Emergency & Critical Care ADMISSION CRITERIA TO ICU

الموضوع في 'كتب طبية' بواسطة ashdom, بتاريخ ‏ديسمبر 3, 2018.

  1. ashdom

    ashdom Active Member

    إنضم إلينا في:
    ‏ديسمبر 8, 2008
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    المصدر: ADMISSION CRITERIA TO ICU
    في منتدى : كتب طبية



    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 (newly discovered)

    * 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 (newly discovered)

    * 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 (acute onset)

    * Unequal pupils in an unconscious patient

    * Burns covering > 10% BSA

    * Anuria

    * Airway obstruction

    * Coma

    * Continuous seizures

    * Cyanosis

    * Cardiac tamponade
     
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