[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › Critical care # 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 dysreflexia** After an acute spinal cord injury, the ICU nurse protects the spine, watches breathing and blood…](https://durgical.com/en/nursing/acute-spinal-cord-injury-in-the-icu-spinal-precautions-log-roll-breathing-neurog/) - [**After heart surgery in the ICU: bleeding, tamponade, rewarming, pacing wires and chest drains** After heart surgery the nurse watches bleeding, temperature, rhythm and output, alert to…](https://durgical.com/en/nursing/after-heart-surgery-in-the-icu-bleeding-tamponade-rewarming-pacing-wires-and-che/) - [**Basic care of the ICU patient: eyes, mouth, skin, devices and device-related pressure injuries** ICU patients cannot blink, swallow or move as usual: scheduled eye, mouth and skin care, and…](https://durgical.com/en/nursing/basic-care-of-the-icu-patient-eyes-mouth-skin-devices-and-device-related-pressur/) - [**Caring for the ventilated patient: modes and settings in general terms, the hourly check and what to record** The nurse checks the patient first, then the ventilator: settings, pressures, alarms, tube and…](https://durgical.com/en/nursing/caring-for-the-ventilated-patient-modes-and-settings-in-general-terms-the-hourly/) - [**Communicating with the patient who cannot speak: boards, yes/no signals, lip reading and reorientation** An intubated patient who is awake can still communicate: closed questions, gestures, mouthed…](https://durgical.com/en/nursing/communicating-with-the-patient-who-cannot-speak-boards-yes-no-signals-lip-readin/) - [**Continuous renal replacement therapy: the circuit in general terms, fluid removal, anticoagulation checks, alarms and electrolytes** In continuous renal replacement therapy the nurse runs the circuit around the clock: pressures…](https://durgical.com/en/nursing/continuous-renal-replacement-therapy-the-circuit-in-general-terms-fluid-removal/) - [**End of life in the ICU: limitation of therapeutic effort, withdrawing the ventilator and comfort care** When the team and family decide to limit treatment, the nurse prepares the patient and family…](https://durgical.com/en/nursing/end-of-life-in-the-icu-limitation-of-therapeutic-effort-withdrawing-the-ventilat/) - [**Insulin infusion and glucose control in the ICU, including DKA and HHS: checks, potassium and hypoglycaemia** An insulin infusion follows a written protocol: frequent glucose checks, potassium before and…](https://durgical.com/en/nursing/insulin-infusion-and-glucose-control-in-the-icu-including-dka-and-hhs-checks-pot/) - [**Massive transfusion and the lethal triad: warming, calcium and clotting checks, and transfusion reactions** During a massive transfusion the nurse checks every unit, warms the blood and the patient, sends…](https://durgical.com/en/nursing/massive-transfusion-and-the-lethal-triad-warming-calcium-and-clotting-checks-and/) - [**Moving the critically ill patient: intrahospital transport, admission to the ICU and handing over at discharge** Moving an ICU patient to a scan or to another unit is risky; planning, the right monitors and a…](https://durgical.com/en/nursing/moving-the-critically-ill-patient-intrahospital-transport-admission-to-the-icu-a/) - [**Nursing measures for raised intracranial pressure and after craniotomy: position, triggers to avoid and the Cushing response** In the ICU, the nurse lowers the strain on the brain: head up and straight, normal oxygen and…](https://durgical.com/en/nursing/nursing-measures-for-raised-intracranial-pressure-and-after-craniotomy-position/) - [**Nursing the patient in shock: early signs, monitoring, fluid challenge and fluid overload, positioning, by type of shock** In shock the nurse spots poor perfusion early, measures the response to each fluid challenge…](https://durgical.com/en/nursing/nursing-the-patient-in-shock-early-signs-monitoring-fluid-challenge-and-fluid-ov/) - [**Nursing the patient with ARDS: lung-protective ventilation, oxygenation goals, fluids and positioning** Low tidal volumes by predicted weight, plateau pressure checks, the ordered oxygen target…](https://durgical.com/en/nursing/nursing-the-patient-with-ards-lung-protective-ventilation-oxygenation-goals-flui/) - [**Nursing the patient with major burns: inhalation injury, circulation to the limbs, wounds, infection, temperature, pain and nutrition** In a major burn the nurse watches the airway, the pulses of burned limbs, temperature and…](https://durgical.com/en/nursing/nursing-the-patient-with-major-burns-inhalation-injury-circulation-to-the-limbs/) - [**Nutrition in the ICU: early enteral feeding, feeding intolerance, parenteral nutrition, glucose and refeeding** Most ICU patients are fed through the gut within 48 hours, slowly at first; the nurse