Critical Care Medicine Frequently Asked Questions
Critical Care Medicine (CCM) is a specialty that involves the management of patients with life-threatening, frequently complex medical illnesses. The CCM physician has expertise in the evaluation and management of these critically ill patients. These patients may have dysfunction or failure of one or more organ systems, including the cardiac, pulmonary, neurologic, liver, kidney, or gastrointestinal systems. The critical care physician may utilize nutritional, hemodynamic, artificial ventilatory, and other sophisticated treatment modalities to help stabilize the patient. After stabilizing the patient, the CCM physician strives to gain an understanding of the cause of the patient’s critical illness.
Procedures used to help support and identify the cause of the critical condition include intubation, central venous catheterization, arterial cannulation, pulmonary artery catheterization, thoracentesis, bronchoscopy, lumbar puncture, paracentesis, and chest tube thoracostomy.
The CCM physician coordinates the care provided to the critically ill patient with other medical or surgical specialists, as well as ancillary professionals such as dietary, respiratory therapy, and pharmacology.
The CCM physician regularly meets with the patient and family to provide information regarding the patient’s condition, diagnosis, support, required testing, treatments, and prognosis. With input from the patient (if the patient is able to participate in decision-making) along with the family the CCM physician makes sure the CCM care plan is consistent with the patient’s previously stated or written wishes.
An Intensive Care Unit (ICU) is a specialized area of the hospital where expert care of critically ill patients can be delivered efficiently. Nurses and physicians who have special interest and training in the care of critically ill patients staff the ICU. Patients are admitted to the ICU for very close monitoring (the nurse-to-patient ratio is usually one nurse for every two or three patients), specialized nursing care not available on regular hospital units, or management of critical illness.
The patients are usually observed utilizing continuous cardiac and oxygen saturation monitors. Patients may also have a urinary bladder catheter (with urinary output monitored hourly), central venous catheter, peripheral and/or pulmonary artery catheter, and other forms of monitors placed. Many of these devices have “alarms” that ring to signify to the nurse that one of the parameters (for example, heart rate) is outside of a pre-set range. Monitor alarms do beep frequently in the ICU but usually do not indicate a serious problem.
Due to the severity of illness and intensity of the care required in the ICU setting, most ICUs have limited visitation times. However, when patients are more stable, the ICU staff may allow more flexible visitation. Families visiting their loved ones are often overwhelmed by the severity of their family member’s illness as well as the ICU environment with all of its bells, whistles and gadgets. Family members should feel free to ask the ICU staff about their loved one’s condition and diagnosis as well as the purpose of any equipment or monitors in the room.
Family meetings with the physicians can be arranged at the onset of the illness and thereafter on as needed basis. During these meetings, the physician may discuss the patient’s diagnosis, condition, progress, prognosis, and treatment options. Usually one family member is appointed to be the “family spokesperson”. This person is the primary contact and should be at all family meetings, if at all possible. Although other family members may attend family meetings, it is encouraged to channel all communication with the physician through the family spokesperson.
- Acute Liver Failure
- Acute Renal Failure
- Acute Respiratory Distress Syndrome
- Congestive Heart Failure
- Endocrine Emergencies
- Gastrointestinal Bleeding
- Multiple System Organ Failure
- Post-Operative Care of Surgical Patients
- Respiratory Failure
- Sepsis Syndrome and Septic Shock
- Stroke and Other Neurologic Emergencies
- Toxic Ingestions and Overdoses
- Intravenous Catheterization
- Central Venous Catheterization
- Arterial Cannulation
- Nasogastric Tube
- Pulmonary Artery Catheterization
- Lumbar Puncture
- Chest Tube
- Arterial Blood Gas
- Chest X-Ray
- Blood Tests