Critical Illness

Aka: Critical Illness, Catastrophic Illness, Intensive Care, Critical Care

II. Indications

  1. Cardiovascular Emergencies
    1. Ventricular Fibrillation or Pulseless Ventricular Tachycardia
    2. Asystole or Pulseless Electrical Activity (PEA)
    3. Unstable Bradycardia
    4. Unstable Tachycardia
    5. Acute Coronary Syndrome
    6. Aortic Dissection
    7. Cardiac Tamponade
    8. Cardiogenic Shock (acute pulmonary edema)
    9. Hypertensive Emergency
  2. Respiratory Emergencies
    1. Pulmonary Embolism
    2. Foreign Body Aspiration
    3. Tension Pneumothorax
    4. Status Asthmaticus
    5. Acute Respiratory Failure
    6. Acute Respiratory Distress Syndrome (ARDS)
    7. Corona Virus 19 (COVID-19, SARS-CoV2)
  3. Neurologic Emergencies
    1. Status Epilepticus
    2. Closed Head Injury
    3. Brainstem Herniation
    4. Cerebrovascular Accident
    5. Penetrating Neck Trauma
  4. Fluids, Electrolytes and Nutrition Emergencies (as well as renal emergencies)
    1. Hemorrhagic Shock
    2. Metabolic Acidosis
  5. Infectious Emergencies
    1. Septic Shock
    2. Meningitis
    3. Encephalitis
  6. Abdominal Emergencies
    1. See Acute Abdomen
    2. Abdominal Aortic Aneurysm
    3. Ruptured Ectopic Pregnancy
  7. Trauma and Environmental Injuries
    1. Heat Related Illness
    2. Burn Injury
    3. Hypothermia Management
    4. Unknown Ingestion
    5. Biological Weapon
    6. Chemical Weapon
    7. Mass Casualty Incident
    8. Blast Injury
    9. Gunshot Wound
    10. Knife Wound

III. Findings: Most significant markers of Critical Illness

  1. Tachypnea
  2. Metabolic Acidosis

IV. Management: Specific Cohorts

  1. See Obesity and Emergency Stabilization
  2. See CPR in Pregnancy
  3. See Trauma in Pregnancy
  4. See Hemodialysis Emergency
  5. See Oncologic Emergencies
  6. See Emergencies in Children

V. Management: Respiratory

  1. Monitoring
    1. Capnography continuous
    2. Venous Blood Gas or Arterial Blood Gas as indicated to answer clinical questions
  2. Noninvasive Ventilation
    1. Positive End-Expiratory Pressure (PEEP)
    2. High Humidity High Flow Nasal Oxygen (High Flow Nasal Cannula, HHFNC)
      1. Children with acute respiratory distress (Croup, Respiratory Syncytial Virus)
      2. Post-Extubation (prevents re-intubation)
    3. Continuous Positive Airways Pressure (CPAP)
    4. Bilevel Positive Airway Pressure (BiPaP)
  3. Mechanical Ventilation
    1. See Rapid Sequence Intubation
    2. See Endotracheal Intubation
    3. See Mechanical Ventilation
    4. See Post-Intubation Sedation and Analgesia

VI. Management: FEN

  1. Blood Sugar Management
    1. See Glucose Control in the Intensive Care Unit
    2. See Diabetes Mellitus Glucose Management
    3. See Perioperative Diabetes Management
    4. See Diabetes Sick Day Management
  2. Nutrition
    1. See Nutrition in the Intensive Care Unit
    2. See Feeding Critically Ill Patients (includes Enteral Nutrition for Intubated Patients)
    3. See Enteral Nutrition
  3. Fluid Status
    1. See Fluids and Electrolytes in Critical Care
    2. See Inferior Vena Cava Ultrasound for Volume Status
    3. See Fluid Resuscitation in Trauma
  4. Electrolytes
    1. See Fluids and Electrolytes in Critical Care
    2. See Hypernatremia
    3. See Hyponatremia
    4. See Hyperkalemia Management
    5. See Hypokalemia
    6. See Hypomagnesemia
    7. See Hypocalcemia