watches…](https://durgical.com/en/nursing/nutrition-in-the-icu-early-enteral-feeding-feeding-intolerance-parenteral-nutrit/) - [**Sepsis and septic shock: screening, the first-hour bundle from the nursing side and watching organ dysfunction** Nurses screen for sepsis, raise the alarm and deliver the first-hour actions: lactate, cultures…](https://durgical.com/en/nursing/sepsis-and-septic-shock-screening-the-first-hour-bundle-from-the-nursing-side-an/) - [**The ABCDEF (ICU liberation) bundle and early mobility** The ABCDEF bundle joins pain, awakening and breathing trials, sedation choice, delirium, early…](https://durgical.com/en/nursing/the-abcdef-bundle-and-early-mobility/) - [**The family in the ICU: needs, flexible visiting, information, family conferences and presence during resuscitation** The family of an ICU patient needs clear information, flexible visits, a part in rounds and…](https://durgical.com/en/nursing/the-family-in-the-icu-needs-flexible-visiting-information-family-conferences-and/) - [**The patient on neuromuscular blockers: sedation first, train-of-four, eye care and skin** A paralysed patient cannot move, blink or show pain: the nurse keeps them deeply sedated…](https://durgical.com/en/nursing/the-patient-on-neuromuscular-blockers-sedation-first-train-of-four-eye-care-and/) - [**The potential organ donor: brain death in Colombia, keeping the donor stable and the nurse's role in donation** After brain death is diagnosed, the nurse keeps the donor's organs working and supports the…](https://durgical.com/en/nursing/the-potential-organ-donor-brain-death-in-colombia-keeping-the-donor-stable-and-t/) - [**The trauma patient in the ICU: the primary and secondary survey from the nursing side, the tertiary survey and complications to watch** In the ICU the nurse repeats the ABCDE check, helps with the tertiary survey and watches for…](https://durgical.com/en/nursing/the-trauma-patient-in-the-icu-the-primary-and-secondary-survey-from-the-nursing/) - [**Vasopressor and inotrope infusions: line, pump, titrating to a goal, extravasation and never flushing the line** Vasopressors and inotropes run on their own line, on a smart pump, titrated to a goal the team…](https://durgical.com/en/nursing/vasopressor-and-inotrope-infusions-line-pump-titrating-to-a-goal-extravasation-a/) - [**Ventilator alarms: high and low pressure, low volume and apnoea, and what to do first** Go to the patient first; if they are in distress and the cause is unclear, ventilate with a bag…](https://durgical.com/en/nursing/ventilator-alarms-high-and-low-pressure-low-volume-and-apnoea-and-what-to-do-fir/) - [**Weaning from the ventilator: readiness, the spontaneous breathing trial, extubation and the hours after** Each day the team checks readiness and pairs a sedation break with a breathing trial; the nurse…](https://durgical.com/en/nursing/weaning-from-the-ventilator-readiness-the-spontaneous-breathing-trial-extubation/) ## Assessment - [**Analgesia first, then light sedation: RASS and SAS, sedation goals and the daily awakening** In the ICU, pain is treated first, sedation is kept as light as possible and checked with a…](https://durgical.com/en/nursing/analgesia-first-then-light-sedation-rass-and-sas-sedation-goals-and-the-daily-aw/) - [**Arterial blood gases: the Allen test, drawing the sample and reading it step by step** Check collateral flow, draw the arterial sample without air, press the site, send it quickly…](https://durgical.com/en/nursing/arterial-blood-gases-the-allen-test-drawing-the-sample-and-reading-it-step-by-st/) - [**Bleeding and clotting emergencies in the ICU (DIC, low platelets, HIT) and tumour lysis: what nurses watch** Nurses watch for bleeding from many sites, new clots, falling platelets and, after cancer…](https://durgical.com/en/nursing/bleeding-and-clotting-emergencies-in-the-icu-and-tumour-lysis-what-nurses-watch/) - [**Capnography (end-tidal CO2): tube confirmation, the waveform and what a change means** Capnography shows exhaled CO2 breath by breath: it confirms the tube, warns of disconnection and…](https://durgical.com/en/nursing/capnography-tube-confirmation-the-waveform-and-what-a-change-means/) - [**ICU delirium: CAM-ICU and ICDSC screening, types, risk factors and prevention** ICU delirium is a sudden, fluctuating confusion; nurses screen for it every shift with a…](https://durgical.com/en/nursing/icu-delirium-cam-icu-and-icdsc-screening-types-risk-factors-and-prevention/) - [**Measuring central venous pressure: transducer and water manometer, the phlebostatic axis and reading trends** Central venous pressure is read from a central line at the level of the heart, at the end of…](https://durgical.com/en/nursing/measuring-central-venous-pressure-transducer-and-water-manometer-the-phlebostati/) ## Procedure - [**Arterial line: setting up, levelling and zeroing the transducer, the