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Continuous Monitoring for Critically ill or Injured Patients in Hebbal, Bangalore

Continuous Monitoring for Critically ill or Injured Patients

Continuous Monitoring for Critically ill or Injured Patients in Hebbal, Bangalore

The purpose of monitoring patients in Hebbal, Bangalore is organ dysfunction detection and guiding of the maintenance and restoration of tissue oxygen delivery. It forms a crucial aspect of patient care for the critically ill in the emergency department since the outcome is linked strongly and directly to the physiological response to critical illness. The main goal of the Intensive Care Unit is to curb any deterioration of the critically ill patient's physiologic during the process of managing the underlying disease.

Significance of Monitoring Critically ill Patients

The key reason for monitoring critically ill patients is providing assistance with treating or preventing cellular injury and organ dysfunction through optimisation of oxygen supply to tissues.  Since delivery of oxygen is the outcome of blood oxygen content and cardiac output, various variables that are commonly monitored provide data about oxygen delivery. Heart rate and stroke volume provide the cardiac output and this is easily monitored and measured.  Blood oxygen content is related to oxygen saturation and haemoglobin content, both easily monitored and measured. If there is an early goal‐directed therapy for the critically ill in the emergency department, the mortality rate will decrease. 

When critically ill patients are monitored, it becomes possible to quantify the patient’s physiological reserve and assess how effective the interventions are proving to be. 

Vital Signs

For recognising even the most acute change in the physiology of a patent, it is important to accurately assess the patient’s vital signs,

  • Heart rate

  • Respiratory rate

  • Blood pressure

  • Oxygen saturation

  • Level of consciousness

  • Temperature

  • Pain

  • Urine output

  • Biochemical analysis

Blood pressure

Alterations in blood pressure (BP) generally reflect underlying pathologies or the attempt of the body to sustain homeostasis. A fall in BP generally occurs just before a cardiac arrest. Inadequate perfusion of vital organs can also be caused by hypotension. Hypertension increases the myocardial workload that can lead to cerebrovascular incidents. 

A non-invasive measuring of BP is done with a sphygmomanometer (BP cuff), but generally it is done invasively with arterial lines that are, usually, inserted in large blood vessels (example, femoral or radial artery. This continuously provides extremely reliable data and ease of collecting arterial blood for checking blood gas and performing acid - base analysis. The central venous pressure line used for BP measuring provides right atrial filling pressure and enables in assessing intraventricular volume and the functioning of the heart. 

Respiratory Rate

Respiratory rate (RR) is the number of breaths in a minute. The normal being 12-20 breaths per minute. A raised RR is the best indication for clinical deterioration that will lead to such events as respiratory failure, cardiac arrest, or even death. 

When a patient loses the ability for spontaneous breathing, mechanical ventilation will be employed. This is a treatment that is frequently used in the ICU. A ventilator is connected to the patient with a tracheostomy tube or an endotracheal tube in a closed circuit. The types of ventilators are based on the methods used for cycling between the expiratory and inspiratory phase, and are,

  • Pressure Control Mode: Both inspiratory pressure and rate are set, with the volume being dependent on the lung compliance of the patient

  • Volume Control Mode: Tidal volume is pre-set and rate is set, while the peak inspiratory pressure varies based on the degree of lung compliance of the patient

Pulse

Pulse is an artery’s palpable rhythmic expansion caused due to the increased volume of blood that is pushed into the vessel by the heart’s contraction and relaxation. It provides circulating volume and contractility strength. Pulse is impacted by several factors, such as,

  • Age

  • Existing medical conditions (for example, fever)

  • Medication (for example, beta-blockers)

  • Status of fluid (hypovolaemia / hyper)

One part of the pulse is its measurable characteristic, heart rate. With a palpating pulse, the amplitude / strength of the pulse, its regularity, and its peripheral equality is to be considered. Monitoring of several pulse characteristics is done with an ElectroCardiograph (ECG) that proves key in cardiac rhythm disorder diagnosis. Cardiac arrhythmia incidents in ICU are attributable to imbalance in electrolyte, invasive lines, metabolic disturbances, multiple drug therapy and fast changes in intravascular volumes. Cardiac monitoring in the ICU continuously measures ECG, heart rate, rhythm, and oxygen saturation. With continuous monitoring, problems are caught immediately and response can be timely. 

Arrhythmias fall into one of the two groups; bradycardias and tachycardias. 

Pulse Oximetry or Oxygen Saturation

Pulse oximetry is used for measuring saturation of arterial oxygen in peripheral blood vessels. This technique is painless, easy to perform, and non invasive, in which a probe is placed on the patient’s earlobe or fingertip for measuring oxygen saturation.

Temperature

Clinically, there are three types of body temperature, 

  • Core body temperature

  • How the patient is feeling

  • How patient feels to touch / surface body temperature

Core thermometers that can be located on catheters and such probes that can be inserted into oesophagus, rectum, bladder, or pulmonary artery, are appropriate for the critically ill.

Cool temperature of skin should be assessed as it could indicate poor peripheral perfusion and capillary refill time.

Level of Consciousness

The most important single indicator for cerebral functioning is level of consciousness. It refers to a patient’s degree of awareness and arousal. With the critically ill, assessing of LOC is commonly done with Glasgow Coma Scale (GCS). 

With GCS, the following is assessed,

  • Wakefulness 

  • Awareness in the patient to understand and demonstrate what was said by a practitioner by completing tasks

AVPU rapid neuro assessment method is also used at times, that is,

  • Alert

  • Responsive to Verbal stimulation

  • Responsive to Painful stimulation

  • Unresponsive

Pain

Pain assessment is crucial to the recovery of patients and their improved functional outcomes. Pain assessment tools in ICU comprise numeric pain rating scale, analogue scale, critical care pain observation scale, and behavioural pain scale and the. Heightening of sympathetic activity, such as raised heart rate, hypertension, and restlessness are seen as pain indicators in patients who are paralysed or are heavily sedated.

Since pain is a hindrance in physiotherapy, steps, such as administering analgesia to the patient, should be taken before the session. Pain related physiotherapeutic interventions are not analgesic medication’s substitute, but are meant to decrease the analgesic medication’s dosage that is being used so that their side effects can be reduced.

Urine Output

Urine output indicates renal perfusion, and also indicates cardiac output because 25% cardiac output is seen to perfuse kidneys. When kidneys don’t excrete metabolism’s waste products it causes hyperkalemia, metabolic acidosis, and uremia. A drop in urine output leads to renal failure. 

Consult with a team of experts in Hebbal at Manipal Hospitals to know more about treatment now.

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