Intensive Care consult guide

Intensive Care consult guide

Jun 18, 2018 0
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onthephones

Editor:  Jared Ellsmore

Contributor:  Oliver Flower

Reviewed:  Janice Yeung

 

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

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Tags: #ABG,#Blood cultures,#Blood glucose,#consult guide,#critical care,#ICU,#ICU consult,#IDC insertion,#intensive care unit,#IV cannula insertion,#VBG

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