II. Indications
- Cardiovascular Emergencies
- Respiratory Emergencies
- Neurologic Emergencies
- Fluids, Electrolytes and Nutrition Emergencies (as well as renal emergencies)
- Infectious Emergencies
- Abdominal Emergencies
- Trauma and Environmental Injuries
III. Findings: Most significant markers of Critical Illness
IV. Imaging
-
Bedside Ultrasound
- Cardiac Ultrasound
- Rapid Ultrasound in Shock (RUSH Exam)
- Lung Ultrasound for Pneumothorax (Sliding Lung Sign, Lung Point)
- Bedside Lung Ultrasound in Emergency (Blue Protocol)
- Inferior Vena Cava Ultrasound for Volume Status
- Abdominal Aorta Ultrasound
- DVT Ultrasound (including Focused Lower Extremity Venous Ultrasound)
- Radiology Department Transfer in Unstable Patients
- Balance diagnostic yield of imaging (e.g. AAA, Dissection, Sepsis or Hemorrhage source) with risk of decompensation in radiology
- Nursing and medical provider should accompany critically ill, Unstable Patients to allow for continued Resuscitation
- Be prepared for worst case scenarios, and bring protentially needed Resuscitation equipment (including Ambu Bag)
- Make use of imaging protocol pauses to perform Resuscitation tasks (e.g. IV medication, transfusion initiation)
- Monitor Vital Signs and cardiac rhythm should be easily visualized from imaging control window
- Complete critical stabilization procedures prior to imaging (e.g. Endotracheal Intubation, Vascular Access, Chest Tube)
- If considering Endotracheal Intubation after imaging, consider instead performing before imaging
- References
- Weingart and Swaminathan in Swadron (2023) EM:Rap 23(1): 2-3
V. Management: Specific Cohorts
VI. Management: Respiratory
- Monitoring
- Capnography continuous
- Venous Blood Gas or Arterial Blood Gas as indicated to answer clinical questions
-
Noninvasive Ventilation
- Positive End-Expiratory Pressure (PEEP)
-
High Humidity High Flow Nasal Oxygen (High Flow Nasal Cannula, HHFNC)
- Children with acute respiratory distress (Croup, Respiratory Syncytial Virus)
- Post-Extubation (prevents re-intubation)
- Continuous Positive Airways Pressure (CPAP)
- Bilevel Positive Airway Pressure (BiPaP)
- Mechanical Ventilation
VII. Management: FEN
- Blood Sugar Management
- Nutrition
- Fluid Status
- Electrolytes
VIII. Management: Sedation and Analgesia
IX. Management: Complications
X. Management: Prevention
- See Thromboprophylaxis in Critical Illness and Major Trauma
- See Gastric Ulcer Prevention in Patients with Critically Illness (Gastrointestinal Prophylaxis)
- See Drug-induced Nephrotoxicity
- Avoid NSAIDs
- Avoid ACE Inhibitors and Angiotensin Receptor Blockers
- May consider continuing if chronic use for Congestive Heart Failure
- Alternative: Hydralazine and Isosorbide Dinitrate
- Delirium Prevention
XI. Management: Disposition
XII. Resources
- Internet Book of Critical Care (EMCRIT.org)
XIII. References
- Marino (2014) The ICU Book, p. 901-22
Images: Related links to external sites (from Bing)
Related Studies
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 |
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 |
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 |
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 |
Ontology: Unstable status (C0443343)
Concepts | Finding (T033) |
SnomedCT | 263922001 |
LNC | LP28572-3, LA14123-6 |
English | Unstable status, unstable, Unstable, Unstable status (qualifier value) |
Spanish | estado inestable (calificador), estado inestable |