Editor:  Jared Ellsmore

Contributor:  Oliver Flower 

Reviewed:  Janice Yeung

 

In a hurry? Make sure you know:

  • Reason for ICU consult
  • Recent resuscitative efforts
  • Limits of care

 

What history should JMOs know/collect?

  • Clinical situation – what has changed recently to warrant an ICU review (i.e. why are you concerned?)
  • Background of the patient – in particular their co-morbidities and functional status
  • Active treatments – what has been done to resuscitate the patient so far, and how have they have responded

 

What examination and investigations should JMOs perform/order?

  • Patient appearance – is the patient looking unwell/critical?
  • Oxygen saturation – including whether they have improved with supplemental oxygen on the ward
  • Respiratory rate – key marker for respiratory failure which may require ventilatory support in ICU
  • Heart rate and blood pressure (and know the trends)
  • IV cannula insertion, and fluid resuscitation if appropriate
  • Bloods – including full blood count and EUC
  • Blood cultures – prior to commencing antibiotic therapy
  • IDC insertion – for fluid balance monitoring
  • VBG
  • Blood glucose

 

What additional information would impress you?

  • Knowledge of the limits of care for that patient (especially relevant in palliative care and oncology cases, or where limits of resuscitation have been discussed)

 

What are common mistakes/omissions made by JMOs?

  • Cessation of oxygen therapy when taking an ABG on an unstable patient – this increases the risk of hypoxia and potential cardiac arrest. Clinically, knowing the fraction of inspired oxygen should be sufficient for interpretation of the blood gas
  • Taking an unstable/potentially unstable patient to radiology for further imaging (advisable to arrange on the ward imaging or else wait till ICU transfer)
  • Continuing with other ward jobs when the patient you are requesting ICU admission for should be your priority
  • Not having a clear request – i.e. what do you need ICU to do (provide advice, review for admission to ICU, stabilise)

 

Helpful resources

www.intensivecarenetwork.com

 

 

Podcasts

Anderson, David.   (2015).  End of life care. [podcast].  Available at: https://onthewards.org/end-life-care/ [Accessed 24 March 2015].

Flower, Oliver. (2016). The ICU consult. [podcast].  Available at: https://onthewards.org/the-icu-consult/  [Accessed 16 December 2016]

Flower, Oliver. (2017). Identifying the sick patient. [podcast]. Available at: https://onthewards.org/identifying-the-sick-patient/ [Accessed 29 June 2017]

Rashid, Nudrat.  (2017).  Organ donation. [podcast].  Available at: https://onthewards.org/organ-donation/ [Accessed 30 August 2017]

Gatward, Jon. (2017).  Tracheostomies. [podcast].  Available at: https://onthewards.org/tracheostomies/ [31 January 2017]

Mitchell, Imogen.   (2018).  End of life care. [podcast].  Available at:  https://onthewards.org/end-of-life-care/ [Accessed 20 June 2018].

Collett, Luke.   (2018).  End of life care. [podcast].  Available at: https://onthewards.org/rapid-response-system/  [Accessed 11 July 2018].

Collett, Luke.   (2018).  Tips for junior doctors on an intensive care unit (icu) rotation. [podcast].  Available at:  https://onthewards.org/tips-for-junior-doctors-on-an-intensive-care-unit-icu-rotation/ [Accessed 12 September 2018].