The Intensive Care Unit treats all critically ill patients irrespective of age who require specialised medical and/or nursing care to provide the best posssible outcome. A wide range of conditions are therefore managed with complex disorders often affecting more than one organ of the body. It is important to realise that the major part of such treatment is of a supportive nature allowing time for the natural healing function of the body to proceed.

 
The following list represents some of the more common conditions managed on the ICU: 

  • Abdominal Trauma Open or Close

    Abdominal trauma occurs when the structure and organs of the abdominal cavity are injured through falls, car accidents or deliberate acts of violence.

     

     

    • The Abdomen

    abdomen

    The structures contained in the abdomen include the gastrointestinal system (stomach, liver, pancreas, and intestines), the renal system (kidneys), the spleen and arteries and veins including the aorta.

    Source: Family Doctor UK

     

    • What is abdominal trauma?

    Abdominal trauma is generally categorised as blunt or penetrating trauma.

    Blunt abdominal trauma typically results in injury to solid organs eg liver, spleen, kidneys and pancreas. Hollow organs eg stomach, intestines, bladder tend to be compressible but may rupture. Road crashes, falls, assaults and industrial accidents cause the majority of blunt trauma. The injuries are caused when the abdominal organs are compressed against the backbone, or when internal structures are stretched at their attachments.

    Penetrating trauma typically results in injury to organs in the direct path of the instrument or missile, but high-velocity weapons may cause injury to adjacent organs as well.

     

    • Treatment for abdominal trauma

    Hospital treatment for abdominal trauma begins with a rapid assessment in Emergency. Suspected haemorrhage will be identified quickly using clinical assessment and an abdominal ultrasound. Patients identified as suffered a life threatening haemorrhage are rapidly transported to theatre for definitive surgery. Other injuries will be identified after this. Chest and abdominal x-rays may indicate disruption of the gastrointestinal tract or may identify penetrating objects. CT scans are used to detect solid organ lacerations or haematomas An angiogram (x-ray scanning using dye to look at the blood flow in blood vessels) may be used to detect haemorrhage from pelvic blood vessels, if there is a pelvis fracture. A range of blood tests will be done including haemoglobin (Hb).

    There are a number of operations that may be performed according to the findings at operation. Below is a short list of common terms that may be of use:

    laparotomy - an exploratory operation where the surgeons look for problems and operate according to their findings

    laparoscopy - an exploratory operation performed using key hole surgery

    splenectomy - removal of the spleen

    nephrectomy - removal of a kidney

    anastomosis - surgical procedure where two parts of the bowel are joined together

     

    • What happens in Intensive Care?

    A patient with abdominal trauma will be admitted to Intensive Care if they have suffered a severe injury. They may have experienced trauma to a number of other body areas (classified as multi-trauma). On most occasions the patient will be admitted to the Intensive Care following surgery. Once in ICU the patient will be under the care of the Intensive Care team with the surgical team reviewing the patient on a regular basis.

    The care in Intensive Care will be focussed on monitoring and supportive measures. The patient will be connected to a patient monitor for close monitoring of their vital signs including heart rate, blood pressure, breathing rate, temperature and oxygen saturation. An arterial line may be used for continuous monitoring of blood pressure and taking blood tests. The patient's breathing will be supported by additional oxygen via an oxygen mask, however the patient may be on a ventilator and have a breathing tube inserted into their airway. They will be receiving intravenous fluids via several intravenous cannulas or central line. A urinary catheter is used to monitor urine output and a nasogastric tube will be used to rest the intestine if this has been injured or if the patient is ventilated. Anti-thrombotic stockings will be applied to guard against the development of a deep vein thrombosis (DVT) in the lower limbs. A sequential compression device may also be used. Pain medication will be given to ensure they are as pain free as possible. If the hospital has a pain team they will become involved to further ensure pain relief is optimised. Nutrition will be started as early as possible. Feeding via a nasogastric tube is preferred. However if this is not possible, the patient will be fed intravenously.

