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Principles of
Critical Care Medicine
Bellson 2011 06
Principles of
Critical Care Medicine
Bellson C
Cellphone number
13564407870
Direction always goes first
Where to go?
Principles of
Critical Care Medicine
Scoring system : APACHE II,MPM, SAPS.
Why? What for?
Diaganose and Classification of Shock; Monitoring : Pulmonary Artery Catheter
Respiratory:
a. Four types of Respiratory Failure
b. Endotracheal intubation and Mechanical Ventilatory Support
c. Weaning from Ventilation
d. Monitoring : Pulse Oximetry, Blood gas, Respiratory System Mechanics
Common complications in CCU and the definition of MOFs
NEUROLOGIC DYSFUNCTION IN CRITICALLY ILL PATIENTS Common symptoms
WITHHOLDING AND WITHDRAWING CARE
Why CCU is a fighting place?
Everything focuses on life.
3 main parts of the treatment in CCU.
Respiratory
Circulation/Shock
Central nervous system
What does CCU look like?
What are the stuffs in the CCU?
Ventilators
Ventilators
Ventilators
Masks
Who should stay in the CCU?
Scoring system acts as a law.
It is useful in guiding hospital
administrative policies .
It guides hospital administrative
policies, nursing and ancillary care .
It predicts outcomes in critical illness
the most commonly utilized
scoring systems
APACHE (acute physiology and
chronic health evaluation)
system US
the MPM (mortality probability
model) Europe
the SAPS (simplified acute
physiology score) system
common variables
age;
vital signs;
assessments of respiratory,
renal, and neurologic function;
and an evaluation of chronic
medical illnesses.
Shock
What is Shock?
Shock is defined by the
presence of multisystem end-
organ hypoperfusion.
Classification
Cardiogenic shock
Septic shock
Anaphylactic shock
hypovolemic shock
neurogenic shock
Diagnose of Shock
1. BP < 90/60 mmHg
2. Why?
3. Clinical indicators :
tachycardia, tachypnea, cool
skin and extremities, acute
altered mental status, and
oliguria.
Monitoring and Therapy
BP
CVP (central venous pressure)
PAC (Pulmonary Artery Catheter )
Pulse Oximetry, Blood gas
EKG
……
Therapy……
Respiratory failure:
Four types of Respiratory
Failure
Endotracheal intubation
Mechanical Ventilatory Support
Weaning from Ventilation
Monitoring : Pulse Oximetry,
Blood gas, Respiratory System
Mechanics
Four types of Respiratory
Failure
Acute Hypoxemic Respiratory Failure
alveolar flooding
and subsequent intrapulmonary shunt
Type II Respiratory Failure
a result of alveolar hypoventilation
-> the inability to effectively eliminate carbon dioxide
Type III Respiratory Failure
a result of lung atelectasis.
Type Iv Respiratory Failure
shock, hypo perfusion -> the weakness of respiratory muscles
Monitoring
Blood gases analysis
Pulse Oximetry
BP
EKG
……
Therapy Strategy
Endotracheal intubation
the optimal mean of ventilating unconscious patient
or patient with severe respiratory distress ;
the most reliable but not the only way
Mechanical Ventilatory Support
Care of The Mechanically Ventilated Patient
Weaning from Ventilation
spontaneous respiration for 8 hours;
an acceptable level of arterial blood gases
analysis
Care of The Mechanically Ventilated
Patient
The management of airway
The management of pain
(Opiates )
The management of anxiety
anxiolysis
Neuromuscular blocking agents
Care of The Mechanically Ventilated
Patient
pros and cons
patient-ventilator synchrony
less stress/less inflammation reaction
Amnesia / a myopathy known as the postparalytic syndrome
? hepatic and renal function
* So daily interruption of sedative infusions has been shown to prevent excessive drug accumulation and shorten the duration of mechanical ventilation and length of stay in the ICU.
Weaning from Ventilation
Generally Speaking:
spontaneous respiration for 8 hours;
an acceptable level of arterial blood gases analysis
For All intubated, mechanically ventilated patients :
the screening test and undergo a spontaneous breathing trial are necessary.
In the end, (f/VT) is <105, the patient can be extubated.
Common complications in CCU
and the definition of MOFs
What is MOSF ?
Severe sepsis, shock of any
kind, severe inflammatory
conditions such as pancreatitis,
and trauma might cause MOSF.
Tips : >24h;
Mortality risk increases ;
SIRS is a common basis
Mechanism?
Gastrointestinal Tract
bacteria migrating etc.
Lungs
Kidneys
……
COMPLICATIONS OF
CRITICAL ILLNESS
Sepsis
Ventilator associated pneumonia; ……
Deep Venous Thromboses
Pulmonary embolism
Stress Ulcers
Anemia
AKI
Malnutrition
NEUROLOGIC DYSFUNCTION
Recognizing:
Common symptoms
Global or Local
MRI/CT
NEUROLOGIC
DYSFUNCTION
Delirium
(eg. clozapine over the dose)
Anoxic Cerebral Injury
Stroke
Subarachnoid Hemorrhage
Status Epilepticus
Brain Death
THANKS