Jun 18, 2018 0

Editor: Jared Ellsmore

Contributor: Oliver Flower

Reviewed: Janice Yeung

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)