Long-Stay Patient Hot Case

by Chris Nickson, Last updated December 7, 2012

GENERAL APPROACH

Illness requiring ICU admission
Reason for ongoing admission
Things that need to happen to allow discharge

INTRODUCTION

CUBICLE

personal items
weaning or rehabilitation plan

INFUSIONS

minimal IV therapy
feeding established
treatments required for slowly resolving problems (ongoing IV antibiotics for endocarditis)

VENTILATOR

mode
level of oxygenation: high FiO2, PEEP
pressure support
weaning strategy
tracheostomy

MONITOR

lack of invasive monitoring suggest respiratory wean man problem.

EQUIPMENT

type of bed: prevention of pressure areas
DVT prophylaxis strategies
limb splints to prevent joint contractures: pressure areas

QUESTION SPECIFIC EXAMINATION

hands/arms -> head -> chest -> abdo -> legs/feet -> back

-> general:
-> cardiovascular:
-> respiratory:
-> abdominal:

neurological: conscious

signs of slow improvement: being dressed in own items, dentures, wearing spectacles, interest in entertainment for stimulation.
depression: flat affect
pressure areas
DVT
scars/wounds: vascular access or traumatic injuries
eye care
personal hygiene
mouth care
grooming
nutrition
bowel function
psychoactives: antidepressants, anxiolytics, hypnotics, antipsychotics.

RELEVANT INVESTIGATIONS

OPENING STATEMENT

=

Global statement
Reason for admission
Obvious complications
How to progress from here

About Chris Nickson

FCICM FACEM BSc(Hons) BHB MBChB MClinEpid(ClinTox) DipPaeds DTM&H GCertClinSim

Chris is an Intensivist at the Alfred ICU in Melbourne and is an Adjunct Clinical Associate Professor at Monash University. He is also the Innovation Lead for the Australian Centre for Health Innovation and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He has a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia's Northern Territory, Perth and Melbourne. He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. He coordinates the Alfred ICU's education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the 'Critically Ill Airway' course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of Lifeinthefastlane.com, the RAGE podcast, the Resuscitology course, and the SMACC conference. His one great achievement is being the father of two amazing children. On Twitter, he is @precordialthump.

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