Critical illness is a multisystem process that can result in significant morbidity and mortality. In most patients, critical illness is preceded by a period of physical deterioration; evidence suggests that early symptoms of this are frequently missed. Identification of these symptoms requires well-trained medical personnel to be able to assess and correct and provide the standard approach ABCDE (airway, breathing, circulation, disability, and exposure). Good outcomes rely on rapid identification, diagnosis, and definitive treatment, and all medics should possess the skills to recognize critically ill patients and instigate appropriate initial management.
Being in critical condition means the patient’s vitals are unstable and not within normal limits. According to American Hospital Association guidelines, there’s a standard language used to determine a patient’s condition these include
Undermined
The patient is awaiting a physician’s and on assessment
Good
Vitals signs are stable within normal limits patient is conscious and comfortable. Indicators are excellent
Fair
Vital signs are stable, and within normal limits, patient is conscious but may be uncomfortable, and indicators are favorable
Serious
Vital signs may be unstable and not within normal limits; the patient is acutely ill. Indicators are unfavorable
Critical
Vital signs are unstable and not within normal limits; the patient may be unconscious indicators that are unfavorable.
Treated and released
This could mean the patient was sent home or released to another facility.
Most critical patients end up in the intensive care unit. These patients have extreme breathing difficulties and are at risk of end-organ damage or failure, so the lung is the most commonly supported organ in the intensive care unit.
Identification of critical patients depends on direct observation or monitoring and physical examination and alternating depending on the patient’s illness
Monitoring includes measurement of vital signs, which include:
Systolic blood pressure
Heart rate
Respiration rate
Level of consciousness
Oxygen saturation
Temperature
In specific circumstances, extra monitoring should be considered
. Hourly urine output
. The biochemical analysis includes lactate, blood glucose, base deficit, and arterial ph.
SIGNS AND SYMPTOMS OF A POTENTIAL CRITICAL PATIENT
. Sweaty
. pale
. anxious
. agitation
. confusion
. eyes open to voice only
. respiratory rate is 4mmol/L is associated with poor outcomes. However, any level >2mmol/L is abnormal and warrants attention. Monitoring the trend is also useful to help identify a deteriorating patient.
Intracranial pressure monitoring is another way of identifying a critical patient. This monitoring is standard for patients with a closed head injury. It is also used in some brain disorders like hydrocephalus and intracranial hypertension or in postoperative or post-embolic management of arteriovenous malfunction. According to Medscape, Cerebral blood flow is relatively well-maintained by autoregulation in a normal state (mean arterial pressure (MAP) between about 60 mmHg and 150 mmHg and an intracranial pressure (ICP) of about 10 mmHg). Outside of this range, autoregulation fails, and the risk of cerebral ischemia due to poor CPP rises. The ideal CPP for patients with brain injury such as traumatic brain injury or subarachnoid hemorrhage is not well known. However, current management commonly targets maintaining CPP at or above 60 mmHg.
Indicators of a deteriorating patient in need of intensive care
This relates to the early warning systems instituted for nurse and doctor-led escalation of care. These indicate deranged physiology as a marker of the
oTacky/bradycardia
oHyper/ hypotension
oHypoxia
oTemperature
oAltered mental state
Christine is a dedicated and compassionate registered nurse with over five years of experience in the healthcare field. She has a strong passion for patient care and education and has spent much of her career in acute care settings. Christine’s goal is to provide accurate, up-to-date information on a wide range of healthcare topics.
Article by: Christine Kinya February 8, 2023