Common medications used in critical care

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I often see posts from students who have received placement allocations in critical care and are wondering what to read up on. Here are a list of the most common medications used in critical care that I hope others may find useful.

Sodium Chloride 0.9% (also known as normal saline) – every patient will usually have this on ITU, it is a source of water and electrolytes. Used for replenishing fluid and restoring/maintaining the concentrations of sodium and chloride ions.

Hartmanns fluid – used to replace body fluid and mineral salts. A mixture of sodium chloride, sodium lactate, potassium chloride and calcium chloride in water.

Propofol – sedation used in ITU for critically ill patients on ventilators. Propofol is given continuously via IV infusion.

Alfentanil – used as an opioid analgesia. Suppresses respiratory activity in patients receiving invasive ventilation. Acts within 1-2 minutes and has a short duration of action. Often used alongside sedation such as Propofol.

Noradrenaline – a vasoconstrictor used to treat hypotension. Norad is administered continuously via IV infusion into a central line.

Atracurium – a muscle relaxant used to paralyse. Dose is calculated on patients’ ideal body weight, not actual body weight. Able to be used in patients’ with hepatic or renal impairment due to the way it metabolises. Atracurium relaxes the vocal cords to allow intubation.

Vasopressin – often used as support for other vasoconstrictors, such as norad.

Ranitidine – reduces gastric acid output. Ranitidine is mainly used to stop stomach acid coming up from the stomach while the patient is under anaesthetic or sedation. It can also help to clear up infections within the stomach, when taken with antibiotics.

Remifentanil – used for sedation. Has a shorter onset duration than Alfentanil. Remi is often used overnight for patients who are not quite ready for extubation.

Digoxin – is a cardiac glycoside which increases the force of myocardial contraction and reduces conductivity within AV node. Digoxin helps make the heart beat with a more regular rhythm. Digoxin is used to treat atrial fibrillation.

Quetiapine – antipsychotic. Used for the treatment of ‘mania’ episodes.

Haloperidol – antipsychotic. Mainly used to ease agitation or restlessness in elderly patients.

Furosemide – diuretic. Used in critical care to offload a large positive fluid balance or if the patient is not passing an adequate amount of urine per hour.

Aminophylline – used to treat reversible airway obstructions.  Aminophylline is usually given via IV infusion and is used to treat the acute symptoms of asthma, bronchitis, emphysema, and other lung diseases. Will often be given to patients who become ‘wheezy’ if nebulisers do not appear to be helping. Aminophylline belongs to a group of medicines known as bronchodilators.

Clonidine – used as a sedative agent when weaning patients off stronger sedation.

Tinzaparin –  an anticoagulant used to prevent blood clots in patients with reduced mobility. As the patients in critical care are often sedated and bed bound, all patients will be administered tinzaparin or a variant of this.

Antibiotics – The common ones used are Co-Amoxiclav, Tazocin, Meropenum and Clindamycin.

Love,

T x

 

Information was collated through talking to consultants, critical care nurses and further research through the BNF.

 

 

A day on HDU

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My first placement of year 2 is 6 weeks on ITU/HDU. At Derby university in second year, we have two hub placements. One is for 6 weeks and the other is for 12 weeks. We also have a spoke placement where we spend 4 weeks.

The shift pattern at my placement is:

Long day: 07:15 – 19:45

Nights – 19:15 – 07:45

There are 1/2 days but I won’t be doing any of these during my placement block.

There is no ‘typical’ day on HDU as every day can be different from the next. Below is one day that I experienced on HDU. Other areas/trusts will vary and I would love to hear about your typical days on placement!

07:15 – 07:45 – During this time, we received a handover from the nurse in charge. We then went onto the ward and received a more detailed handover for the patients we would be looking after that day. This included details about why the patient was admitted and followed the A-E approach with a few extra sections. This handover also included any planned interventions for that day, such as x-rays or planned transfers. On HDU, the staff nurses’ usually have 2 patients each for the whole day (2:1).

07:45 – 10:00 – The nurse in charge checks the resus trolley and ventilation trolley to ensure all the correct equipment is present, working and within the expiry date. The staff nurses also complete bedside equipment checks such as ensuring the equipment alarms are operating, checking the oxygen and suction points are working and checking the infusions to ensure there is enough left to last a couple of hours. After all these checks, the patient is asked if they would like to have a wash and a fresh gown. If the patient declines, they are re-positioned and a skin check completed. Everything is documented on the daily observations chart, an A3 sheet with information on both sides. All observations, fluid input/output and re-positioning is documented on there. The patients have a drink and breakfast if they are able to eat.

10:00 – 12:00 – Usually between this time, the consultants and nurse in charge will do a ward round. They discuss each patient and what the next step of their medical plan should be. Sometimes this will be a new medication or transfer to a ward such as respiratory or stroke wards, depending on the patient.

12:00 – 18:00 – It’s hard to fully describe what happens in the afternoon as every day is different. Obs are done hourly or 2 hourly, depending on the patient. Obs on HDU include fluid input and output. Fluid input includes any medications given. Fluid output includes blood taken as well as urine output. NG tube aspirations are included in the fluid output also. Every hour/2 hours the balance is recorded so we can see if the patient is in negative or positive fluid balance. Equipment checks are carried out once again throughout the afternoon to ensure alarms are still functioning correctly.

Personal care needs are met as needed and re-positioning is carried out regularly if the patient is unable to do so themselves. Patients observations are monitored closely and medications/oxygen can be adjusted accordingly. Equipment may also be changed if needed, such as changing a patient from a nasal cannula to an oxygen face mask. ABG’s may be taken in this time and the results recorded on the daily observation chart, as well as the patients medical notes.

New patients can be admitted from surgery, A&E or other wards.

18:00 – 19:15 – Daily notes are completed for the patients we have been looking after. The daily handover sheet is updated ready for the handover to the night shift team.

19:15 – 19:45 – Night shift arrive and the nurse in charge gives a handover covering the whole ward. The night shift team then come onto the ward and receive detailed handovers for their patients.

Look out for further blog posts in my HDU/ITU series!

Love,

T x