Hospital’s intensive care unit has devoted enthusiasts

Press, 6 February 1982, Page 13

Hospital’s intensive care unit has devoted enthusiasts

By

DENIS DWYER,

North Canterbury Hospital Board

information Officer,

Hospital treatment of the critically injured or ill may involve many procedures, and much teamwork, with members working against the clock 24 hours a day, but with precision and purpose. To provide such care as efficiently as possible, upgrading of existing facilities occurred at Christchurch Hospital in 1978, and the reorganised Intensive Care Unit came into being. The present head of the unit is Dr Keith Hickling. He explains the specialist nature of the work.

“Our patients are basically those with acute, potentially life-threatening conditions, which are reversible. Examples of cases treated include haemorrhage, shock, acute respiratory problems, acute cardiac failure, convulsive and comatose states, and poisoning and drug overdoses. Some 60 per cent are referred from Accident and Emergency and the remainder from the hospital wards. Intensive care is essential to the success of certain surgical procedures.”

After the patient has had a full clinical examination, his or her condition is regularly checked. There may be measurement of cardiac output and assessment of the cardiovascular and circulatory state by monitoring of pressures within the heart and main blood vessels. The close and early co-operation of the Pathology Department is required for the determining of precise blood groupings, and studies of the body fluids and chemistry, often at repeated intervals.

X-rays help in distinguishing different forms of respiratory difficulty, and may confirm the need for the early relief of difficulties in breathing that arise when the lung is perforated, or when blood accumulates in it. Or, if the airway is obstructed, the doctor may insert a tube into the windpipe to keep the airways clear. Besides artificial ventilation, sorrie patients require treatment by drugs or other forms of resuscitation.

“Our general philosophy is that if we can get to these patients early, we may prevent the condition becoming worse,” says Dr Hickling. “Acute illnesses tend to cause secondary effects on a number of organs, particularly the heart, lungs, and kidneys, if not treated early. If ward staff feel a patient may be sick enough for admission to Intensive Care, we would like to know sooner rather than later. Usually the decision on whether or not to admit is straightforward.”

The medical staff see nursing care as a very important aspect of the unit's service, with each nurse having a very high level of individual

responsibility. Besides the basic nursing care, there could at any one time be four or more machines linked up to one patient and the sophisticated equipment must be very closely monitored. There are also many measurements to make from various monitoring devices, at frequent intervals.

One patient may require a nurse continuously at his side for long periods, with a second nurse giving frequent assistance. This type of nurs.ing is associated with considerable stress.

The unit is at present housed in an old part of the Christchurch Hospital — off the main corridor, adjoining

the Accident and Emergency Department. The unit will move eventually to an upgraded ward, and this will bring urgently-needed space for beds, and for storage of equipment. One of the unit’s top priorities for new equipment is a computer for monitoring data, analysis, and storage of information, and complex calculation of physiologic measurements. This will aid in patient management and reduce nursing workload, and

will reduce the requirement for other expensive monitoring equipment The cost of this is considerable, however, and shortage of funds maymake immediate purchase impossible. Dr Hickling is an unabashed enthusiast for the role of an Intensive Care Unit. Besides the obvious advantage of specialist care, he cites the proven cost advantage of having a fully comprehensive intensive care unit, handling substantial numbers of patients.

Under intensive care, the seriously injured or ill can often receive treatment necessary for their survival which is not available in a general ward

It is hoped that by use of such aggressive management early in the course of certain illnesses, it may be possible to prevent further deterioration in the condition, and to reduce over-all hospital stay as well as improving survival.

"The typical patient admitted to an intensive care unit is relatively young, and has the potential of making a good recovery and returning to a normal productive lifestyle." Dr Hickling adds.