Guidelines

Guideline for Prevention of Venous Thrombo-Embolism (VTE) in patients admitted to Critical Care Unit

Venous thromboembolism (VTE) has been found to be one of the most common complications in the critical care patient population.

The reported incidence of deep vein thrombosis (DVT) in intensive care unit (ICU) patients, using routine venography or doppler ultrasound, ranges from < 10% to almost 100%, reflecting the wide spectrum of critically ill patients.

The risks of VTE in surgical, obstetrics, trauma and acutely ill medical patients are well established and are relevant to the critical care population, which is principally composed of these subgroups.

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Guideline for Intensive Care Unit Design

Introduction

Intensive care unit is a distinct organisational & geographic entity for clinical activity & care, operating in cooperation with other departments integrated in a hospital. It is preferably an independent unit or department with controlled access that functions as a closed unit under the full medical responsibility of the ICU staff in close concert with the referring medical specialists.

An ICU should accommodate as a minimum at least 6 beds with 8-12 beds considered as the optimum. Larger ICU may create separate specialised functional sub units with 6-8 beds sharing the same geographical, administrative and other facilities.

To establish a critical care unit in a hospital in Sri Lanka, it is strongly recommended do so only in centers which has a minimum of two Consultant Intensivists/ Anaesthetists, so that 24/7 cover to the unit can be guaranteed.

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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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