Working In ICU

[angela929]

I am a new graduate from university. And I am so lucky that is employed by a hospital. As By now, I have been working for 3 months already. By next month, I will be going to have my Sunday Duty which means that I have to go into ICU. Which makes me very nervous!!! As in my student placement, I have never worked in ICU before. Is there anything special that I have to notice or anything that I should have revise before my duty.
Thanks !!!!

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[alophysio]

My advice is simple - don't kill anyone.

Nurses tend to be militant and know what is going on so it's pretty hard to kill someone.

If in doubt, ask someone there. Don't be a hero!

That's what I always did and no-one died! Now i am a musculo physio i don't have to worry about ICU! Yippee!

[sdkashif]

There is a an interesting answer made to your question by alophysio. Any how if you don't have experience in working in ICU, don't be nervous. The important thing is that you should be theoretically very sound regarding the basic skills of physiotherapy like breathing exercises both inspiratory & expiratoiry, breathing control teaching, relaxation teaching, mobilization techniques like percussion shaking, suction methods, manual hyper inflation, working on IPPV machines and doing the physiotherapy to mobilizing the secretions while detaching the patients for short period of time for suction. A physiotherapist working in ICU is always a member of multidisciplinary team managing the pateint under some incharge of the ICU. In UK settig an anaesthetist usually is the incharge of the ICU, some times invoving the cardiologists, medical specialist and many other specialists according to the needs of the pateint. Physiotherapy needs of patient should always be dicussed with the ICU supervisor.

Aims of Physiotherapy In the ICU

Physiotherapist may vary his approach according to the needs of different patients in the ICU. However, there are certain general aims of Physiotherapy which should always be kept in mind while dealing with a diversity of the patients. These can be modified according to the needs of different patients. These are:

1- To assist in removal of excessive bronchial secretions

2- To ensure adequate ventilation of all areas of lungs and to help prevent atelectasis and/or consolidation.

3- To maintain full joint range and muscle power by passive movements- if the patient is unable to perform active exercises.

4- To maintain mobility and good circulation by free active exercises when possible.

5- To ensure maintenance of a good posture by accurate positioning and advice.

6- To help rehabilitate the patient to as full and independent a life as possible by always considering the over all team approach to his mamanement.

Treatment Techniques:

These are postural drainage, manual techniques like percussion, shaking and vibrations, breathing exercises, coughing and huffing, Manual Hyperinflation, suction, IPPV (Intermittent positive pressure ventilation), CPAP, Exercises which include passive ROM, active assistive ROM and Active ROM, positioning and regular turning of the patient.

Patients who require Intermittent Positive Pressure Ventilation (IPPV):

There are variety of patients which require the IPPV. These are :

Patients with acute respiratory failure

Patients with acute ventilatory failure

Prophylactic postoperative ventilation in poor risk patients like cardiac surgery patients & patients with major surgeries

Head injury- to avoid hypoxia and hypercarbia which increase cerebral blood flow and increased intra cranial pressure, hyperventilation to reduce intracranial pressure

Trauma- Chest injury and lung contusion

Severe left ventricular failure with pulmonary oedema

Coma with breathing difficulties. e.g. drug overdose.

Further Information resources:

Have a look over these for further information

Postoperative management in the recovery room compared to ICU for Cardiac Surgery Patients

Physiotherapy in the ICU: Useful or Useless ?

Intensive care

Is intermittent calf compression better than electrical calf stimulation in preventing deep vein thrombosis in high-risk surgical patients?

Does massage given to patients in intensive care improve clinical outcomes?

How do friends and relatives perceive the intensive care unit?

What are the criteria for admission/re-admission to an intensive care unit?

What is the optimal positioning for patients with drug
induced or non drug induced partial or total paralysis in intensive care unit?

Early ambulation after cardiac surgery

Is chest physiotherapy beneficial in ICU ?

Airway Clearance in the ICU

Intensive care Unit

Physiotherapy Guidelines in the Management of
Patients with SARS in hospital

Physiotherapy treatment guideline in handling of Atypical pneumonia

A survay of physiotherapy practices in ICU

Standing with assistance of a tilt table in intensive care:A
survey of Australian physiotherapy practice

Supported Arm Training in Patients Recently Weaned From Mechanical Ventilation

PATIENT RECEIVING VENTILATORY ASSISTANCE

Bronchoscopy for atelectasis in the ICU : a case report and review of the literature - intense care unit

Incidence Of Readmissions And Outcome In A Surgical Intensive Care Unit


The Jack Steinberg Adult Intensive Care Unit

Does acquired neuromuscular damage impact on the short-term prognosis of critically ill patients?

OUTCOME AND COST AFTER UNILATERAL LUNG TRANSPLANTATION: COMPARISON OF CHEST PHYSIOTHERAPY VERSUS POSITIVE EXPIRATORY PRESSURE THERAPY

[angela929]

Thanks you all for those informative reply...
Hope I could handle the situation...anyway ..thx a lot...
And I will always remember don't kill anyone!!!!

[Rymando]

thanks "sdkashif", the info you have provided is helpful for me a physio student who is on placement in an ICU Dpt at present.

So just thought it necessary to post a comment thanking you for your help.

I plan to read through most of the links in due time.