Introduction

Each year millions of Americans of all ages are admitted to the hospital. Of those admitted, those who are most critically ill or injured are likely to find themselves in the ICU (intensive care unit). This is not only a challenge for those admitted as patients, but also for their families and loved ones. This guide is intended as an information source and "survival guide" for the families of ICU patients. The information section presents the basic facts and operation of the ICU, while the survival guide provides the "tools" for family members to cope with the initial shock, communicate effectively with all concerned and finally, to seek and garner the resources available for themselves and their loved one. The ICU



What Is The ICU?

Simply put, an intensive care unit's the department that is designed and staffed to deliver the highest level of medical and nursing care to the sickest of patients, that a given hospital and modern healthcare is capable of. This is a very important concept and is the anchor-point of all that can and cannot happen in an ICU. All ICUs are not the same. Small or rural hospitals may not have an ICU, while large community or university based medical centers may have a number of specialty ICUs, such as trauma, cardiovascular, surgical, neurological and so on. Children are, as a rule, not admitted to an adult ICU, but are transferred to a medical center with a Pediatric ICU or a Children's Hospital. Physically, an ICU has a relatively small number of beds that are visible and accessible to the nurses' station, often in a large open area. In more modern, well-designed hospitals, the ICU is located a short distance from the emergency department (ED or ER) and surgical department (OR). Access to the ICU is usually through locked doors via a phone to the nurses' station. Lastly, minimum standards and guidelines for the ICU are set forth through federal, state and local governments, as well as by the medical center and medical community itself.

Why Are Patients Admitted To The ICU?

In general, patients who are critically ill, unstable, in need of intensive treatment or continuous monitoring get admitted to the ICU. These include patients who have suffered major trauma, had major or critical surgery or suffered a major medical event and generally have no limits placed on the extent of therapy they are to receive.

Who Staffs The ICU?

ICU staff consists mainly of doctors, nurses and respiratory therapists. The nursing staff is highly skilled and trained in Critical Care nursing, many with nationally recognized certifications in specialty areas and provide continuous care and monitoring of patients. Doctors include the admitting physician, as well as all others providing care and advice. Often a large university-based medical center will have a physician specialist called an Intensivist whose role is to oversee all the care given on the ICU. Respiratory therapists are also frequently or continually present in the ICU, particularly if patients are on a ventilator to assist breathing. Support staff includes laboratory, physical therapy, radiology, dietary or nutritionists and medical social workers.

What Is All That Equipment?

The ICU is full of sophisticated and complex equipment and, as a rule, the sicker the patient and the higher his/her level of care, the more equipment is involved. Every patient has a monitor, a TV-like screen at their bedside (and the nurse's station), which monitors the patient's EKG, blood pressure, temperature and many other things. Many patients have powerful drugs continuously infused via one or many IV pumps. Often patients are on ventilators, which are machines that assist or totally breathe for the patient through a tube inserted in their trachea (windpipe). Most patients have a pulse oximeter a wire with a red light at the end attached to a finger or toe, which determines the level of oxygen in the blood. Patients may have tubes in their bodies that collect fluids, such as the "Foleys" catheter that is inserted into the bladder to collect and measure urine. There are bandages, braces, sophisticated beds and air mattresses to prevent bedsores, traction devices, suction equipment and much more. Keep in mind that everything is there to assist and benefit the patient or to assist the staff in caring for the patient.

What Do The Alarms Mean?

One of the most frightening and upsetting aspects of the ICU, to both patients and families, are when alarms go off. Almost every piece of equipment that monitors patient functions has an alarm. The nursing staff selects what is to be monitored and sets the limits or parameters for each alarm. It's important to remember that an alarm almost never signals an emergency. Instead, it signals to the staff that the patient needs closer attention or an immediate intervention to prevent an emergency. Alarms are tools that can and should be used effectively by staff to assist in the care of your loved one. They are a fact of life in the ICU and should be viewed as such.

Visiting Hours

Visiting hours in a typical ICU run from mid-morning to early evening, usually for 15-minute intervals and are restricted to immediate adult family with children younger than 12 not admitted. Visiting policy is determined by each hospital and exceptions are based on circumstance and are administered by the nursing staff.

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