Bendigo Health ICU Manual
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      • FAST HUGS IN BED PLEASE
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      • Inpatient prescribing practices
      • Common ICU Drugs
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        • Analgesics in ICU
        • Antipyretic
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        • Beta-blockers
        • Neuromuscular Blocking Agents
        • Aperients / Laxatives
        • Prokinetics
    • Care bundle >
      • Post-cardiac arrest care (TTM) (PROMPT)
      • Care of the Post-Operative Patient
      • Spinal Trauma- CPG's (includes cervical spine clearance) (PROMPT)
      • Management Of Uncontrolled, Life Threatening Bleeding (Massive Exsanguination) (PROMPT)
    • Clinical Protocols + Guidelines >
      • Approach to patient with suspected influenza
      • RAPID INFLUENZA AND RSV TESTING
      • Stroke Protocol (SCV Oct 2018)
    • NIV >
      • Domiciliary (Home) non-invasive ventilation (NIV)/CPAP patients
      • NIV (PROMPT)
    • Tracheostomy Management
    • PICCO decision making tree
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    • The Dying Person in ICU >
      • The Dying Patient
      • Care of the Dying Patient
      • Organ & Tissue Donation
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      • Emergency calls to the helicopter pad
      • Transferring ICU patients >
        • Intra & Interhospital transfers
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            • Tracheostomy day for doctors
            • Deteriorating patient workshop
            • Ambu Bronchoscope and Cook Surgical Airway CPD workshop
            • Crucial Conversation workshop
            • Team Skills simulation day
            • ALS Simulation
            • Level 1 ECHO training
            • External Speakers
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            • Bendigo ICU Journal club
          • Expectations for Consultants
          • Expectations for all ICU Registrars
          • Expectations for HMOs
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        • CICM Primary Exam education
        • Curated educational videos & websites >
          • Virtual bronchoscopy
        • Mandatory training for medical staff
      • Term Assessments >
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        • Registrar term assessments (consultant access only) >
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        • Bendigo Health ICU DOPS
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        • CICM Pleural Drain WCA
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        • CICM Communication WCA
        • CICM Brain Death WCA
        • CICM OCA
        • ANZCA DOPS
        • ACEM DOPS
      • Echocardiography in ICU
      • BASIC Provider & Instructor Courses
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      • Other education opportunities
      • Paediatric crit care education
      • Useful learning links
    • Research & Quality >
      • Research >
        • STARRT AKI
        • SuDDICU
        • PLUS study
        • Recent Publications
    • Well-being >
      • Mentorship
      • Looking after yourself and colleagues
    • Medical Students in ICU
  • Paediatric ICU
    • Introduction
    • GO NOW Criteria
    • Admission criteria for paediatric HDU/ICU
    • Commonly used SCV Paediatric Guidelines >
      • Asthma
      • Bronchiolitis >
        • Bronchiolitis
        • Respiratory Distress Score for monitoring patients with bronchiolitis on HFNC and CPAP
      • Croup
      • Diabetic ketoacidosis >
        • Algorithm for the management of DKA (to be read in conjunction with SCV guideline)
        • SCV - Diabetic ketoacidosis
      • Seizures >
        • Febrile seizures
        • Non-febrile seizures
      • The Septic Child >
        • Assessment & Management (SCV)
        • Criteria for rapid ICU admission of children with sepsis
      • Dehydration >
        • Dehydration
        • IV fluid management
    • Paediatric Crit Care Education >
      • ED/Paeds education sessions
      • Paediatric equipment 'treasure hunt'
      • Curated paediatric educational videos
      • Other paediatric crit care education opportunities
    • Paediatric Resus Card
  • Emergency!
    • Code Blue: ALS algorithms >
      • Adult ALS algorithm
      • Paediatric ALS algorithm
      • Obstetric cardiac arrest flowchart
    • Emergency algorithms/mnemonics >
      • Airway
      • Breathing
      • Circulation
      • Disability
    • MET calls: common scenarios >
      • Staff concern
      • Hypoxic Type 1 Respiratory Failure
      • Hypercapnoeic Type 2 Respiratory Failure
      • Atrial Fibrillation
      • Hypotension and CV Shock
      • Altered consciousness
      • The Agitated Patient
      • Interface with other disciplines
      • Oliguria/Anuria
    • MET calls: resources
    • Paediatric Resus Card

Analgesics

Morphine is the agent most commonly used in ICU.  For severe renal impairment, ie. eGFR <30ml/min, fentanyl should be used. Pethidine is not to be used without prior discussion with the intensivist on duty.  

