Download Unit 6

Unit 6
ICU
Word Formation
ped/o ( child)
iatr/o ( medicine) e.g. pediatrics
tele- ( distance) e.g. telemetry
-metry ( measurement)
-meter ( instrument) e.g. oximeter
endo- (inside) e.g. endotracheal
trache/o (trachea)
ex/o (outside) e.g. extubation
diet-(food) e.g. dietetics
para-(outside, abnormal)
enter/o ( intestines) e.g. parenteral
-ia (diseased condition) e.g. arrhythmia
-lysis ( dissoved) e.g. thrombolytic
orth/o (straight, normal) e.g. orthopedic
calc(i)- ( calcium) e.g. hypercalcemia
vas/o (vessel) e.g. vasopressor
brady- (slow) e.g. bradycardia
tachy- (fast) e.g. tachycardia
cardi/o (heart)
-pnea ( respiration) e.g. tachypnea
spir/o (respiration) e.g. respiratory
therm/o (heat) e.g. thermal
encephal/o ( brain) e.g. encephalopathy
dia- ( apart from) e.g. dialysis
intra- ( inside) e.g.
crani/o ( skull) e.g. intracranial
anesthesia/aneasthesia
----(Greek word aisthēsis means “sensation”,
a/an----without ) 1. 感觉缺失,麻木 2. 麻醉
angina----from Greek meaning “strangling“(窒息)
pectoris---- from Latin meaning "chest"
angina pectoris can therefore be translated as
"a strangling feeling in the chest".
Questions to consider:
1. What do you know about ICU ?
2. Are you familiar with some common devices
in the ICU ?
3. Do you have an idea about general
requirements for both doctors and nurses in
the ICU ?
ICU Overview

Definition
An intensive care unit, or ICU, is a specialized section
of a hospital that provides comprehensive and
continuous care for persons who are critically ill and
who can benefit from treatment.
Intensive care has been shown to benefit patients who
are severely ill and medically unstable—that is, they
have a potentially life-threatening disease or disorder.
 ICU care requires a multidisciplinary team that
consists of but is not limited to intensivists (clinicians
who specialize in critical illness care); pharmacists and
nurses; respiratory care therapists; and other medical
consultants from a broad range of specialties including
surgery, pediatrics, and anesthesiology.
The ideal ICU will have a team representing as many as
31 different health care professionals and practitioners
who assist in patient evaluation and treatment. The
intensivist will provide treatment management, diagnosis,
interventions, and individualized care for each patient
recovering from severe illness.
Description
ICUs are highly regulated departments, typically
limiting the number of visitors to the patient's immediate
family even during visiting hours. The patient usually has
several monitors attached to various parts of his or her
body for real-time evaluation of medical stability. The
intensivist will make periodic assessments of the patient's
cardiac status, breathing rate, urinary output, and blood
levels for nutritional and hormonal problems that may
arise and require urgent attention or treatment.


Patients who are admitted to the ICU for observation
after surgery may have special requirements for
monitoring. These patients may have catheters placed
to detect hemodynamic (blood pressure) changes, or
require endotracheal intubation to help their breathing,
with the breathing tube connected to a mechanical
ventilator.
In addition to the intensivist's role in direct patient
care, he or she is usually the lead physician when
multiple consultants are involved in an intensive care
program. The intensivist coordinates the care provided
by the consultants, which allows for an integrated
treatment approach to the patient.

Nursing care has an important role in an intensive
care unit. The nurse's role usually includes clinical
assessment, diagnosis, and an individualized plan of
expected treatment outcomes for each patient
(implementation of treatment and patient evaluation
of results). The ICU pharmacist evaluates all drug
therapy, including dosage, route of administration,
and monitoring for signs of allergic reactions.

In addition to checking and supervising all levels of
medication administration, the ICU pharmacist is also
responsible for enteral and parenteral nutrition (tube
feeding) for patients who cannot eat on their own. ICUs
also have respiratory care therapists with specialized
training in cardiorespiratory (heart and lung) care for
critically ill patients.

Respiratory therapists generally provide medications
to help patients breathe as well as the care and support
of mechanical ventilators. Respiratory therapists also
evaluate all respiratory therapy procedures to maximize
efficiency and cost-effectiveness.
Large medical centers may have more than one ICU.
These specialized intensive care units typically include a
CCU (coronary care unit); a pediatric ICU (PICU,
dedicated to the treatment of critically ill children); a
newborn ICU or NICU, for the care of premature and
critically ill infants; and a surgical ICU (SICU, dedicated
to the treatment of postoperative patients).

ICU Ventilator
ICU Ward
ICU Bed
Understanding the Text
Para. 1
Question:
1. Why are the numbers of ICU on the rise in hospitals
nowadays ?
Because the need for ICU is growing.
1) There are more and more critically ill patients
nowadays such as the most premature infants,
adults with cardiovascular disease, the severely
injured and so on.
2) People nowadays can live much longer, when they
become ill they need a series of intensive care in
hospitals.
Para. 2
Question:
2. What does this paragraph mainly talk about ?
Para. 3-4
Question:
3. What are the general qualifications of both
physicians and nurses in the ICU ?
Para. 5
Question:
4. What do respiratory therapists usually do in the
ICU ?
Para. 6
Question:
5. What are the responsibilities of a pharmacist in the
ICU ?
Para. 7
medical social worker
Who are medical social workers and what do they do?
 Medical social workers assist patients and their families
with health-related problems and concerns. They lead
support group discussions, help patients locate
appropriate health care and other health services, and
provide support to patients with serious or chronic
illnesses.
They help patients and their families find important
resources they need to overcome unhealthy conditions
such as child abuse, homelessness and drug abuse.
They also help patients with finding legal resources
and financial aid for paying for health services.
How do medical social workers typically spend their
workday?
As a medical social worker, you will likely work in a
hospital, nursing home, health clinic or community health
agency. You will work closely with patients and other
health professionals. For example, you may help a patient
find nursing home care or you may visit hospitals to
counsel patients who have life-threatening diseases. You
may help new mothers find specialized care for their
disabled infants or you could lead a support group for
these women. You also help meet outpatients' needs by
helping them obtain needed equipment and support, such
as meal delivery and home health aides.