     

    • Complications

    Haemorrhage can result in shock and complications associated with massive blood transfusions. Delayed haemorrhage from liver or spleen bruising tends to occur several days after the initial injury.

    Infection: intra-abdominal infection can be a significant problem. Predisposing factors include injury to the intestines, open wounds, delayed diagnosis of hollow organ injuries, and large amounts of damaged tissue.

    The stomach and intestines often fail to work for a variable time after injury. This causes problems such as delayed stomach emptying and paralytic ileus (paralysed bowel).

    Severe haemorrhage, bowel swelling or bowel paralysis can lead to a high intra-abdominal pressure as the fluid collects inside the abdomen. This can make it more difficult for a patient to breathe because of increasing size and pain. Sometimes the pressure inside the abdomen may need an operation to reduce it and afterwards the surgeons use a mesh repair or leave the abdomen open. Repeated operations are required and the abdomen is closed in stages.

    • How long will the patient remain in Intensive Care?

    This is a difficult question to answer and all depends on the patient's initial injuries and subsequent complications. Please direct questions regarding a specific patient to the intensive care and surgical staff.

     

    Note:

    The information contained on this page is general in nature and therefore cannot reflect individual patient variation. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nursing staff for your loved one.

  • Pneumonia Open or Close

    pneumonia

    Pneumonia is an infection in the lung(s).

    Many types of germs cause pneumonia including bacteria, viruses, fungi and others.

    Many types of pneumonia are successfully treated with antibiotics and/or antivirals. Patients with severe forms of pneumonia may require insertion of a breathing (endotracheal) tube and use of a breathing machine (mechanical ventilator).

    Pneumonia is a common condition from which most people recover. Pneumonia can be very serious and especially when combined with other diseases or injuries can lead to death. Two terms that have no formal or technical medical meaning are commonly used outside the medical community to describe pneumonia. While they are not commonly used within the medical community, they are explained here for clarification purposes. "Walking pneumonia" implies a less serious form of pneumonia that is frequently treated at home (outpatient). "Double pneumonia" implies a more serious form of pneumonia involving multiple parts of one or both lungs. It is most frequently treated in the hospital (inpatient).

    Further information about pneumonia can be found here:
    British Thoracic Society

    NHS Choices

    Patient.co.uk

     

    Note:

    The information contained on this page is general in nature and therefore cannot reflect individual patient variation. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nursing staff for your loved one.

  • Sepsis Open or Close

    Sepsis is a condition that starts with a widespread infection throughout the body and grows to life threatening condition. In sepsis, the body's response to the infection creates a new problem, one that traditional antibiotics are unlikely to treat.  Persons at risk for sepsis include those who have experienced trauma and those with chronic disease, low immune function, recent surgery and those with large wounds. Symptoms of sepsis include fever, rapid heart rate and rapid breathing. In more severe cases, blood pressure drops and shock may occur.

    The cause of sepsis is unknown.  While we are learning more about sepsis all the time, we do not know why it occurs.  We do know it follows an infection.  The most important way to stop sepsis is to prevent infections.

    An international effort is underway to treat sepsis (the Surviving Sepsis Campaign).  Therapies such as treating the infection with appropriate antibiotics are essential for success.   New treatments like goal directed therapy are promising.  Rapid treatment is urgent in sepsis.  The longer treatment is delayed, the less likely sepsis can be treated effectively. 

    Sepsis can be very dangerous even when optimally treated. Sepsis can lead to widespread organ damage and organ failure making it one of the most common causes of death in ICU patients.

     

    Note:

    The information contained on this page is general in nature and therefore cannot reflect individual patient variation. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nursing staff for your loved one.

  • Abdominal Aortic Aneurysm Open or Close

    An abdominal aortic aneurysm (AAA) is a widening or “ballooning” of a part of the abdominal aorta.