VII. Management: Sedation and Analgesia

  1. See Sedation and Analgesia in Intensive Care (includes Insomnia Management in Critical Care)
  2. See Richmond Agitation Sedation Scale (RASS, Modified RASS)
  3. Critical Care Pain Observation Tool (CPOT)
  4. See Acute Pain Management
  5. See Procedural Sedation and Analgesia

VIII. Management: Complications

  1. See Anemia in the Intensive Care Unit
  2. See Critical Illness Myopathy
  3. See Critical Illness Related Metabolic Bone Disease
  4. Fever
    1. See Fever in the Intensive Care Unit
    2. See Postoperative Fever
    3. See Sepsis
  5. Serum Troponin Elevation
    1. See Troponin Increase in ICU Patients

IX. Management: Prevention

  1. See Thromboprophylaxis in Critical Illness and Major Trauma
  2. See Gastric Ulcer Prevention in Patients with Critically Illness (Gastrointestinal Prophylaxis)
  3. See Drug-induced Nephrotoxicity
    1. Avoid NSAIDs
    2. Avoid ACE Inhibitors and Angiotensin Receptor Blockers
      1. May consider continuing if chronic use for Congestive Heart Failure
      2. Alternative: Hydralazine and Isosorbide Dinitrate
  4. Delirium Prevention
    1. See Insomnia Management in Critical Care

X. Management: Disposition

  1. See Transfer of the Critically Ill Patient
  2. See Critical Care Follow-up

XI. Resources

  1. Internet Book of Critical Care (EMCRIT.org)
    1. https://emcrit.org/ibcc/guide/

XII. References

  1. Marino (2014) The ICU Book, p. 901-22

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Related Studies

Ontology: Catastrophic Illness (C0007397)

Definition (MSH) An acute or prolonged illness usually considered to be life-threatening or with the threat of serious residual disability. Treatment may be radical and is frequently costly.
Concepts Disease or Syndrome (T047)
MSH D002388
English Catastrophic Illness, Catastrophic Illnesses, Illness, Catastrophic, Illnesses, Catastrophic, Catastrophic Illness [Disease/Finding], catastrophic illness, Catastrophic illness
Swedish Livshotande tillstånd
Czech katastrofická nemoc
Finnish Henkeä uhkaava sairaus
Russian UGROZHAIUSHCHIE SOSTOIANIIA, ЖИЗНЕОПАСНОЕ ЗАБОЛЕВАНИЕ, BOLEZN', TREBUIUSHCHAIA DOROGOSTOIASHCHEGO LECHENIIA, ZHIZNEOPASNOE ZABOLEVANIE, БОЛЕЗНЬ, ТРЕБУЮЩАЯ ДОРОГОСТОЯЩЕГО ЛЕЧЕНИЯ, УГРОЖАЮЩИЕ СОСТОЯНИЯ
Polish Choroby związane z katastrofami
Italian Malattia grave
Norwegian Livstruende sykdom, Livstruende tilstand
German Krankheit, lebensbedrohliche, Lebensbedrohliche Krankheit
Dutch Levensbedreigende ziekte, Ziekte, levensbedreigende
Portuguese Doença Catastrófica
French Maladie grave, Pathologie lourde, Maladie catastrophique (USA)
Spanish Enfermedad Catastrófica
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Care of intensive care unit patient (C0010337)

Definition (MEDLINEPLUS)

Critical care helps people with life-threatening injuries and illnesses. It might treat problems such as complications from surgery, accidents, infections, and severe breathing problems. It involves close, constant attention by a team of specially-trained health care providers. Critical care usually takes place in an intensive care unit (ICU) or trauma center.

Monitors, intravenous (IV) tubes, feeding tubes, catheters, breathing machines, and other equipment are common in critical care units. They can keep a person alive, but can also increase the risk of infection.