Question:
6. What are the qualifications of a dietician in the ICU ?
Para. 3-7
Question:
7. Why is ICU called a physician-led, multidisciplinary
team ?
Because ICU consists of an intensivist physician as
the team leader and other physicians who may
participate as consultants or coattendings in the ICU,
as well as the critical nurses, physician assistants,
respirotary therapists, a pharmacists, a dietitian,
medical social workers, a unit secretary, residents,
and other trainees. Optimal care to the critically ill
patients depends on the teamwork of ICU.
Para. 8
Question:
8. What kind of patients are usually admitted to ICU ?
Para. 9-15
Question:
9. What are the common reasons for the patients to be
admitted to ICU ?
Para. 16-18
 心电图导联（ECG leads）
体表心电图测量中，一般使用四只肢体电极[分
别置于左手（L）、右手（R）、左足（F）、右
足（N）和六只胸部电极（C1～C6）]。不同的导
联表示不同方式的电极连接和组合状态。
e.g. Diagnostic value of head chest lead ECG on
coronary heart disease
头胸导联心电图诊断冠心病的价值
Question:
10. Catheterization is an important intervention in
ICU. Give examples from these paragraphs.
1) An A-line is inserted in patients who require numerous
arterial blood gases in order to avoid repeated punctures.
2) A central venous catheter allows measurement of
central venous pressure (CVP).
3) A pulmonary artery catheter allows continuous display
of pulmonary artery pressure, and variables such as
cardiac output and pulmonary artery occlusion pressure
or wedge pressure, can be intermittently obtained.
Para. 19
Question:
11. In what ways are bedside monitors helpful
according to this paragraph ?
Para. 20
 FIO2 is short for:
Fractional Inspired O2 Concentration
Question:
12. In what conditions are ventilators usually used in
the ICU ?
1) When the patients aren’t able to protect their
airway due to encephalopathy or massive stroke;
2) When the patients have refractory hypoxemia;
3) When the patients have respiratory failure and are
unable to take adequate tidal volume.
aspiration

Definition
Aspiration occurs when liquid or solid material enters
the windpipe (trachea).
sputum aspiration 吸痰
aspiration pneumonia 吸入性肺炎
----form of pneumonia where infected matter is inhaled
from the bronchi or esophagus
Causes
The body has important protective mechanisms
(reflexes) that usually allow only air to enter the
windpipe. If these reflexes are temporarily or
permanently disturbed, then foreign materials,
such as food, saliva or stomach contents can enter
the windpipe. The protective reflexes are most
commonly disturbed when a patient is unconscious
for any reason (e.g., head injury, drug overdose, or
general anesthesia). Some forms of brain injury, such
as strokes, are also associated with aspiration.

Comments
Many people become seriously ill after aspirating a
substance that damages the lung mucosa. Aspiration
is very very serious because the potential damage to
the inner lining of the lung. Aspiration is an important
cause of acute respiratory distress syndrome (ARDS)
and in the most severe forms may lead to death.
Para. 16-21
Question:
13. What are the common devices of ICU mentioned in
the text ? Cite a few.
1) bedside monitors,
2) mechanical ventilators,
3) intravenous mediation pumps,
4) Foley catheters,
5) transvenous pacemakers,
6) dialysis machines ,
7) intraaortic balloon pumps,etc.
Phrases in the Text
1. Attending physician
2. Premature infants
3. Aggressive / surgical intervention
4. Cardiopulmonary / invasive monitoring
5. Perioperative care
6. Multiple organ dysfunction
7. Intensivist physician
8. Respiratory therapists
9. Forced vital capacity
10. Negative inspiratory pressure
11. Endotracheal intubation
12. Dosing schedules
13. Medical social worker
14. Chart maintenance
15. Respiratory distress
16. Mechanical ventilation
17. Hemodynamic compromise
18. Myocardial ischemia
19. Myocardial infarction
20. Thrombolytic agents
21. Cardiac catheterization
22. Neurologic checks
23. IV fluids
24. Volume overload / status
25. Electrolyte abnormalities
26. Metabolic crises
27. Orthopedic injuries
28. Extensive thermal injures
29. EKG leads
30. Automatically inflating blood pressure
31. Arterial blood gases
32. Superior vena cava
33. Hypertonic parenteral fluids
34. Cardiac output
35. Pulmonary artery occlusion
36. Pulse oximeter reading
37. Oxygen saturation / desaturation
38. Massive stroke
39. Refractory hypoxemia
40. Preselected tidal volume
41. Respiratory rate
42. Sequential compression devices
43. Transvenous pacemakers
44. acid-base disturbances
45. Intraaortic balloon pump