Cardiac and Neurological Monitoring

Two organ systems deteriorate faster than any observation round can catch: the heart and the brain. Both are therefore monitored continuously in the unit.

Cardiac monitoring

Continuous electrocardiography detects rhythm disturbances as they happen rather than at the next set of observations. We monitor patients after cardiac events, with significant arrhythmia, with electrolyte disturbances that threaten the heart rhythm, particularly high or low potassium, and any patient on drugs that affect cardiac conduction.

Blood pressure is monitored continuously where the patient requires vasoactive support, which allows the dose to be adjusted minute by minute rather than in response to intermittent readings.

Neurological monitoring

Level of consciousness is assessed at set intervals using a standardised scale, alongside pupil size and reactivity, limb power and vital signs. The purpose is to detect deterioration early, particularly rising pressure inside the skull, which announces itself in a recognisable pattern well before it becomes irreversible.

Patients monitored this way include those after stroke, after head injury, after seizures or status epilepticus, after neurosurgery, and with reduced consciousness of unclear cause.

Managing raised intracranial pressure

Where pressure inside the skull is raised, management is meticulous rather than dramatic: head position, control of carbon dioxide through ventilation, osmotic therapy, temperature control, seizure prevention, and avoiding anything that raises pressure further. Small details, applied consistently, determine the outcome.