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
- 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)
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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].