What to expect in Critical Care

The Early Stages

We understand that having a relative or friend admitted to Critical Care can be one of the most stressful and upsetting times of your life. It is totally normal for you to feel helpless, scared and powerless to help in the early stages. You may also find yourself feeling emotional and vulnerable. These can be frightening reactions, especially if they are new to you. But remember, these are normal reactions; they are not a sign of your inability to cope with the situation. You are not alone. All of our staff are here for you to talk to. You will be desperate to know any information about the patient and in the early stages it can be difficult to give you updates as our priority at this time is treating them.

The Units are very active with lots of foreign noises and equipment being used. The bedside nurse looking after the patient will happily explain any of these pieces of equipment to you. When you first visit the Unit and see the patient they can look very different from normal. They may have a breathing tube in their mouth, multiple lines attached to them and connected to numerous drug infusions. They may be on strong pain-relieving medications and drugs to sedate them; this may cause them to be unconscious and unable to interact with you when you see them. However, we do encourage you to hold their hand and talk to them as they may be able to hear and feel you, giving them reassurance. At first, we may not be able to fully inform you of what is being done as we need to treat the patient foremost. In the early stages, they may be reviewed by numerous medical teams, have further procedures undertaken, have plans for surgery or are being prepared for scans. If this is the case, then you may be asked to step off the Unit on multiple occasions so that procedures can be undertaken. Sometimes these procedures can take a long time and it is normal to have to wait a while. The nursing staff will endeavour to let you back on the Unit at the earliest possible opportunity.

When things have settled down and the patient is in a more stable condition we will update you on what has been happening and what our plans are. We do not want to give false hope of any outcomes and will be realistic with the care outcomes. It is sometimes the case that in the early stages we do not know what is wrong and are unable to fully answer your questions. Due to the nature of Critical Care, the plan of care is likely to constantly change and change quickly. We will inform you of any changes to the current plan of care.

The Unit routine

All patients are reviewed in the mornings by their parent team (this is the speciality the patient has presented to the hospital with e.g. major trauma or gastroenterology) and will have a thorough review by our own medical team. In the early afternoon, a ward round will be undertaken led by the Critical Care Consultant. This round is a chance for each patient to have a senior review and any further treatment options decided upon. There is also a microbiology round mid-afternoon to review antibiotic treatment for each individual patient. It may not be possible to have an update off the doctors every day within Critical Care. The doctors will prioritise which patient's relatives and friends they will talk to depending on how conditions are changing or if any interventions are planned. There may be some days where it seems like nothing is happening with the patient. This is normal, there are times when the best thing to do is allow the patient to rest and let their body heal.

Within Critical Care, it is either one nurse to one or two patients. As such, you will find the nurses know a lot about the patient and will be able to keep you informed of any changes or planned treatments. The patient will also be seen each day by our Critical Care dieticians, pharmacists and physiotherapists. There may be other teams coming to see the patient during the day such as pain team or occupational therapists.

Looking after yourself

The best thing you can do for the patient is to make sure you take care of yourself. There is no reason to feel guilty if you are not with them 24 hours a day. You need to give yourself a break and give the patient time to rest. The patient will be extremely well cared for while you are not there, the staff can contact you if there are any changes and you can contact the Units whenever you like 24 hours a day. Even if you do not feel like eating or going to bed try to have something to eat and have some rest time for yourself. This may only involve laying down on the sofa and watching TV or taking yourself to bed to read a book. The latter stages of the Critical Care stay are when the patient will need you to be around and you won't be able to be if you don't look after yourself and end up getting tired or ill.

At these times you may find it very lonely even though you are surrounded by other relatives and friends. This is a time to lean on each other and accept help from others. Although someone is in Critical Care the world outside still carries on. You need to make sure that bills are paid for and children are looked after. You may be able to temporarily access the patient's bank account if needed by contacting the bank or you can contact Citizens Advice for information on any financial worries.

If friends or relatives are offering favours this is the time to accept them. It may be simple things like giving you a lift or doing your grocery shopping. This is the time to allow yourself help from those around you. The more help you can get the easier it will be to deal with everything that is going on whilst having someone in Critical Care.

If you have any questions at all whilst a patient is on Critical Care, then please ask any member of staff as they will be happy to help you.

Terminology

Whilst in Critical Care you may hear many different medical terms being used to discuss the care of the patient. Some of the main ones, with explanations, are listed.

Arterial line A cannula inserted into an artery that allows frequent blood sampling and continuous blood pressure monitoring.

Arterial Blood Gases (ABGs) A blood sample from an artery that gives results on acid-base balance, electrolytes and concentration of oxygen and carbon dioxide in the blood.

Bronchoscopy A flexible scope, with a light and a camera on the end, that can be inserted through the ETT (tube in the patient's mouth) or tracheostomy. It allows for inspection of the airway, removal of secretions or taking samples from within the lungs.

Culture Taking bodily fluids to be tested in the laboratory for infections. Commonly blood, sputum, urine or swabs from wounds.

Central line A cannula inserted into a large vein that allows for continuous delivery of drugs. Commonly inserted into the neck, just below the shoulder or the groin.

Electrocardiograph (ECG) A recording of the electrical activity of the heart.

Endotracheal tube (ETT) A tube that is inserted through the mouth or the nose into the patient's windpipe. This tube allows for delivery of oxygen and air from the ventilator and maintains an open airway.

Haemofiltration Filtering of the blood to remove toxic substances or excess fluid when the kidneys fail to work properly.

Intracranial pressures (ICP) monitoring This small catheter is placed inside the brain to closely monitor the pressure within the skull of patients with head injuries.

Inotropes Medications that are used to support the heart and blood pressure.

Monitor A machine that continuously displays the physiological parameters of a patient. Commonly it will display heart rate, blood pressure and oxygen levels.

Nasogastric tube (NG tube) A tube inserted into the patient's nose and goes into their stomach. It can be used to deliver medications, drain stomach contents and deliver nutrition.

Pneumonia An infection of the lungs.

Sepsis The body's reaction to a serious infection. This can be a life-threatening condition.

Suctioning Is when the nurse uses a long thin tube down the ETT (tube in the patient's mouth) or tracheostomy to clear the airway of sputum when the patient is unable to cough adequately.

Tracheostomy An opening in the front of the neck into the windpipe, through which a tube is inserted.

Urinary catheter A thin catheter placed up the urethra into the bladder to allow urine to drain and for accurate measurements of urine output.

Ventilator A machine that helps a patient to breathe. It can either fully breathe for the patient or it can work with the patient to share breathing effort.

Weaning A term used when a patient is being gradually taken off the ventilator.