waveform, sampling and complications** An arterial line shows the blood pressure beat by beat and allows blood samples without new…](https://durgical.com/en/nursing/arterial-line-setting-up-levelling-and-zeroing-the-transducer-the-waveform-sampl/) - [**Assisting endotracheal intubation: preparing, rapid sequence from the nursing side and confirming tube position** The nurse prepares the team, equipment and drugs, watches the patient through the intubation and…](https://durgical.com/en/nursing/assisting-endotracheal-intubation-preparing-rapid-sequence-from-the-nursing-side/) - [**Endotracheal tube care and VAP prevention: securing, cuff pressure, tube depth, oral care, head of bed and unplanned extubation** Each shift the nurse checks tube depth, fixation, cuff pressure and skin, keeps the head of the…](https://durgical.com/en/nursing/endotracheal-tube-care-and-vap-prevention-securing-cuff-pressure-tube-depth-oral/) - [**Intracranial pressure monitoring and the external ventricular drain: levelling, drainage, waveforms and infection** An ICP monitor or a ventricular drain shows the pressure inside the skull; the nurse levels it…](https://durgical.com/en/nursing/intracranial-pressure-monitoring-and-the-external-ventricular-drain-levelling-dr/) - [**Noninvasive ventilation (CPAP, BiPAP) and high-flow nasal oxygen: mask fit, skin, tolerance and failure signs** Fit the interface well, protect the skin, support the patient and check early and often whether…](https://durgical.com/en/nursing/noninvasive-ventilation-and-high-flow-nasal-oxygen-mask-fit-skin-tolerance-and-f/) - [**Prone positioning: the team, the turn, protecting tubes, eyes and pressure points** A trained team of four or five turns the patient face down while one person guards the tube…](https://durgical.com/en/nursing/prone-positioning-the-team-the-turn-protecting-tubes-eyes-and-pressure-points/) - [**Temporary pacing (transcutaneous and transvenous): set-up, capture, sensing and safety** Temporary pacing keeps the heart rate up until the cause is treated; the nurse checks capture on…](https://durgical.com/en/nursing/temporary-pacing-set-up-capture-sensing-and-safety/) ## Calculation - [**Burns: estimating the burned area (rule of nines, Lund–Browder) and the fluid formula, with worked examples** The burned area is a percentage of body surface; with the weight it feeds the fluid formula…](https://durgical.com/en/nursing/burns-estimating-the-burned-area-and-the-fluid-formula-with-worked-examples/) - [**ICU bedside formulas: mean arterial pressure, cerebral perfusion pressure, cardiac output and index, shock index** Five bedside formulas turn monitor numbers into a picture of perfusion: MAP, cerebral perfusion…](https://durgical.com/en/nursing/icu-bedside-formulas-mean-arterial-pressure-cerebral-perfusion-pressure-cardiac/) ## Fundamental - [**Haemodynamic monitoring in general terms: MAP, CVP, cardiac output, preload, afterload and perfusion signs** Haemodynamic monitoring tracks pressure, blood flow and tissue perfusion, so the ICU team can…](https://durgical.com/en/nursing/haemodynamic-monitoring-in-general-terms-map-cvp-cardiac-output-preload-afterloa/) - [**Post-intensive care syndrome: prevention, ICU diaries and follow-up for the patient and family** Many ICU survivors leave with new weakness, memory problems, anxiety or depression; their…](https://durgical.com/en/nursing/post-intensive-care-syndrome-prevention-icu-diaries-and-follow-up-for-the-patien/) ## A to Z - [A](https://durgical.com/en/nursing/a-z/a/) - [B](https://durgical.com/en/nursing/a-z/b/) - [C](https://durgical.com/en/nursing/a-z/c/) - [D](https://durgical.com/en/nursing/a-z/d/) - [E](https://durgical.com/en/nursing/a-z/e/) - [F](https://durgical.com/en/nursing/a-z/f/) - [G](https://durgical.com/en/nursing/a-z/g/) - [H](https://durgical.com/en/nursing/a-z/h/) - [I](https://durgical.com/en/nursing/a-z/i/) - [J](https://durgical.com/en/nursing/a-z/j/) - [K](https://durgical.com/en/nursing/a-z/k/) - [L](https://durgical.com/en/nursing/a-z/l/) - [M](https://durgical.com/en/nursing/a-z/m/) - [N](https://durgical.com/en/nursing/a-z/n/) - [O](https://durgical.com/en/nursing/a-z/o/) - [P](https://durgical.com/en/nursing/a-z/p/) - [Q](https://durgical.com/en/nursing/a-z/q/) - [R](https://durgical.com/en/nursing/a-z/r/) - [S](https://durgical.com/en/nursing/a-z/s/) - [T](https://durgical.com/en/nursing/a-z/t/) - [U](https://durgical.com/en/nursing/a-z/u/) - [V](https://durgical.com/en/nursing/a-z/v/) - [W](https://durgical.com/en/nursing/a-z/w/) - [Y](https://durgical.com/en/nursing/a-z/y/) [← Nursing: fundamentals and procedures](https://durgical.com/en/nursing/) 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. --- Source: https://durgical.com/en/nursing/areas/critical-care/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/areas/critical-care/