     

    aaa

    The aorta is a large blood vessel which carries blood rich in oxygen from the heart to every part of the body. It passes from the heart through the chest area and then down through the abdominal area. Around the navel (bellybutton) it branches into two smaller vessels to supply the legs. This section of aorta in the abdomen is called the abdominal aorta.

    An abdominal aortic aneurysm is a widening or “ballooning” of part of the abdominal aorta. This is most commonly due to hardening of the arteries (arteriosclerosis) which causes an area of the wall of the aorta to become weakened. The pressure of the blood being pumped through the aorta causes the weakened area to bulge. Many people with an abdominal aortic aneurysm have no symptoms and it is often only discovered while having investigations done for other reasons.

     

    • Who is most likely to have an abdominal aortic aneurysm

    Abdominal aortic aneurysms are found mostly in the over 60 year old age group and are more common in men than women. The person will often have a history of some or all of the following; high blood pressure, diabetes, high blood cholesterol level and smoking.

     

    • What is the treatment for an abdominal aortic aneurysm

    Abdominal aortic aneurysms which have no symptoms and are 5cms or less in width do not require surgery. They are monitored every 6 to 12 months by scanning (ultrasound) the abdomen and high blood pressure is controlled with medication. Smoking is discouraged. Some patients who are young and healthy may decide to have surgery for aneurysms between 4 and 5cms. Aneurysms will usually require surgery if they are larger than 5cm, getting larger or causing symptoms.

    There are two main methods of repairing a AAA: the open approach and a stent graft. When the patient has an open operation the area of aorta affected by the aneurysm is cut open and a tube of synthetic material inserted to provide a safe channel for the blood to flow through. The aneurysm is then sewn around the synthetic material.

    These days the aneurysm can in some cases be repaired by a method called a “stent graft” or Endovascular Aneurysm Repair (EVAR). This does not involve the abdomen being opened. Instead the aneurysm is reached by a thin tube (catheter) passed into a blood vessel through a small cut made in the groin. Attached to the catheter is a long capsule containing a tube of synthetic material encased in a collapsed metal-mesh cylinder. When the catheter reaches the area of the aneurysm the stent is activated and springs open and attaches itself to the wall of the aorta. The synthetic tube now provides a safe passage for blood flow.

    Patients having this method of treatment generally have shorter stays in hospital and are back on their feet quicker than those having the more traditional operation.

     

    • What are the complications an abdominal aortic aneurysm?

    The big risk with large abdominal aortic aneurysms is rupture which is a medical emergency. A lot of blood is lost and the patient quickly becomes shocked. Survival rate is less than 50%.

    A blood clot can easily form in the aneurysm and a piece can break off and get stuck in the smaller blood vessels in the legs. This blocks blood supply beyond this point and urgent treatment in hospital is required to stop the tissue in the leg from dying.

     

    • What happens in ICU?

    Monitoring - Blood pressure is displayed continuously on the bedside monitor via an arterial catheter . Heart monitoring with electrocardiograph (ECG) is displayed on the bedside monitor. Oxygen levels are checked by a blood sample from the arterial line and by a probe attached to the finger.

    Medication to control blood pressure is often given as an infusion at first via a rate controlled pump. This allows for strict blood pressure control. When the patient is fully awake and able to swallow, blood pressure tablets may also be given.

    Circulation to the legs is assessed regularly to observe for new signs of reduced blood flow to the area.

    Urine output is monitored via a tube (catheter) in the bladder to assess kidney function.

    Pain relief is provided as necessary.

    Artificial Ventilation may be required in some instances.

    • How long will the patient remain in ICU?

    Generally the patient needs to stay in the Intensive Care Unit for one or two days following repair of an abdominal aortic aneurysm. The stay following repair of a ruptured aortic aneurysm however is considerably longer.

     

    • Internet Links

    Vascular Web

     

     

     

    Note:

    The information contained on this page is general in nature and therefore cannot reflect individual patient variation. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nursing staff for your loved one.

A comprehensive list of conditions can be found on the NHS Choices website.