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)