family.

41 pages

Safe practice

• Acute spinal cord injury in the ICU: spinal precautions, log roll, breathing, neurogenic shock and autonomic dysreflexiaAfter an acute spinal cord injury, the ICU nurse protects the spine, watches breathing and blood…
• After heart surgery in the ICU: bleeding, tamponade, rewarming, pacing wires and chest drainsAfter heart surgery the nurse watches bleeding, temperature, rhythm and output, alert to…
• Basic care of the ICU patient: eyes, mouth, skin, devices and device-related pressure injuriesICU patients cannot blink, swallow or move as usual: scheduled eye, mouth and skin care, and…
• Caring for the ventilated patient: modes and settings in general terms, the hourly check and what to recordThe nurse checks the patient first, then the ventilator: settings, pressures, alarms, tube and…
• Communicating with the patient who cannot speak: boards, yes/no signals, lip reading and reorientationAn intubated patient who is awake can still communicate: closed questions, gestures, mouthed…
• Continuous renal replacement therapy: the circuit in general terms, fluid removal, anticoagulation checks, alarms and electrolytesIn continuous renal replacement therapy the nurse runs the circuit around the clock: pressures…
• End of life in the ICU: limitation of therapeutic effort, withdrawing the ventilator and comfort careWhen the team and family decide to limit treatment, the nurse prepares the patient and family…
• Insulin infusion and glucose control in the ICU, including DKA and HHS: checks, potassium and hypoglycaemiaAn insulin infusion follows a written protocol: frequent glucose checks, potassium before and…
• Massive transfusion and the lethal triad: warming, calcium and clotting checks, and transfusion reactionsDuring a massive transfusion the nurse checks every unit, warms the blood and the patient, sends…
• Moving the critically ill patient: intrahospital transport, admission to the ICU and handing over at dischargeMoving an ICU patient to a scan or to another unit is risky; planning, the right monitors and a…
• Nursing measures for raised intracranial pressure and after craniotomy: position, triggers to avoid and the Cushing responseIn the ICU, the nurse lowers the strain on the brain: head up and straight, normal oxygen and…
• Nursing the patient in shock: early signs, monitoring, fluid challenge and fluid overload, positioning, by type of shockIn shock the nurse spots poor perfusion early, measures the response to each fluid challenge…
• Nursing the patient with ARDS: lung-protective ventilation, oxygenation goals, fluids and positioningLow tidal volumes by predicted weight, plateau pressure checks, the ordered oxygen target…
• Nursing the patient with major burns: inhalation injury, circulation to the limbs, wounds, infection, temperature, pain and nutritionIn a major burn the nurse watches the airway, the pulses of burned limbs, temperature and…
• Nutrition in the ICU: early enteral feeding, feeding intolerance, parenteral nutrition, glucose and refeedingMost ICU patients are fed through the gut within 48 hours, slowly at first; the nurse watches…
• Sepsis and septic shock: screening, the first-hour bundle from the nursing side and watching organ dysfunctionNurses screen for sepsis, raise the alarm and deliver the first-hour actions: lactate, cultures…
• The ABCDEF (ICU liberation) bundle and early mobilityThe ABCDEF bundle joins pain, awakening and breathing trials, sedation choice, delirium, early…
• The family in the ICU: needs, flexible visiting, information, family conferences and presence during resuscitationThe family of an ICU patient needs clear information, flexible visits, a part in rounds and…
• The patient on neuromuscular blockers: sedation first, train-of-four, eye care and skinA paralysed patient cannot move, blink or show pain: the nurse keeps them deeply sedated…
• The potential organ donor: brain death in Colombia, keeping the donor stable and the nurse's role in donationAfter brain death is diagnosed, the nurse keeps the donor's organs working and supports the…
• The trauma patient in the ICU: the primary and secondary survey from the nursing side, the tertiary survey and complications to watchIn the ICU the nurse repeats the ABCDE check, helps with the tertiary survey and watches for…
• Vasopressor and inotrope infusions: line, pump, titrating to a goal, extravasation and never flushing the lineVasopressors and inotropes run on their own line, on a smart pump, titrated to a goal the team…
• Ventilator alarms: high and low pressure, low volume and apnoea, and what to do firstGo to the patient first; if they are in distress and the cause is unclear, ventilate with a bag…
• Weaning from the ventilator: readiness, the spontaneous breathing trial, extubation and the hours afterEach day the team checks readiness and pairs a sedation break with a breathing trial; the nurse…

Assessment

• Analgesia first, then light sedation: RASS and SAS, sedation goals and the daily awakeningIn the ICU, pain is treated first, sedation is kept as light as possible and checked with a…
• Arterial blood gases: the Allen test, drawing the sample and reading it step by stepCheck collateral flow, draw the arterial sample without air, press the site, send it quickly…
• Bleeding and clotting emergencies in the ICU (DIC, low platelets, HIT) and tumour lysis: what nurses watchNurses watch for bleeding from many sites, new clots, falling platelets and, after cancer…
• Capnography (end-tidal CO2): tube confirmation, the waveform and what a change meansCapnography shows exhaled CO2 breath by breath: it confirms the tube, warns of disconnection and…
• ICU delirium: CAM-ICU and ICDSC screening, types, risk factors and preventionICU delirium is a sudden, fluctuating confusion; nurses screen for it every shift with a…
• Measuring central venous pressure: transducer and water manometer, the phlebostatic axis and reading trendsCentral venous pressure is read from a central line at the level of the heart, at the end of…

Procedure

• Arterial line: setting up, levelling and zeroing the transducer, the waveform, sampling and complicationsAn arterial line shows the blood pressure beat by beat and allows blood samples without new…
• Assisting endotracheal intubation: preparing, rapid sequence from the nursing side and confirming tube positionThe nurse prepares the team, equipment and drugs, watches the patient through the intubation and…
• Endotracheal tube care and VAP prevention: securing, cuff pressure, tube depth, oral care, head of bed and unplanned extubationEach shift the nurse checks tube depth, fixation, cuff pressure and skin, keeps the head of the…
• Intracranial pressure monitoring and the external ventricular drain: levelling, drainage, waveforms and infectionAn ICP monitor or a ventricular drain shows the pressure inside the skull; the nurse levels it…
• Noninvasive ventilation (CPAP, BiPAP) and high-flow nasal oxygen: mask fit, skin, tolerance and failure signsFit the interface well, protect the skin, support the patient and check early and often whether…
• Prone positioning: the team, the turn, protecting tubes, eyes and pressure pointsA trained team of four or five turns the patient face down while one person guards the tube…
• Temporary pacing (transcutaneous and transvenous): set-up, capture, sensing and safetyTemporary pacing keeps the heart rate up until the cause is treated; the nurse checks capture on…

Calculation

• Burns: estimating the burned area (rule of nines, Lund–Browder) and the fluid formula, with worked examplesThe burned area is a percentage of body surface; with the weight it feeds the fluid formula…
• ICU bedside formulas: mean arterial pressure, cerebral perfusion pressure, cardiac output and index, shock indexFive bedside formulas turn monitor numbers into a picture of perfusion: MAP, cerebral perfusion…

Fundamental

• Haemodynamic monitoring in general terms: MAP, CVP, cardiac output, preload, afterload and perfusion signsHaemodynamic monitoring tracks pressure, blood flow and tissue perfusion, so the ICU team can…
• Post-intensive care syndrome: prevention, ICU diaries and follow-up for the patient and familyMany ICU survivors leave with new weakness, memory problems, anxiety or depression; their…

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← Nursing: fundamentals and procedures

Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Representative model, for educational purposes only.