منتدى احدث الكتب الطبيه والبرامج

Forum latest medical books and programs


    ADMISSION CRITERIA TO ICU

    شاطر

    دكتور أشرف
    عضوا دائم
    عضوا دائم

    عدد المساهمات : 106
    تاريخ التسجيل : 15/10/2011

    ADMISSION CRITERIA TO ICU

    مُساهمة من طرف دكتور أشرف في 03/02/14, 09:53 pm


    ADMISSION CRITERIA TO ICU


    The Intensive Care Unit is an expensive resource area and should be reserved for patients with reversible medical conditions with a reasonable prospect of substantial recovery
    .
    Patients with the following conditions are candidates for admission to the General Intensive Care Unit. The following conditions include, but are not limited to
    A- Respiratory
    1- Acute respiratory failure requiring ventilatory support
    2- Acute pulmonary embolism with haemodynamic instability
    3- Massive haemoptysis
    4- Upper airway obstruction

    B- Cardiovascular
    1- Shock states ( ex. Cardiogenic shock )
    2- Life-threatening dysrhythmias
    3- Dissecting aortic aneurysms
    4- Hypertensive emergencies
    5- Need for continuous invasive monitoring of cardiovascular system
    ( arterial pressure, central venous pressure, cardiac output)
    6- Acute myocardial infarction with complications
    7-Unstable angina, particularly with dysrhythmias, hemodynamic instability, or persistent chest pain
    8- Acute congestive heart failure with respiratory failure and/or requiring hemodynamic support
    9- Cardiac tamponade or constriction with hemodynamic instability

    C- Neurological
    1- Severe head trauma
    2- Status epilepticus
    3- Meningitis with altered mental status or respiratory compromise
    4- Acutely altered sensorium with the potential for airway compromise
    5- Progressive neuromuscular dysfunction requiring respiratory support and / or cardiovascular monitoring (myasthenia gravis, Gullain-Barre syndrome)
    6- Brain dead or potentially brain dead patients who are being aggressively managed while determining organ donation status
    7- Coma: metabolic, toxic, or anoxic
    8- Intracranial hemorrhage with potential for herniation
    9- Acute subarachnoid hemorrhage

    D- Renal
    1- Requirement for acute renal replacement therapies in an unstable patient
    2- Acute rhabdomyolysis with renal insufficiency

    E- Endocrine
    1- Diabetic ketoacidosis complicated by haemodynamic instability, altered mental status
    2- Severe metabolic acidotic states
    3- Thyroid storm or myxedema coma with haemodynamic instability
    4- Hyperosmolar state with coma and/or haemodynamic instability
    5- Adrenal crises with haemodynamic instability
    6- Other severe electrolyte abnormalities, such as:
    - Hypo or hyperkalemia with dysrhythmias or muscular weakness
    - Severe hypo or hypernatremia with seizures, altered mental status
    - Severe hypercalcemia with altered mental status, requiring haemodynamic monitoring
    -Hypo or hypermagnesemia with hemodynamic compromise or dysrhythmias
    -Hypophosphatemia with muscular weakness

    F- Gastrointestinal
    1- Life threatening gastrointestinal bleeding including hypotension, angina or continued bleeding
    2- Acute hepatic failure leading to coma, haemodynamic instability (Fulminant hepatic failure )
    3- Severe acute pancreatitis
    4- Esophageal perforation with or without mediastinitis

    G- Haematology
    1- Severe coagulopathy and/or bleeding diasthesis
    2- Severe anemia resulting in haemodynamic and/or respiratory compromise
    3- Severe complications of sickle cell crisis
    4- Haematological malignancies with multi-organ failure

    H-Obstetric
    1- Medical conditions complicating pregnancy
    2- Severe pregnancy induced hypertension/eclampsia
    3- Obstetric haemorrhage
    4- Amniotic fluid embolism

    I- Multi-system
    1- Severe sepsis or septic shock
    2- Multi-organ dysfunction syndrome
    3- Polytrauma
    4- Dengue haemorrhagic fever/dengue shock syndrome
    5- Drug overdose with potential acute decompensation of major organ systems
    ( Hemodynamically unstable drug ingestion, Seizures following drug ingestion, Drug ingestion with significantly altered mental status with inadequate airway protection )
    6- Environmental injuries (lightning, near drowning, hypo/hyperthermia)
    7- Severe burns

    J- Surgical
    1- High risk patients in the peri-operative period
    2- Post-operative patients requiring continuous haemodynamic monitoring/ ventilatory support, usually following:
    - vascular surgery
    - thoracic surgery
    - airway surgery
    - craniofacial surgery
    - major orthopaedic and spine surgery
    - general surgery with major blood loss/ fluid shift
    - neurosurgical procedures

    Objective Parameters

    Vital Signs
    * Pulse < 40 or > 150 beats/minute
    * Systolic arterial pressure < 80 mm Hg or 20 mm Hg below the patient's usual pressure
    * Mean arterial pressure < 60 mm Hg
    * Diastolic arterial pressure > 120 mm Hg
    * Respiratory rate > 35 breaths/minute
    * SaO2< 88% with O2 supply

    Laboratory Values

    * Serum sodium < 110 mEq/L or > 160 mEq/L
    * Serum potassium < 2.5 mEq/L or > 7.0 mEq/L
    * PaO2 < 50 mm Hg
    * pH < 7.1 or > 7.7
    * Serum glucose > 600 mg/dl
    * Serum calcium > 15 mg/dl
    * Toxic level of drug or other chemical substance in a hemodynamically or neurologically compromised patient
    Radiography/Ultrasonography/Tomography

    * Cerebral vascular hemorrhage, contusion or subarachnoid hemorrhage with altered mental status or focal neurological signs
    * Ruptured viscera, bladder, liver, esophageal varices or uterus with hemodynamic instability
    * Dissecting aortic aneurysm

    Electrocardiogram
    * Myocardial infarction with complex arrhythmias, hemodynamic instability or congestive heart failure
    * Sustained ventricular tachycardia or ventricular fibrillation
    * Complete heart block with hemodynamic instability
    Physical Findings

    * Unequal pupils in an unconscious patient
    * Burns covering > 10% BSA
    * Anuria
    * Airway obstruction
    * Coma
    * Continuous seizures
    * Cyanosis
    * Cardiac tamponade

      الوقت/التاريخ الآن هو 27/04/18, 10:26 am