Ketamine may also be considered as an adjunct to opiates.

Antineuropathic agents, such as pregabalin and amitryptilline, should be considered in the presence of neuropathic pain.

Paracetamol - do not prescribe regular intravenous paracetamol unless authorised by the Duty Consultant.
  • Oral or enteral paracetamol is absorbed in the stomach, so is effective in patients who are “nil by mouth” or have an ileus.
  • Each time an intravenous line is accessed, the risk of a line infection increases
  • Intravenous paracetamol is much more expensive than oral / enteral paracetamol, and is no more effective if the patient has a working GIT.

Consider input from the Acute Pain Management Team for advice if pain is difficult to control or consideration of regional blocks, eg. epidurals or intercostal blocks.  For patients with end-of-life considerations, input from the Palliative Medicine team is also valuable, especially for intractable pain and anxiety.


See also, Epidural Management Protocol (PROMPT) - includes information on trouble-shooting and timing of antithrombotics.
  • Home
  • Administration
    • Team members
    • Useful contacts
    • Orientation & Guides
    • Roster rules for ICU junior doctors (Appendix A)
    • App user tips >
      • FindMyShift
      • Kronos
      • Synapse
      • Offsite access to additional email addresses
    • VHIMS >
      • VHIMS Resources (intranet only)
      • How to enter a VHIMS (intranet only)
    • Social Media Etiquette
    • BASIC equipment loan
    • Medical Students in ICU
    • ICU Consultants Only >
      • Echuca Telehealth Consults
      • Shift swap form for consultants
      • Electronic TiL request form
      • CME Claim Process
    • ERH VITCCU
  • Clinical
    • Interface with ED & home teams >
      • ED
      • Surgical teams
      • Cardiology
      • Paediatrics
    • Admissions & Discharges >
      • Admissions & Discharges
      • Admission guidelines for surgical elective and emergency operations
    • Admission guidelines for surgical elective and emergency operations
    • Daily ICU review & care >
      • FAST HUGS IN BED PLEASE
      • Oxygen prescribing
      • Oxygen - Paediatric considerations
      • Care of the Invasively Ventilated Patient – Adult Patient (PROMPT)
      • Assessing for extubation
      • Nutrition in ICU
      • Thiamine prescribing
      • Patient Diaries
    • Drugs & Infusions >
      • Inpatient prescribing practices
      • Common ICU Drugs
      • Drug Infusions A-Z
      • Drugs by system/action >
        • Antibiotics
        • Diuretics
        • Antithrombotic therapy
        • Analgesics in ICU
        • Antipyretic
        • Anticonvulsants
        • Antiplatelets
        • Antihypertensives
        • Beta-blockers
        • Neuromuscular Blocking Agents
        • Aperients / Laxatives
        • Prokinetics
    • Care bundle >
      • Post-cardiac arrest care (TTM) (PROMPT)
      • Care of the Post-Operative Patient
      • Spinal Trauma- CPG's (includes cervical spine clearance) (PROMPT)
      • Management Of Uncontrolled, Life Threatening Bleeding (Massive Exsanguination) (PROMPT)
    • Clinical Protocols + Guidelines >
      • Approach to patient with suspected influenza
      • RAPID INFLUENZA AND RSV TESTING
      • Stroke Protocol (SCV Oct 2018)
    • NIV >
      • Domiciliary (Home) non-invasive ventilation (NIV)/CPAP patients
      • NIV (PROMPT)
    • Tracheostomy Management
    • PICCO decision making tree
    • CRRT
    • Procedures
    • The Dying Person in ICU >
      • The Dying Patient
      • Care of the Dying Patient
      • Organ & Tissue Donation
    • Patient transfers >
      • Emergency calls to the helicopter pad
      • Transferring ICU patients >
        • Intra & Interhospital transfers
        • MRI transfers - special considerations
    • Welfare & other supports for patients and family >
      • Visiting times
      • Social work, pastoral care & aboriginal hospital liaison officer support
      • Interpreter services
