Recognising patients who need escalation, calling for help and effective referral

Question 1

What is the role of ICU?

Answer 1

• To care for patients with severe life threatening illness who require enhanced monitoring and organ support.
• Provide supportive care i.e. replace the organ system that is failing.

Question 2

Outline the role of the critical care outreach team

Answer 2

• Specialist nurses who can review deteriorating patients, at risk of critical illness, on the ward. Either prevent them from needing critical care or refer to ICU.
• Review patients who have been discharged from ICU.

Question 3

Management for fluid resistant hypotension?

Question 4

What is an early sign of sepsis?

Answer 4

Raised RR

Question 5

Define ceilings of care

Answer 5

This is a phrase heard particularly in Intensive and Palliative care. It refers to the maximum level of care which the patient is set to receive, and this is often a complex and sensitive decision reached between the patient, their family and the healthcare team responsible for the patient.

Question 6

Is a DNACPR legally binding?

Answer 6

A recorded DNACPR decision is not, in itself, legally binding and should be regarded as a clinical assessment and decision, made and recorded in advance, to guide immediate clinical decision-making in the event of a patient’s cardiorespiratory arrest.

Question 7

What are Critical Care Units (CCU)?

Answer 7

• Critical care units (CCUs) are specialist hospital wards that treat patients who are seriously ill and need constant monitoring.
• These units are staffed by specially trained health care professionals who deliver intensive levels of care and treatment.
• Consist of: HDUs (level 2) or ICUs/ITUs (level 3).

Question 8

Outline the clinical response to NEWS2 scores

Answer 8

• NEWS 0: 12 hourly monitoring.
• NEWS 1-4: 4-6 hourly monitoring.
• NEWS 3 in a single parameter: 1 hourly monitoring.
• NEWS 5: 1 hourly monitoring, urgent assessment.
• NEWS 7: continuous monitoring of vital signs, emergency assessment by team with critical care competencies, consider transfer to level 2/3.

Question 9

Who should be admitted to intensive care?

Answer 9

• Intensive care is appropriate for patients requiring or likely to require advanced respiratory support, patients requiring support of two or more organ systems, and patients with chronic impairment of one or more organ systems who also require support for an acute reversible failure of another organ.
• Early referral is particularly important. If referral is delayed until the patient’s life is clearly at risk, the chances of full recovery are jeopardised.

Question 10

When should patients be admitted to intensive care?

Answer 10

• Patients should be admitted to intensive care before their condition reaches a point from which recovery is impossible.
• Early referral improves the chances of recovery, reduces the potential for organ dysfunction, may reduce length of stay in intensive care and hospital, and may reduce the costs of intensive care. - Patients should be referred by the most senior member of staff responsible for the patient.

Question 11

Describe the criteria for calling intensive care staff to adult patients

Answer 11

• Threatened airway
• All respiratory arrests
• Respiratory rate ⩾40 or ⩽8 breaths/min
• Oxygen saturation <90% on ⩾50% oxygen
• All cardiac arrests
• Pulse rate <40 or >140 beats/min
• Systolic blood pressure <90 mm Hg
• Sudden fall in level of consciousness (fall in GCS >2 points)
• Repeated or prolonged seizures
• Rising arterial carbon dioxide tension with respiratory acidosis
• Any patient giving cause for concern

Question 12

What is the purpose of safety netting?

Answer 12

• Safety netting advice can protect both the patient and the doctor.
• It can help to ensure that a patient with unresolved or worsening symptoms knows when and how to access further advice, and is an important way of reducing clinical risk and the risk of receiving a complaint.
• Be specific, give a timeframe, book a follow-up appointment.