Intensive Care Unit

In the ICU we care for the sickest patients in the hospital. For that reason, you will notice several differences when compared to other areas of the hospital:

• It’s very busy in the ICU. There are a lot of people providing care, patients are receiving a lot of medications, there are monitors with lights and noises, and often there is complex equipment in the room.
• Patients require careful monitoring. This means that we are watching their vital signs at all times. That is why they need to have wires glued to their skin and sometimes also tubes.
• Nurses are caring for only a few patients at a time. That way they can spend a lot of time with each patient and make sure they are safe.
• Sometimes patients will be awake, but very often they will be confused, very sleepy or even sedated. This sometimes happens because patients are very sick. Other times it happens because we have to give patients medication to keep them relaxed or asleep, for example, when they are connected to a breathing machine.
• Often patients will need very intensive therapies like a breathing machine and other types of life support.

We want to support you as you are going through this difficult time. We have Social Workers and Chaplains available to speak with you. You can request to speak with them by asking your loved one’s nurse or doctor, or you can directly call the Social Work office (323-409-7441) or the Spiritual Care office (323-409-4715).

Doctors: Resident, Fellow, Attending

Each patient has a team of ICU doctors assigned to care for them. In addition to the ICU team, there will often be additional teams of doctors from other specialties. Each team has doctors at different levels of training. The supervising doctor is the Attending – this is an experienced doctor specialized in critical care medicine who also frequently serves as a medical school professor. They oversee the care for every patient in the ICU. Just below the attending is a Fellow – these doctors have finished their residency training and are specializing in critical care medicine. The next level is the Resident – these are doctors who are completing specialty training after finishing medical school. All the doctors work together to provide care for ICU patients.

Nurses

ICU nurses are specially trained in critical care. Every patient has a primary nurse assigned to them. They provide medications, monitor the patient’s status, and provide general care (e.g. keeping the patient clean, turning). In the ICU each nurse cares for 2 patients at the same time. The nurses in the morning shift start at 7AM and the night shift starts at 7PM.

Social Workers

Social workers speak to patients or family members when the doctors call them, or if a patient or family requests their help. Social workers can help provide emotional support as well as guidance related to insurance or community resources. If you would like to speak with a social worker, please inform the ICU nurse or doctor caring for your loved one.

Respiratory Therapist

Respiratory therapists help administer breathing treatments and other medications and devices that help someone breathe. They help manage ventilators and other forms of oxygen.

Chaplains

If a patient or family member would like to receive spiritual support, there are several chaplains in the hospital who are available for prayer or to talk about what people are going through. The chaplains in our hospital are available to support patients or family members regardless of what religion they have or even if they don’t have a religion. If you would like to request a chaplain visit, please inform the ICU nurse or doctor caring for your loved one.

Other team members

There are many other team members that you might not see very often, but that are also helping to care for your loved one. These include pharmacists, dietitians, nursing assistants, rehabilitation professionals, staff in charge of cleaning and maintenance, amongst others.

If you have questions for the nurse or doctors taking care of your loved one, you can call the unit where they are located. If you don’t know the number to the unit, you can call the general hospital number (323-409-1000) and the operator can connect you. The nurse taking care of your loved one can give you some information about the patient’s status. If you need more detailed information, the nurses can ask the doctors to give you a call later in the day. If you’re hoping to speak with the doctor, it’s better to call during the daytime, before 5PM. It’s useful if one person in your family is designated as the point-person to receive updates. That person is then responsible for informing the rest of the family members how your loved one is doing.

Medical Therapies and Life Support

Ventilator, also known as breathing machine, breathing tube, life support or “the vent”

If someone cannot breathe on their own, they may be connected to a breathing machine. Most of the time, this is done by inserting a plastic tube into the mouth and down the throat so that the breathing machine can push air into the lungs. People cannot eat or talk when this tube is in place. Because this is not comfortable, patients need sedatives and pain medications to be asleep most of the day. The ICU team will try very hard to treat the patient’s illness so they can breathe on their own and come off the ventilator as soon as possible. In some people this might take a few days, for others it’s longer. There are some cases where despite the best treatments, the patient’s breathing doesn’t improve. If this happens, the ICU team will inform the family and together make decisions about next steps.

