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Southern DHB Te Puna Wai Ora, Southern Critical Care - Dunedin Hospital

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    Te Puna Wai Ora - Southern Critical Care has the capability and resources to deliver long term life support to critically ill patients. It acts as a tertiary (specialised) referral service for other health care providers in Otago and Southland.
     
    What is Critical Care?
    Critical care is the specialist care given to patients with acute (sudden), potentially reversible, life-threatening diseases. This may include patients who have life-threatening conditions such as a major accident, a severe infection or those recovering from a major operation. Critical care units may be  divided into two areas; the Critical Care Unit where the sickest patients are cared for, and the High Dependency Unit (HDU) where patients who are not well enough to return to general wards are treated. In some hospitals coronary care patients and other high care areas may be combined within a critical care area.
     
    Critical Care is staffed by a team of highly experienced and professional doctors and nurses who are supported by other allied healthcare professionals. Specialist doctors trained to look after very ill patients staff the ICU. Most patients requiring critical care treatment have a nurse allocated to look after them individually.  High Dependency Unit patients may be cared for by a nurse who is also looking after other patients in the HDU. The Critical Care Unit and HDU also have physiotherapists, dietitians, pharmacists and many other healthcare professionals to help care for these very ill people.
     
    What to expect
    Much of the value of the Critical Care Unit comes the careful monitoring of the progress of a disease and the body’s response to complex treatments. This allows timely adjustment of such treatments. In order to achieve this, many investigations and monitoring processes will occur. It may be necessary at times to perform complex procedures in the Critical Care Unit, which may be time-consuming and require the Unit to be closed to visitors. 
     
    Besides blood tests (see below), monitoring of other body functions is also commonplace. Heart rate, arterial blood pressure, central venous pressure, oxygen saturation and urine output monitoring are routine. Specific conditions may require other investigations. The changes are monitored and therapy adjusted as a result of the monitoring.

    Practitioners

    • Dr Craig Carr

      Clinical Director, Consultant Anaesthetist & Intensivist
    • Dr Martin Dvoracek

      Consultant Anaesthetist & Intensivist
    • Dr Markus Renner

      Consultant Anaesthetist & Intensivist
    • Dr David Silverman

      Consultant Anaesthetist & Intensivist
    • Dr Myles Smith

      Consultant Intensivist
    • Dr Katherine Stephens

      Consultant Anaesthetist & Intensivist
    • Dr Pawel Twardowski

      Consultant Anaesthetist & Intensivist
    • Dr Stefan Wiebe

      Consultant Intensivist
    • Dr Mark Woolley

      Consultant Anaesthetist & Intensivist
    • Dr Hansjoerg Waibel

      Consultant Anaesthetist & Intensivist
    Procedures

    Blood Tests

    In the Critical Care Unit blood tests are usually done at least once a day. They measure such things as how the kidneys are working, cardiac markers (to make sure the heart is healthy) and levels of potassium (K+) and calcium (Ca++) as well as other elements. These are some of the indicators of how the body is working and can show the intensive care specialist how well a patient’s body is coping with their illness. Intra-arterial and intravenous lines (tubes placed in arteries and veins) are often used to monitor the body and, once established, allow rapid, reliable and pain-free access  for repeated blood tests.  Some conditions will require multiple repeated blood testing every few hours.

    Cardiovascular Problems

    Patients with critical illness commonly develop problems with their hearts and circulation. Various factors are involved, some related to the primary disease while others are secondary effects. Problems include changes in: the distribution and volume of body fluid, the condition of the blood vessels and the ability of the heart to pump blood around the body.  Treatment for cardiovascular problems may include fluids therapy and a wide range of medicines to control the heart rate, cardiac function and blood pressure.

    Respiratory Problems

    Respiratory failure occurs when the respiratory system is no longer able to provide enough oxygen requirements or remove enough carbon dioxide from the body. Hypoxia (not enough oxygen is reaching the tissues) may occur unless there are interventions. Large amounts of carbon dioxide may also build up in respiratory failure. Mechanical VentilationThis is the use of a ventilator (sometimes called a life support machine) to do the breathing for a patient experiencing respiratory failure. The ventilator fills the lungs with air, thereby providing oxygen to, and removing carbon dioxide from, the body via the lungs. Usually the ventilator delivers oxygen directly into the airway of the patient. This is done using an endotracheal tube which is a plastic tube that is passed through the mouth into the larynx (the top of the trachea or windpipe). Conscious patients are usually given a medication to make them sleepy or unconscious and a muscle relaxant to help them relax while the tube is inserted.  Sometimes people may require a ventilator for a long time. If this is the case a tracheostomy (when an opening is made in the trachea) is performed and the endotracheal tube inserted into the opening. For many very ill patients mechanical ventilation lasting only hours or a few days is enough and, after normal breathing is established, the ventilator can be removed.  Unfortunately, a patient whose underlying disease is long-term may become dependent on the ventilator. Their continuing need for mechanical ventilation may be total i.e. 24 hours a day, or it may be limited i.e. only during sleep or occasionally through the day. Noninvasive Positive Pressure Ventilation Some patients may receive ventilation without needing intubation, with the breathing support being delivered via a sealed mask applied to the face. However noninvasive ventilation is useful only in some circumstances and in some patients.  Acute Respiratory Distress Syndrome (ARDS) This is a life-threatening condition. It results from any illness that causes widespread inflammation of the lungs. In ARDS, fluid builds up in the air sacs of the lungs (alveoli) and other lung tissue. When the air sacs fill with fluid, the lungs can no longer fill properly with air and the lungs become stiff. This makes breathing difficult. The main symptom of ARDS is severe shortness of breath. This may develop within minutes or gradually over a few days. A doctor may confirm a diagnosis of ARDS by: a chest x-ray  arterial blood gas analysis, which measures the oxygen content in blood. Treatment depends on the underlying cause but may include a breathing machine (mechanical ventilation) until the lungs heal.

    Nasogastric Tube

    A nasogastric tube is often inserted at the same time as the endotracheal tube. The nasogastric tube is inserted into the stomach via the nose. This tube ensures that patients receive the necessary nutrition while they are in the Intensive Care Unit.

    Kidney Problems

    Kidney (or renal) failure is when a patient’s kidneys are unable to remove wastes and excess fluid from the blood. The likelihood that the kidneys will get better depends on what caused the kidney failure. Kidney failure is divided into two general categories, acute and chronic.    In acute (or sudden) kidney failure, when kidneys stop functioning due to a sudden stress, they might be able to start working again. However, when the damage to the kidneys has been continuous and has worsened over a number of years, as in chronic renal failure (CRF), then the kidneys often do not get better. When CRF has progressed to end stage renal disease (ESRD), it is considered irreversible or unable to be cured. There are a number of causes of acute renal failure and in intensive care patients there is often more than one factor that contributes to its development.