      • Patient relations office
  • Beyond Clinical
    • Education & Training >
      • Education & Training >
        • Learning and Training in ICU
        • Bendigo Health ICU Medical Education Principles >
          • Departmental overview
          • Medical Stream
          • Medical Weekly Schedule >
            • Wednesdays
            • Airway training (hands-on-real time) in Operating theatre
            • Radiology Conference
            • ‘Labs/lytes’ session or equipment or Journal club
            • Tracheostomy day for doctors
            • Deteriorating patient workshop
            • Ambu Bronchoscope and Cook Surgical Airway CPD workshop
            • Crucial Conversation workshop
            • Team Skills simulation day
            • ALS Simulation
            • Level 1 ECHO training
            • External Speakers
            • VICEN
            • Bendigo ICU Journal club
          • Expectations for Consultants
          • Expectations for all ICU Registrars
          • Expectations for HMOs
          • Medical Student program
          • North West Training Hub
          • ICU Simulation
        • CICM Primary Exam education
        • Curated educational videos & websites >
          • Virtual bronchoscopy
        • Mandatory training for medical staff
      • Term Assessments >
        • Registrar Assessments and In-Training Evaluation Reports (ITERs)
        • Registrar term assessments (consultant access only) >
          • Term Assessment form (consultant access only)
      • Procedures and Skills Competency Assessments >
        • Bendigo Health ICU DOPS
        • CICM CVC WCA
        • CICM Tracheostromy WCA
        • CICM Pleural Drain WCA
        • CICM Ventilation WCA
        • CICM ALS & BLS WCA
        • CICM Communication WCA
        • CICM Brain Death WCA
        • CICM OCA
        • ANZCA DOPS
        • ACEM DOPS
      • Echocardiography in ICU
      • BASIC Provider & Instructor Courses
      • Paediatric BASIC Provider & Instructor Courses
      • Other education opportunities
      • Paediatric crit care education
      • Useful learning links
    • Research & Quality >
      • Research >
        • STARRT AKI
        • SuDDICU
        • PLUS study
        • Recent Publications
    • Well-being >
      • Mentorship
      • Looking after yourself and colleagues
    • Medical Students in ICU
  • Paediatric ICU
    • Introduction
    • GO NOW Criteria
    • Admission criteria for paediatric HDU/ICU
    • Commonly used SCV Paediatric Guidelines >
      • Asthma
      • Bronchiolitis >
        • Bronchiolitis
        • Respiratory Distress Score for monitoring patients with bronchiolitis on HFNC and CPAP
      • Croup
      • Diabetic ketoacidosis >
        • Algorithm for the management of DKA (to be read in conjunction with SCV guideline)
        • SCV - Diabetic ketoacidosis
      • Seizures >
        • Febrile seizures
        • Non-febrile seizures
      • The Septic Child >
        • Assessment & Management (SCV)
        • Criteria for rapid ICU admission of children with sepsis
      • Dehydration >
        • Dehydration
        • IV fluid management
    • Paediatric Crit Care Education >
      • ED/Paeds education sessions
      • Paediatric equipment 'treasure hunt'
      • Curated paediatric educational videos
      • Other paediatric crit care education opportunities
    • Paediatric Resus Card
  • Emergency!
    • Code Blue: ALS algorithms >
      • Adult ALS algorithm
      • Paediatric ALS algorithm
      • Obstetric cardiac arrest flowchart
    • Emergency algorithms/mnemonics >
      • Airway
      • Breathing
      • Circulation
      • Disability
    • MET calls: common scenarios >
      • Staff concern
      • Hypoxic Type 1 Respiratory Failure
      • Hypercapnoeic Type 2 Respiratory Failure
      • Atrial Fibrillation
      • Hypotension and CV Shock
      • Altered consciousness
      • The Agitated Patient
      • Interface with other disciplines
      • Oliguria/Anuria
    • MET calls: resources
    • Paediatric Resus Card