Vasopressors or pressors

When someone is very sick, their blood pressure can become so low that it causes damage to organs like the brain, heart, and kidneys. Vasopressors are powerful medications that raise the blood pressure when it drops to dangerously low levels. These medications can be very helpful, but sometimes they can cause serious complications, which is why they are used only when someone is very sick and for short periods of time. There are some patients that are so sick that even despite these medications the blood pressure continues to drop.

Dialysis

When someone is very sick, different parts of their body can stop working. If the kidneys do not work anymore, sometimes the patient receives a therapy called dialysis. The dialysis machine will remove extra fluid and wastes from the body. This therapy can be permanent or temporary depending on if the kidneys recover and on the patient’s overall condition. Not everyone with kidney problems needs to receive dialysis. And sometimes even if the kidneys have completely stopped working, dialysis cannot be given because the person is so sick that dialysis would not help them, or it would be too risky. If dialysis is an option, the doctors will speak with you so that you can decide together if starting dialysis is the right choice for your loved one.

Tubes/Catheters

IV Lines

IV lines are very small plastic tubes inserted in the veins of the hands or arms so the patient can receive fluids or other medications.

Central Lines

A central line is a special kind of large IV line that is inserted into the deep veins of the arm, leg, or neck. They are used to give specialized medications like vasopressors or chemotherapy.

NG tube/feeding tube/nasogastric tube

When someone cannot safely eat on their own, they might need a feeding tube to deliver nutrition directly to their stomach. This is a plastic tube that goes from someone’s nose or mouth, down their throat, and into the stomach. Sometimes these tubes are not used to give nutrition and instead they help remove stomach contents when the patient’s body is unable to move them through.

Foley Catheter

This is a plastic tube that is used to collect a patient’s urine. It is inserted into the bladder through the urethra (penis or vagina). It can be used to drain the bladder when someone cannot do it themselves, or if we need to carefully monitor the amount of urine they are making.

Chest Tube

If someone has liquid around their lungs that is making it hard for them to breathe, sometimes they need to have a chest tube. This is a plastic tube inserted into the chest wall, between the ribs, to help drain fluid. Sometimes it is used to get extra air out of the chest so the lungs can expand into a more normal location, also to help someone breathe.

Other Important Terms

Code Status

Code Status is a way for patients to make their wishes known to their doctors about what treatments they would want if they become so sick that their heart stops beating. Some patients would like their doctors to try cardiopulmonary resuscitation (CPR) but others would not. In the same way, some people would like to be connected to a breathing machine if they can’t breathe, but others would not. Many times patients are too sick to make these decisions for themselves, so family members will have to make the decisions for them. Because CPR and intubation can be helpful in some cases but not in others, doctors will help guide you when making these important decisions. The doctors will speak with patients or family members about the code status as early as possible so that they know what to do in case of an emergency.

Surrogate Decision Maker

Sometimes a patient is too sick to make decisions for themselves, and someone else must make decisions about their healthcare for them. This person is called a surrogate decision maker. With the help of doctors, nurses and other people at the hospital, the surrogate decision maker will help the healthcare team know what the patient would choose, if they could make decisions for themselves.

Family Meeting

It’s very important for the medical team that you are kept well informed about everything that is happening with your loved one when they are in the ICU. It is also very important that the interventions and treatments are in line with what patients would choose for themselves. The doctors will update family members regularly about how their loved one is doing, and sometimes they will invite family members to participate in a “family meeting” either in person or over the phone. One of the reasons to have these meetings is to update more than one family members at the same about the patient’s condition and to answer all the questions they might have. Many times, the reason for these meetings is because the patient’s medical condition is changing and important decisions need to be made about their medical care. In these cases, the doctors need help from the family to decide together what would be best for a patient in their current condition considering the patient’s goals and values.

The Term “Stable”

You will often hear that nurses or doctors might use the term “stable”. This term is confusing because it might sound like if a patient’s condition is “good” or “improving”, but that’s not what it means. Stable means that a patient’s condition is “unchanged”.