General management |
Central line insertion and monitoring |
Arterial line insertion and monitoring |
Nasogastric tube insertion |
Foley’s catheter insertion |
Care lines, intubation tube, Foley’s catheter; consider changing when necessary |
Maintain the head of the bed at 30°–40° elevation |
Continue side-to-side body positioning |
Warming blankets to maintain body temperature around 36.5°C |
Maintain pneumatic compression device for preventing deep vein thrombosis |
Eye protection |
Frequent airway suctioning |
Ulcer prophylaxis |
Broad spectrum antibiotics |
Monitoring |
Vital signs check every 1 hour |
Urine output check every 1 hour |
Arterial blood pressure with continuous monitoring |
ABG analysis every 6 hours |
Body temperature check every 1 hour |
Therapeutic target |
Mean arterial pressure: >65 mmHg |
Hemoglobin: >10 g/dl |
Sodium: <160 mmol/L |
Potassium: 3.5–5 mmol/L |
Central venous or mixed venous oxygen saturation: >70% |
SpO2: >92% |
Arterial blood gases within the normal range (with the exception of permissive hypercapnia) |
Lactate: <3 mmol/L |
PCO2: 35–45 mmHg |
Blood sugar: 140–180 mg/dl |
Hourly urine output: 100–300 ml |
Central body temperature: >36.0°C |
Investigations-lab |
Routine complete blood count, serum electrolyte panel including total CO2
|
Glucose |
Blood urea nitrogen |
Serum creatinine |
Total calcium (Ca), ionized Ca, magnesium (Mg), phosphate (P) |
Total bilirubin, direct bilirubin |
Aspartate aminotransferase, alanine transaminase |
Alkaline phosphatase, gamma-glutamyl transpeptidase |
Protein, albumin |
Amylase, lipase |
Total cholesterol, triglyceride, cholesterol (low density lipoprotein and high density lipoprotein) |
Uric acid |
C-reactive protein, erythrocyte sedimentation rate |
Procalcitonin |
Creatinine phosphokinase |
Creatinine kinase-muscle/brain, troponin I |
N-terminal pro B-type natriuretic peptide |
Carcinoembryonic antigen, prostate-specific antigen |
CA 19-9, CA 125, alpha-fetoprotein |
T3, T4, thyroid stimulating hormone |
aPTT and prothrombin time |
Hemoglobin A1c |
Typing, antibody |
Urine analysis |
ABG study |
Hepatitis A virus (HAV) antibody testing: HAV Ab IgM, HAV Ab IgG |
Hepatitis B virus antigen and antibody testing: HBcAb, HBcAb IgM (enzyme-linked immunosorbent assay), |
HBsAg, HBsAb, HBeAg, HBeAb; HBsAg confirmatory test (reverse transcription polymerase chain reaction) |
Hepatitis C virus Ab confirmatory test (RT-PCR) |
Human immunodeficiency virus testing: HIV Ag and Ab combination (screening)screening test |
Cytomegalovirus (CMV) antibody test: CMV IgM, CMV IgG |
Epstein-Barr virus antibody (EBV) test: EBV EA DR IgG, EBV EA DR IgM |
Venereal disease research laboratory test: if positive then, treponema pallidum latex agglutination test or treponema pallidum hemagglutination assay HLA A DNA, HLA B DNA, HLA DR DNA, HLA DQ DNA |
HLA crossmatch B test |
Culture and sensitivity (urine), gram stain (urine) |
Culture and sensitivity (sputum), Gram stain (sputum) |
Culture and sensitivity (blood), aerobic |
Culture and sensitivity (blood), anaerobic |
24-Hour urine: glucose, K, Cl, Ca, total, urea nitrogen, creatinine, uric acid, protein |
Microalbumin |
Investigation-imaging |
Chest X-ray posteroanterior view |
Hepatobiliary and kidney ultrasonogram |
Abdomen and pelvis CT scan (non-contrast enhanced) |
Brain CT scan (non-contrast enhanced) |