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KEY POINTS
Physicians, advanced care practitioners, and nurses all share the responsibility of having basic knowledge about bedside technology to properly manage patients as well as to ensure patient safety and reduce complications due to user error.
Standard pulse oximeters use transmittance spectrophotometry, that is, the light source and photodetector regions of the sensor should be directly opposite each other; they are completely unreliable if placed on the forehead or in any configuration that does not allow the transmitter and receiver to be opposite each other.
Medical air is 21% oxygen from a yellow-coded outlet that is used to power air-driven medical equipment; 100% oxygen supplied by a green-coded outlet is for oxygen delivery to the patient. Make sure they are connected properly.
Patients on positive end-expiratory pressure (PEEP) to maintain oxygenation, and require bag-valve-mask (BVM) ventilation during disconnection from mechanical ventilation, should be ventilated with a BVM containing a built-in PEEP valve or with a PEEP valve added to the exhalation port of the BVM.
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The critically ill patient is in constant flux and both monitoring and therapeutic equipment are essential for managing these patients in the intensive care unit (ICU). Physicians, advanced care practitioners, and nurses all share the responsibility of having basic knowledge about bedside technology to properly manage patients as well as to ensure patient safety and reduce complications due to user error.
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BEDSIDE MONITORING SYSTEM
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The bedside monitor is the most prominent device garnering the most attention for both medical staff and patients and their families. Bedside monitoring is designed to display, store, and trend the patient's heart rate, respiratory rate, blood pressure reading (noninvasive and invasive), oxygen saturation, electrocardiographic (ECG) tracing, and pressure waveforms generated from arterial, venous, or bladder catheters. The individual bedside monitor is connected to a computerized central monitoring system outside of the patient's room that will sound an alarm when abnormal measurements are recorded prompting immediate notification of the ICU staff and evaluation of the patient.
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Alarm limits and scales are set by the nursing staff depending on the patient's clinical status (Figure 9–1). For instance, the ECG scale may be set to amplify the tracing 2- to 4-fold in a low-voltage state. Pressure waveform scales can vary based on the patient's pressure range; generally, the right atrial pressure is set at 20 mm Hg, pulmonary artery systolic pressure is set at 40 mm Hg, and systolic arterial blood pressure is set at 180 mm Hg.1
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Electrophysiologic Monitor
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Cardiac monitoring is indicated for all critically ill patients and is used for the assessment of hemodynamics, rhythm diagnosis, and detection of ischemic changes. Monitors can employ 3-lead or 5-lead wire systems to depict the electrical activity of the heart; ...