Critical Care Information

Question 1

Consider critical care for any patient…

Answer 1

at risk of serious deterioration

Question 2

Specifically, consider critical care if…

Answer 2

withdrawal or failure to initiate urgent interventions would likely result in a life threatening condition or permanent disability

Question 3

What are the three tiers for critical care billing?

Answer 3

Minimal: 30-74 minutes
Moderate: 75-119 minutes
Extensive: 120+ minutes

Question 4

For any patient with a serious illness, ask your doctor:

Answer 4

1. Would you like critical care for this patient?

2. How many minutes?

Question 5

What is critical care?

Answer 5

direct delivery of medical care for any critically ill or critically injured patient

Question 6

What is considered a critical illness or injury?

Answer 6

One that acutely impairs one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient’s medical condition

Question 7

What do critical care patients require?

Answer 7

1. Constant attendance of the physician
2. Involve a high complexity of medical decision making to assess, manipulate, and support vital system function to treat single or multiple vital organ system failure
3. To prevent further life threatening deterioration of the patient’s condition

Question 8

Remember that cumulative time spent…

Answer 8

excludes procedures

Question 9

critical care diagnoses

Answer 9

patients diagnosed with these conditions will qualify for critical care

Question 10

Cardiovascular (12)

Answer 10

1. ACS/ Acute MI / Unstable angina
2. Aortic dissection
3. Bradycardia requiring intervention
4. Cardiac arrhythmias requiring intervention
5. Cardiac tamponade
6. Catecholamine crisis
7. Digitalis toxicity (severe)
8. Eclampsia
9. Hypertensive encephalopathy
10. Malignant hypertension
11. Tachycardia requiring intervention
12. Ventricular tachycardia

Question 11

Gastrointestinal/Genitourinary (3)

Answer 11

1. Bowel perforation
2. Ectopic pregnancy
3. Significant upper or lower GI bleeding

Question 12

Neurological (8)

Answer 12

1. Altered mental status including coma or unresponsiveness
2. Carbon monoxide poisoning (severe)
3. Cerebral vascular accident with intervention
4. Glasgow coma scale below 14
5. Hypoglycemia coma
6. severe medical, psychiatric, or neurological delirium
7. Status epilepticus
8. Toxicological crisis with intervention (overdose or various poisonings)

Question 13

Respiratory (9)

Answer 13

1. Acute pulmonary edema
2. Acute CHF exacerbation with aggressive airway or respiratory management
3. Acute COPD exacerbation with aggressive airway or respiratory management
4. Allergic reaction with impending airway obstruction (e.g. angioedema)
5. Asthma (severe)
6. Hypovolemia
7. Pneumothorax
8. Pulmonary embolism
9. Respiratory failure or impending respiratory failure

Question 14

Shock (7)

Answer 14

1. Cardiogenic
2. Hypovolemic
3. Anaphylactic
4. Septic
5. neurogenic
6. Spinal
7. Critical burns

Question 15

Trauma (4)

Answer 15

1. Blunt or penetrating trauma with airway, neurovascular, or cardiovascular compromise
2. Burn care with airway, neurovascular or cardiovascular compromise
3. Trauma care for conditions that post an immediate threat to life
4. Trauma care that post a threat to prolonged bodily impairment

Question 16

General (10)

Answer 16

1. Abnormal vital signs (severe)
2. Acidosis
3. Dehydration (severe)
4. Hepatic failure
5. Hypothermia
6. Infection (severe)
7. Metabolic failure
8. Post-operative complications (severe)
9. Renal failure
10. Sepsis

Question 17

Medications: A

Answer 17

1. Adenocard
2. Adenosine
3. Atropine

Question 18

Medications: B

Answer 18

Bretylium

Question 19

Medications: C

Answer 19

Cardizem drip

Question 20

Medications: D

Answer 20

1. Dobutamine

2. Dopamine

Question 21

Medications: E

Answer 21

Epinephrine

Question 22

Medications: H

Answer 22

Heparin drip

Question 23

Medications: I

Answer 23

Isuprel

Question 24

Medications: L

Answer 24

1. Levophed

2. Lidocaine IV

Question 25

Medications: M

Answer 25

1. Magnesium sulfate

2. Mannitol

Question 26

Medications: N

Answer 26

1. Narcan
2. Nipride
3. Nitroglycerine drip

Question 27

Medications: P

Answer 27

Procainamide

Question 28

Medications: S

Answer 28

1. Sodium bicarbonate

2. Stretokinase

Question 29

Medications: T

Answer 29

1. Thrombolytic therapy

2. Tissue plasminogen activator (tPA)

Question 30

Medications: V

Answer 30

1. Vasopressin

2. Verapamil

Question 31

Critical Care Procedures

Answer 31

Procedures are excluded from critical care time, but they are indications that critical care was performed

Question 32

Critical Care Procedures (13)

Answer 32

1. Bag-valve-mask
2. Bi-PAP
3. C-PAP
4. Cardioversion
5. Central line placement
6. Chest tube
7. Cardio-pulmonary resuscitation (CPR)
8. Defibrillation
9. Intubation
10. Thrombolytic therapy
11. Transcutaneous pacemaker
12. Transvenous pacemaker placement
13. Ventilator mangement

Question 33

CC Procedures: B

Answer 33

1. Bag-valve-mask

2. Bi-PAP

Question 34

CC Procedures: C

Answer 34

1. C-PAP
2. Cardioversion
3. Central line placement
4. Chest tube
5. Cardio-pulmonary resuscitation (CPR)

Question 35

CC Procedures: D

Answer 35

Defibrillation

Question 36

CC Procedures: I

Answer 36

Intubation

Question 37

CC Procedures: T

Answer 37

1. Thrombolytic therapy
2. Transcutaneous pacemaker
3. Transvenous pacemaker placement

Question 38

CC Procedures: V

Answer 38

Ventilator management