Long-Stay Patient Hot Case
GENERAL APPROACH
- Illness requiring ICU admission
- Reason for ongoing admission
- Things that need to happen to allow discharge
INTRODUCTION
CUBICLE
- personal items
- weaning or rehabilitation plan
INFUSIONS
- minimal IV therapy
- feeding established
- treatments required for slowly resolving problems (ongoing IV antibiotics for endocarditis)
VENTILATOR
- mode
- level of oxygenation: high FiO2, PEEP
- pressure support
- weaning strategy
- tracheostomy
MONITOR
- lack of invasive monitoring suggest respiratory wean man problem.
EQUIPMENT
- type of bed: prevention of pressure areas
- DVT prophylaxis strategies
- limb splints to prevent joint contractures: pressure areas
QUESTION SPECIFIC EXAMINATION
- hands/arms -> head -> chest -> abdo -> legs/feet -> back
-> general:
-> cardiovascular:
-> respiratory:
-> abdominal:
- neurological: conscious
- signs of slow improvement: being dressed in own items, dentures, wearing spectacles, interest in entertainment for stimulation.
- depression: flat affect
- pressure areas
- DVT
- scars/wounds: vascular access or traumatic injuries
- eye care
- personal hygiene
- mouth care
- grooming
- nutrition
- bowel function
- psychoactives: antidepressants, anxiolytics, hypnotics, antipsychotics.
RELEVANT INVESTIGATIONS
OPENING STATEMENT
=
- Global statement
- Reason for admission
- Obvious complications
- How to progress from here
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC
