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    Systemic Approach in Intensive Care Medicine

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    Gx Navin
    The document outlines a systemic approach for intensive care physicians to manage complex ICU patients. It involves: 1) Reviewing the patient's history and identifying all medical problems in a hierarchical order. 2) Conducting a thorough physical examination of the patient, their environment, and monitoring equipment. 3) Developing a specific management plan to address each problem by further investigating, controlling complications, and creating an environment for healing.

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    Systemic Approach in Intensive Care Medicine

    Uploaded by

    Gx Navin
    46 views16 pages
    The document outlines a systemic approach for intensive care physicians to manage complex ICU patients. It involves: 1) Reviewing the patient's history and identifying all medical problems in a hierarchical order. 2) Conducting a thorough physical examination of the patient, their environment, and monitoring equipment. 3) Developing a specific management plan to address each problem by further investigating, controlling complications, and creating an environment for healing.

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    Systemic Approach In Intensive Care Medicine

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    The document outlines a systemic approach for intensive care physicians to manage complex ICU patients. It involves: 1) Reviewing the patient's history and identifying all medical problems in a hierarchical order. 2) Conducting a thorough physical examination of the patient, their environment, and monitoring equipment. 3) Developing a specific management plan to address each problem by further investigating, controlling complications, and creating an environment for healing.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    46 views16 pages

    Systemic Approach in Intensive Care Medicine

    Uploaded by

    Gx Navin
    The document outlines a systemic approach for intensive care physicians to manage complex ICU patients. It involves: 1) Reviewing the patient's history and identifying all medical problems in a hierarchical order. 2) Conducting a thorough physical examination of the patient, their environment, and monitoring equipment. 3) Developing a specific management plan to address each problem by further investigating, controlling complications, and creating an environment for healing.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 16

    Systemic Approach In Intensive

    Care Medicine
    Badrul Amin
    Introduction

    • Understand the thought process of the intensivist in


    managing ICU patients.
    • Conventional approach in medicine - history,PE ,DD,Ix
    and Tx
    • ICU patient is complex,multisystem disease processes
    • Understand that the initial diagnosis for ICU admission is
    often not the problem which keeps the patients in ICU
    • Review patient
    • List of problems by hierarchy
    • Role - clinical problem solver

    - management plan construction

    But 1st, find the problem !


    Patients with problems related to disease
    •Cardiac arrest survival

    •traumatic brain injury

    •spinal cord injury

    •obstetric

    •intra abdominal catastrophe


    Principle of Management

    •Admission - major physiological derangement - invasive monitoring / intensive interventions

    •Derangements like ???

    •Hemodynamic Insufficiency

    •Respiratory Insufficiency

    •Deteriorating consciousness level

    •Fuid, Electrolyte imbalance + renal dysfunction

    •Purpose of Intensive Care


    •Reverse abnormal physiology

    •Control source of problem

    •Create favorable healing environment


    QUESTIONS TO ASK ?

    •Why admitted ?

    •What happened thereafter ? Complications ?

    •What chronic health problems ?

    •Why still admitted ? Currently what problem ?

    •How are we addressing problem now ?

    •Prognosis ? Futile situation ?


    History & Identification
    Of Known Problems
    •Purpose

    get facts - set foundation - further physical examination, data intepretation

    •Dealing with Elective / emergency surgery / medical

    •Age, baseline health status

    •Problems admitted with

    •Complications that followed

    •Problem keeping patient

    •Physiologic targets
    Examination

    •Ensure infection control procedures observed

    •Physically examine from afar ; patient, environment, technology

    •Step back - overall look - move in

    •Walk up to bed ; isolation, equipment, odor

    •End of bed ; comatose, pale, jaundice, head up


    •1. Environment

    •cubicle - bed type, isolated, infection cntrl

    •Infusion - meds Insulin , fluids TPN

    •Ventilator - setting, FiO2, Sp02, strategy

    •Monitor - vitals, arrythmias, NIBP, WHY ???

    •Equipment - Intravasc catheters


    - renal replacement therapy
    - special cooling bed / trauma bed
    - Surgical drains
    - ICP monitor
    •2. System Based Approach - H2T . F2B

    •Infection control, full exposure, modesty

    •Approach, introduce, simple command

    •Systematic - IPPA

    •A . B . C. D . E . F. G

    •List Problems b(active/inactive,health status,allergies,alcoholism)

    •Specific Plan for each (specific & general), further Ix,

    •Review ECG, RADIO, PATHO, REPORTS

    •Communicate with patient, family, nurses about management, address concerns,

    •Family meeting - discuss treatment options, progress

    •F AST HUG maintenance

    •ETHICS - AUTONOMY, BENEFICIENCE, NON MALEFICIENCE, JUSTICE


    •A - irway ; ETT size, depth, cuff pressure, if tracheostomy; skin around
    insertion

    •B - reathing ; Observe, effort, rate, distress, examine lungs, chest drain,


    ventilator - spont / controlled, Sp02, PEEP, sputum, CXR

    •C - irculation ; Periphery pulses, heart, cardiovascular drugs, MAP,


    rhythm, urinary output, acid base, lactate, ECG

    •D - isability ; Simple tasks, assess GCS, C&P NS


    •E - lectrolytes

    •F - luids ; Fluid status, balance, management; tissue turgor, peripheral


    edema, JVP, CVP, Examine intravascular devices - infection, thrombosis,

    •G - astrointestinal ; abdomen, renal function, blood glucose, bowel


    motion, peripheries - impaired perfusion, pressure areas, DVT, drains -
    bottles, fluid types (blood, serous, pus), dressing, wound, puncture sites
    •F - luid & Feces

    •I - nfection

    •D - rugs (medication ; dosage, action, duration, SE)


    •D - ialysis

    •L - ines (Indication, insertion days, complications)

    •E - lectrolytes
    FAMILY MEETING

    •Family members - rarely calm, rational.

    •Stressed, nervous, aggressive sometimes

    •Need
    •Good structure,
    •Objectives,
    •Layman language
    •Introduction - you, staff, relationships, Explain WHY meeting ?

    •Gather information - ? they know & think of future. Best rep

    •Give information - Explain Condition, Prognosis, Ix, Treatment

    •Check understanding

    •Agree to a plan - Clear conclusion, all agree

    •Plan next meeting - If above unsuccessful, plan another

    •Document - objectives, discussion, aggreement, attendance

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