What Work is Included in the MICU

1. Patient Monitoring & Assessment

• Continuous vital sign monitoring (heart rate, blood pressure, SpO2, temperature, respiratory rate)
• Hourly urine output measurement
• Neurological status checks (GCS, pupil response, CAM-ICU for delirium screening)
• Hemodynamic monitoring via arterial lines, central venous pressure (CVP), pulmonary artery catheters
• Serial ABG (Arterial Blood Gas) interpretation
• Comprehensive daily head-to-toe physical examinations

2. Respiratory Support

• Mechanical ventilation management - setting and adjusting ventilator modes (AC, SIMV, PSV), FiO2, PEEP, tidal volume
• Monitoring for and preventing Ventilator-Associated Pneumonia (VAP) (head-of-bed elevation, oral care, sedation holidays)
• Weaning protocols and spontaneous breathing trials (SBT)
• Management of respiratory failure (both Type 1 hypoxemic and Type 2 hypercapnic)
• High-flow nasal oxygen (HFNO) and non-invasive ventilation (BiPAP/CPAP)
• Endotracheal intubation and extubation

3. Cardiovascular Management

• Management of dysrhythmias (AF, VT, heart blocks)
• Vasopressor initiation and titration (norepinephrine, vasopressin, dopamine)
• Inotrope use (dobutamine, milrinone)
• Management of cardiogenic, distributive (septic), and hypovolemic shock
• Fluid resuscitation and fluid balance management
• Post-cardiac arrest care and targeted temperature management

4. Sepsis & Infectious Disease

• Implementation of Sepsis Bundles (Hour-1 bundle: cultures, antibiotics, IV fluids, lactate)
• Broad-spectrum antibiotic initiation and de-escalation
• Central line-associated bloodstream infection (CLABSI) prevention and management
• Management of pneumonia, meningitis, endocarditis, intra-abdominal sepsis
• Fungal and viral infections in immunocompromised patients

5. Renal Care

• Monitoring for acute kidney injury (AKI) - KDIGO criteria
• Fluid and electrolyte management
• Renal Replacement Therapy (RRT/CRRT - continuous dialysis) initiation and monitoring
• Bladder catheter care

6. Neurological Care

• Management of altered consciousness, delirium (CAM-ICU protocol)
• Seizure management (status epilepticus)
• Intracranial pressure monitoring when indicated
• Stroke management
• Sedation and analgesia (ABCDEF bundle - sedation scales like RASS, Richmond Agitation-Sedation Scale)

7. Endocrine & Metabolic Care

• Blood glucose monitoring and insulin drip protocols (glycemic control)
• Management of diabetic emergencies (DKA, HHS)
• Thyroid storms, adrenal crises
• Electrolyte correction (K+, Na+, Mg2+, Ca2+, Phosphate)

8. Procedures Performed in MICU

• Central venous catheter (CVC) insertion (internal jugular, subclavian, femoral)
• Arterial line placement
• Endotracheal intubation
• Thoracentesis (pleural fluid drainage)
• Paracentesis (abdominal fluid drainage)
• Lumbar puncture
• Bronchoscopy (at bedside in select cases)
• Chest tube insertion (for pneumothorax/hemothorax)
• Bedside ultrasound (POCUS - point-of-care ultrasound for cardiac, lung, vascular assessment)

9. Nursing-Specific Work in MICU

• Administering IV medications, drips, and titrating vasopressors per protocol
• Wound care and pressure ulcer prevention (turning schedules, specialty beds)
• Nutritional support - enteral (NG/NJ tube feeds) or parenteral (TPN)
• Restraint monitoring and sedation assessment
• Family communication and end-of-life discussions
• Documentation in real-time (flowsheets, MAR)

10. Prevention of Iatrogenic Complications

• DVT prophylaxis (heparin, compression devices)
• Stress ulcer prophylaxis (PPIs/H2 blockers)
• Preventing hospital-acquired infections (hand hygiene, sterile techniques)
• Daily "spontaneous awakening and breathing trials" (SAT/SBT bundles)
• Early physical therapy and rehabilitation ("ICU liberation")

11. Multidisciplinary Team Rounds

• Daily attending physician rounds with fellows, residents, and students
• Pharmacist medication reconciliation and review
• Respiratory therapist collaboration on ventilator management
• Dietitian input for nutritional goals
• Social work and palliative care consultations
• Family meetings for goals of care

12. Conditions Commonly Managed in MICU

Key steps shown in these videos:

• Perform Modified Allen's Test first (confirm ulnar collateral supply)
• Position wrist in dorsiflexion (extend wrist ~30-45 degrees)
• Palpate radial pulse with index and middle fingers (both proximal to puncture site)
• Insert 23G needle at 45° angle, bevel up, aiming toward the pulse
• Allow arterial pressure to passively fill the pre-heparinised syringe (~1-2 mL)
• After withdrawal, apply firm pressure for 5 minutes (longer if on anticoagulants)
• Remove air bubbles, cap syringe, and transport to ABG analyser immediately on ice

Key steps for femoral artery blood sampling:

• Indication: Used when radial access is not possible - e.g., peri-arrest, peripheral vascular disease, or radial artery contraindications
• Landmark: Femoral artery lies at the mid-inguinal point (midway between ASIS and pubic symphysis) - remember NAVEL from lateral to medial: Nerve, Artery, Vein, Empty space, Lymphatics
• Position: Patient supine, hip slightly extended and externally rotated
• Needle angle: Insert at 90° (perpendicular) to the skin, unlike radial (45°)
• Sample: Allow arterial pressure to passively fill the pre-heparinised syringe (~2 mL)
• After procedure: Apply firm pressure for at least 10 minutes (longer if on anticoagulants) - haematoma risk is higher here than at the radial site
• Check after: Assess distal limb perfusion and monitor puncture site for bleeding or haematoma formation