Question

Scenario # 7

There has been a car accident and the driver if the car was brought to PRU. She has been stabilized in the emergency department; however, transferring her to another facility 40 miles to ICU away would not be appropriate in her health status for her injuries would not sustain life.

The patient has to be placed in ICU in the next 1-2 hours. The night supervisory gains composure and describes the status of patients occupying the 4 ICU beds.

Patient A- A 59 year old female, comatose, stroke victim who had been in ICU for 33 days; uncertain prognosis; retired, with no family

Patient B- 2- week old premature male, has Down's syndrome and has been in ICU since birth; hospital has brought a legal action to permit surgery to repair a duodenal atresia, a procedure the parents had not permitted; family in adjacent city.

Patient C- 35 year old male who underwent emergency appendectomy, developed severe wound infection and septicemia, source of infection is unknown; because of previous anaphylactic shock in reaction to antibiotics; requires ICU care; bachelor; aged mother in city.

Patient D- 13 year old female undergoing chemotherapy for leukemia with an experimental drug; has been in remission three times in the past; close monitoring of the experimental protocol and potential reaction to drug requires ICU care; family in city.
New Patient- 24 year old patient; college honor student in physics. scholarship winner; pregnant; engaged; no family known.

The supervisor ended the brief description by asking, "What should I do?"

Randall has to make a decision. (continued on next page)

1. What should Randall do? Why is your choice the best answer? Support your thoughts.

2. What steps should be taken in reaching a decision?

3. Describe a means to avoid a similar problem in the future and how to deal with issues as they arise. (Adding additional ICU beds is not a budgetary or space option)

Answer 1

1, The lady who has met with an accident need immediate ICU care. Because her injuries to be diagnosed properly and she need continuous vital monitoring and oxygen support atleast for 1 to 2 hours.Unless they found nothing happened in her body and the injuries are not major she must be in close observasion..So in this scenario the hospital already occupied with 4 patient and there is only 4beds in ICU.so the patient can be divided in to seperate care unit according to their disease condition..
?2, patient A: Patient with stroke victim and comatose(state of coma),the patient need to be admotted in intensive care unit(ICU)..But the patient need neuro care must be placed in stroke ICU or stroke unit..Stroke ICU must be speciallized with mechanical ventilator,invasive monitor and intracranial pressure management and nurse -patient ratio must be focused to organised inpatient care. So this patient can be shifted to stroke ICU..If the hospital don't have seperate facility for that then the patient must be in ICU only for the long term management..
?Patient B: Pre mature baby has no protective fat,baby will feel cold in normal temperature..Thet too ICU will be set up high cool technology..Baby can not be placed for long in that unit..Baby must be immediately after born to be placed in an incubator or under a secial heating device called called a radiant warmer to keep the baby warm..So baby must be get shifted to NICU Neonatal ICU rather than being in general ICU BEing with all the patient.The baby also having deodenal atresia they need special care for IV fluids to avoid dehydration..they need tube through nose called nasogastric tube to drain away any fluid and air collection in the stomach..Baby also premature prone to get infected easily..So this baby should be shifted to NICU..baby need close monitoring till it continuous to grow..
?Patient C: Patient developed with anaphylactic shock ,septicemia and wound infection need good wound care. it is important role in preventing sepsis,as any break in the skin can potentially harbor bacteria that may become a cross-infection risk to other patients..
?Patient C: This patient need ICU care .Because inorder to mange the complication and safe handling with small age they must be in ICU..Tumor lysis syndrome,nausea,vomiting,pain mangement and adverse medication effects requiring antidotes are complications for patients receiving chemotherepy in the ICU.
? New paient with pregnancy..she no need any admission.She need only phychological counsilling..
?3, So patient B can be shifted to NICU and accident patient can be placed under observation..Hospital must have facilities for intensive treatment according to patient's condition..It must be divided by Neonatal Icu,Paediatric IcU,Cardiac care unit,Trauma care unit,Post-operative care unit and neuro ICU..Additional Recovery now provides an extensive directory of hospital and health care facilities for all the hospitals..