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Intensive Care Unit

Scope of Service

Types of Patient Served and Range of Conditions and Diagnoses Treated

This unit provides intensive care therapy to patients with medical & surgical conditions requiring such therapy. These include the following:

A. Life – threatening cardiac conditions including:

• Acute ST Elevation Myocardial Infarction (MI)
• Cardiogenic shock
• Non ST elevation MI, Acute Coronary syndrome, persistent chest pain at rest and heart failure
• Complex arrythmias, including tachyarrythmias and bradyarrythmias associated with hemodynamic instability
• Temporary transvenous pacing wires
• Electrolyte imbalance in cardiac patients with Serum potassium abnormalities (hypokalemia or hyperkalemia)
• Dissecting thoracic aneurysm, cardiac tamponade or pericardial constriction with hemodynamic instability

 B. Patients with impending respiratory failure:

• Muscle fatigue evidenced by use of accessory muscles and tachypnea
• Narrowing of the airway associated with stridor
• Acute hypoxia (PO2< 50 or more than 10 mmHg below patient’s normal); and or
• Acute hypercapnia (PCO2 elevation of 10 mmHg above normal or patient’s previous level and pH < 7.2)
• Patient requiring continuous CPAP or BIPAP

C. Patients requiring intubation and mechanical ventilation
D. Patients who require titration of continuous vasoactive drug infusions, cardiac/ invasive monitoring, and pharmacological therapy such as inotropes and antihypertensives 
E. Patients who require treatment of septic shock 
F. Patients with primary cardiogenic shock 
G. Patients requiring invasive or intensive monitoring for conditions such as:

• Hemodynamically compromising cardiac arrythmias or life-threatening arrythmias
• Pulse < 40 or > 150 bpm
• Systolic blood pressure < 80 mmHg or 20 mmHg < patient’s normal systolic BP
• MAP < 60 mmHg
• Pulmonary artery catheter monitoring
• Intracranial pressure monitoring
• Arterial pressure monitoring

H. Significant gastrointestinal bleeding:

• Drop of 2 gms (6% of Hct) from previous or recent Hgb and
• On-going active bleeding

I. Inpatients that require emergent Transesophageal Echocardiogram (TEE) 
J. Cardiac Intervention patients:

• Post angioplasty/ stent
• Intra Aortic Balloon Pump treatment
• Sheath to remain in site

K. Patients requiring CVVHD/F 
L. Paediatric patients who require ventilatory support 
M. Post-surgical patients will be admitted to ICU with the following guidelines:

        1. High risk post-surgical patients defined as:

                a. ASA IV & V and emergency cases
                b. ASA III, IV & V, major surgery for monitoring
                c. Surgery greater than 10 hours duration or 6 hours in prone position
                d. Significant fluid or blood loss
                e. Cardiac history predisposing to perioperative MI
                f. Hemodynamically compromising arrythmias
                g. Patients with high risk for cardio-pulmonary complications
                h. Post operative patients with intensive pain management measures like epidural infusions and morphine infusion

        2. The following post-operative patients will not be recovered in RR and will come directly to ICU:

        a. Patients suffering an intraoperative complication, i.e. hemorrhage, cardiac abnormalities, etc.
        b. Patients who will be maintained on mechanical ventilation
        c. Patients requiring intensive treatment that recovery room is not equipped to provide
        d. RR is full and holding the patient in the OR would negatively affect the OR schedule

N. Other specialized patients to be admitted to ICU may include:

• 1. Life-threatening metabolic abnormalities
• Life-threatening drug overdose
• Thrombolytic therapy for non-cardiac treatment
• Toxic drug levels in a hemodynamically or neurologically-compromised patient
• Refractory seizures

Patients with life-threatening cardiac conditions, who require:

• Monitoring (including invasive hemodynamic monitoring of pulmonary artery and/ or systemic arterial pressures)
• Active titration of intravenous vasoactive drugs, such as inotropes and vasodilators

Range of Treatments or Activities Performed

The following diagnostic and therapeutic modalities are utilized to facilitate patient care:

•  Invasive hemodynamic monitoring
• Administration of Inotropes and Vasoactive Agents
• Mechanical Ventilation
• Cardiac Monitoring
• Cardioversion
• Central Venous Cath placement
• Intra-aortic balloon pump management
• Placement of temporary transvenous pacemaker
• Thrombolytic therapy
• Transcutaneous pacing
• Transesophageal Echocardiography
• Continuous Renal Replacement Therapy
• Hemodialysis
• Kidney biopsy (bedside)
• Fluid and electrolyte replacement 
• Blood and blood component administration
• Airway management
• Skin and respiratory care
• Pain Management, Patient Controlled Analgesia, Epidural Analgesia
• Emergency resuscitation procedures 
• Management of post operative drains and wound care
• Infection Control
• Tracheostomy care
• Nutritional care – TPN / Enteral Feeds
• Bedside bronchoscopy / endoscopy
• Bedside Percutaneous tracheostomy
• ICP monitoring 
• Bedside x-rays
• Arterial blood gases
• Psychosocial care
• Patient / significant other education

Types of Staff Carrying Out these Activities

The ICU is staffed by highly competent nurses trained in ICU care and is headed by a Unit Nurse Supervisor and a Charge Nurse. The nurse to patient ratio is maintained at 1 nurse : 1 patient or 1 nurse : 2 patients. 
An ICU specialist is assigned in the unit at split duty times of 0800 hours to 1200 hours and 1600 hours to 2000 hours and is on-call during weekends and on sharing basis with Internal Medicine residents’ on-duty. 
On off duty hours, Medical & Surgical residents provide ICU coverage. ICU also has a support staff of two nurse assistants and two ward aides. 
Internal Medicine subspecialty consultants make rounds daily and collaborate with other clinical specialties and subspecialties through referral if the need arise. 
In case of need for extra staff nurses in the ICU, the ICU Nurse Supervisor or Charge Nurse collaborates with the Hospital Nursing Supervisor on-duty to ask for pullouts from other units or call off-duty nurses to work overtime. 

Site & Times Care & Service are Provided

ICU is open 24 hours/ 7 days a week and is located in the Third Floor with separate Medical and Surgical Intensive Care area inside the unit plus Isolation Rooms. 
ICU admissions are either through Emergency Room, transfers from the floor, Operating Room (OR), Cardiac Cath Lab (CCL) and the clinics.

Hours of Operation:

Saturday - Thursday (08:00 am - 12:00 pm & 04:00 pm - 08:00 pm

Note: (On-call services 24 hours a day / 7 days a week)

Telephone Number(s)

+966 3 826 2111    Ext. 1156