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

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.