Critical care procedures can be defined as those medical procedures conducted on an emergency or triage basis in order to sustain life. These surgeries or medical procedures can be conducted in a hospital, within a specialized hospital unit — such as the intensive care unit (ICU), emergency department (ED) or a critical care unit (CCU) — or in the field as part of an emergency first response action. Thus, the term critical care procedures refers less to the location where the medical actions take place and more to a patient's condition. Within an acute care hospital environment, some procedures will only regularly be done within a specialized unit to ensure proper nursing care while others — such as a code blue — will be performed anywhere necessary in order to sustain life. Critical care procedures can include intubation, placement of a central intravenous (IV) line, insertion of a temporary cardiac pacemaker, insertion of a chest tube, a pharmacological or electrical cardioversion or a full code blue.
Tracheal intubations are very common critical care procedures. The term refers to the insertion of a breathing tube through the mouth and into the trachea to administer oxygen and assist in pulmonary respiration using a hand-operated Ambu bag or a mechanical ventilator. This procedure requires a degree of training and skill in order to avoid injuring the vocal cords or mistakenly inserting the endotracheal breathing tube into the adjacent esophagus. Intubations are performed by physicians or paramedics and nurses who have completed Advanced Cardiac Life Support (ACLS) training. These procedures are often the second step of a code blue, after chest compressions have begun.
Other emergency critical care procedures include electrical cardioversions to restart a stopped heart or to convert deadly ventricular tachycardia or ventricular fibrillation into a heart rhythm consistent with life. Electrical cardioversions are sometimes the third step of a code blue, following manual chest compression and establishment of an airway. This procedure can be performed by untrained non-medical persons using an automated electrical defibrillator (AED). Advanced training such as that received in an ACLS course is necessary to use a manual defibrillator. Nonemergency chemical cardioversion — the use of intravenous medications to convert an irregular heart rhythm such as atrial fibrillation — is often performed in a critical care unit setting for safety and to offer the ability for personnel to respond quickly should complications arise.
Critical care procedures can also include placement of a central IV line, a temporary cardiac pacemaker or a chest tube. Large bore central IV lines are often used when large amounts of IV fluids are infused or a patient's peripheral circulation is compromised by injury, illness or overuse. External temporary cardiac pacemakers are inserted to maintain a regular cardiac rhythm while awaiting surgical implantation after an episode of heart block or an interruption of the heart's natural pacemaker's control of the heartbeat and rhythm. A collapsed lung caused by a puncture injury or intrathoracic bleeding is usually treated by the insertion of one or more chest tubes into the area to allow for lung re-expansion.