Procedures, Monitoring, and Resuscitation
Core concepts
Understand indications, contraindications, and complications of common ICU procedures: central venous catheterization, arterial line placement, thoracentesis, paracentesis, lumbar puncture, intubation, and chest tube insertion. Know ultrasound guidance to improve success and reduce complications. Master airway management: preoxygenation, rapid sequence intubation, and rescue devices. Understand monitoring modalities: arterial pressure, capnography, pulse oximetry, and invasive hemodynamics. Resuscitation includes high-quality CPR, defibrillation, and post-arrest care.
Traps
Do not attempt central line placement in an anticoagulated patient without weighing bleeding risk; use ultrasound and compressible sites. For thoracentesis, avoid the intercostal nerve and vessels by staying above the rib. In intubation, anticipate the difficult airway and have a backup plan. Capnography confirms tube placement - do not rely on auscultation alone. In cardiac arrest, minimize interruptions in compressions.
Worked example
After intubation, the patient's oxygen saturation falls and breath sounds are absent on the right. Waveform capnography shows no sustained waveform. This suggests esophageal intubation or a displaced tube; immediately reassess and reposition, using capnography as the gold standard for confirmation. Rule of thumb: if the capnography waveform is absent, the tube is not in the trachea.