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
onthewards podcasts
The ICU consult with Oliver Flower
Identifying the sick patient with Oliver Flower
