Assessment of Critically Ill Patient

Patients usually show signs of deteriorating organ function days before organ failure actually develops.
If these signs are picked up and acted upon, the need for organ support may be prevented ==> reduced morbidity.
The greater your physiological reserve, the later these signs develop, thus have a low threshold of suspicion in the young.
Signs can form part of an early warning score to both alert and trigger action by the admitting / ITU outreach team.

Signs include :
-HR > 90, <50 bpm SBP < 90 mmHg RR < 8, > 20 per min.
-Temp < 36, > 38 deg C
-GCS < 15 or AVPU (Awake, responds to Voice, Pain, Unresponsive)
-Urine Output < 0.5ml/kg/hr.
-O2 sats in air < 94%.

US Air Force (USAF) First Lieutenant (1LT) Salerno, Intensive Care Unit  (ICU), Assistant Nurse, 60th Medical Group checks on a patient inside the  hospital at Incirlik AB, Turkey - U.S. National Archives

Get increased score for each sign depending on degree of perturbation from normal.
Assess for evidence of airway compromise – Stridor, tracheal tug.
Resting respiratory rate > 25 is the most sensitive indicator of physiological compromise.
Confusion also early sign of significant physiological compromise.

CURB-65 score useful for pts with pneumonia / Sepsis :
-Elevated Urea.
-Respiratory rate.
-Low Blood pressure.
-Age > 65 yrs.