Many patients in critical care recover, but some die. Having advance directives in place is important. They help health care providers and family members make end-of-life decisions if you are not able to make them.
Definition (MSH) Health care provided to a critically ill patient during a medical emergency or crisis.
Definition (CSP) health care provided at any location to a critically ill patient during a medical emergency or crisis.
Concepts Health Care Activity (T058)
MSH D003422
SnomedCT 133903000
LNC LP32890-3
English Care, Critical, Critical Care, critical care, intensive care unit patient, Care of intensive care unit patient (regime/therapy), Critical care, Care of intensive care unit patient (procedure), Care of intensive care unit patient
Swedish Vård vid livshotande sjukdom
Czech péče o pacienty v kritickém stavu
Finnish Tehostettu hoito
Russian KRITICHESKI BOL'NYM POMOSHCH', КРИТИЧЕСКИ БОЛЬНЫМ ПОМОЩЬ
French Soins de réanimation, Soins aux malades en phase critique, Soins aux patients en phase critique, Soins critiques
Croatian KRITIČNA SKRB
Polish Opieka w stanach krytycznych, Leczenie w stanach krytycznych
Norwegian Pleie av kritisk syke, Pleie ved livstruende sykdom
Spanish atención del paciente en la unidad de terapia intensiva (procedimiento), atención del paciente en la unidad de terapia intensiva (régimen/tratamiento), atención del paciente en la unidad de terapia intensiva, Cuidados Críticos
German Pflege, Wachstation
Italian Assistenza d'urgenza a pazienti gravi
Dutch Zorg, intensieve
Portuguese Cuidados Críticos
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Critical Illness (C0010340)

Definition (MSH) A disease or state in which death is possible or imminent.
Concepts Disease or Syndrome (T047)
MSH D016638
English Critical Illness, Critical Illnesses, Critically Ill, Illness, Critical, Illnesses, Critical, Critical Illness [Disease/Finding], critical illness, critically ill, Critically ill
Swedish Livshotande sjukdom
Czech kritický stav
Finnish Kriittinen sairaus
Russian KRITICHESKIE SOSTOIANIIA, BOLEZN' KRITICHESKAIA, БОЛЕЗНЬ КРИТИЧЕСКАЯ, КРИТИЧЕСКИЕ СОСТОЯНИЯ
Japanese 危篤, 末期状態
Italian Malattia critica
Polish Poważna choroba, Choroba krytyczna
Norwegian Kritisk sykdom, Kritisk tilstand, Kritisk syk
Spanish Estado Crítico, Enfermedad Crítica
Portuguese Doença Terminal, Estado Crítico, Estado Terminal
German Kritisch krank, Kritische Krankheit
Dutch Terminale ziekte, Ziekte, terminale
French Maladie critique, Maladie très grave
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: intensive care (C0085559)

Definition (MSH) Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility.
Definition (CSP) advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring; it is usually administered in specially equipped units of a hospital.
Concepts Health Care Activity (T058)
MSH D017055
HL7 N
English Care, Intensive, Intensive Care, Intensive care, intensive care
Swedish Intensivvård
Japanese ｼｭｳﾁｭｳﾁﾘｮｳ, 集中治療-外科, 外科集中治療, 集中治療
Finnish Tehohoito
Russian INTENSIVNAIA POMOSHCH' KHIRURGICHESKAIA, INTENSIVNAIA TERAPIIA, ИНТЕНСИВНАЯ ПОМОЩЬ ХИРУРГИЧЕСКАЯ, ИНТЕНСИВНАЯ ТЕРАПИЯ
Czech Intenzivní péče, intenzivní péče
Croatian INTENZIVNA SKRB
Polish Opieka intensywna, Leczenie intensywne
Hungarian Intenzív kezelés
Portuguese Terapia Intensiva, Cuidado Cirúrgico Intensivo, Cuidados Cirúrgicos Intensivos, Cuidado Intensivo, Cuidados Intensivos, Cuidados intensivos
Norwegian Intensivpleie
Spanish Cuidado Intensivo Quirúrgico, Terapia Intensiva, Terapia Intensiva Quirúrgica, Cuidado Intensivo, Cuidados Intensivos Quirúrgicos, Cuidados intensivos, Cuidados Intensivos
Dutch intensieve zorg, Intensive care
French Soins intensifs
German Intensivpflege
Italian Terapia intensiva
Derived from the NIH UMLS (Unified Medical Language System)

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