Guidelines

Guidelines for the Care of a Patient with Tracheostomy

Introduction

Temporary tracheostomy is now a common procedure in intensive care as it has become regarded as benificial for the general critical care population who are long-term ventilated. Tracheostomies can be temporary or permanent and performed using either an open surgical technique, or percutaneously. As with all procedures, the benefits are associated with risk, both during and after insertion. The most common problems with tracheostomies in critical care, are related to obstruction or displacement.

Every Hospital must have a procedure for managing patients whose tracheostomy is blocked or displaces. Staff must be aware of this and receive appropriate training to manage the problem.

These guidelines are developed in order to reduce morbidity and morality in this population of patients and also to give a clear guidance for those intensive care who encounter difficulties in managing them.

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Guidelines for the Management of Potassium Imbalance in Adults

Introduction

Potassium imbalance is commonly encountered in the critical care setting and can lead to significant morbidity & mortality if not corrected appropriately.

Normal range for potassium: 3.5‐5.5mmol/l ( May vary slightly between different laboratories)

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Guidelines for Transport of Adult Critical Care Patient in Sri Lanka

Introduction

These guidelines apply to the transport of adult critically ill/ critical care patient in Sri Lanka, transferred outside of a normal critical care environment. This includes both intra-hospital transport and inter-hospital transport and the level of preparation & care needed in both situations is the same. Inter-hospital transfer would be by road as air ambulances are not available in Sri Lanka at the time of these guidelines.

The decision to transfer a patient from the intensive care unit to another hospital must be made by the consultant responsible for the unit in consultation with the consultant under whom the patient has been admitted.

The decision to accept a transferred patient too must be made by a consultant responsible for intensive care unit and the relevant consultant of the receiving hospital.

Once the decision is made to transfer a patient, inform the patient/ family regarding the decision to transfer, but that should not delay an urgent transfer.

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Guidelines on Nutritional Support in ICU

Introduction

These guidelines apply to nutritional support in adult patients in critical care units of Sri Lanka. In this document, enternal feeding refers to non-volitional delivery of nutrients via a tube into the gastrointestinal tract, and parenteral feeding refers to aseptic intravenous delivery of nutrients is not possible.

Critically ill patients are in a catabolic state induced by severe disease and appropriate nutritional support should be initiated as early as possible, in all patients admitted to the critical care unit unless indicated otherwise. Starvation and underfeeding in critical care patients are associated with increased morbidity and mortality.

Nutritional support can be provided by enteral or/and parenteral routes, enteral being the preferred one.

It is important in patients who are malnourished and those who are at risk of malnutrition.

During a critical illness, in addition to catabolic stress, there is an increased inflammatory response leading to increased nutritional requirement. Also there is an altered gut morphology and function, causing impaired digestion and absorption.

Poor nutrition in critically ill patient causes decreased immunity, decreased respiratory muscle function and a reduced respiratory capacity, ventilator associated pneumonia, difficult weaning off ventilator and poor wound healing.

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The protocol for Magnesium Therapy in Tetanus

Introduction

This protocol is suitable for all patients diagnosed as tetanus having generalised muscle rigidity with or without spasms. Patients should be managed in a high dependency unit or ICU with immediate access to ventilatory support if needed.

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