Approximately 25% of patients receiving critical care on an Intensive Care Unit (ICU) come through the ED and patients admitted directly to an ICU from the ED rather than via a ward do better. It is therefore essential that we in the ED are able to identify those in need of critical care, start their management and involve the intensivists early.
So what is Critical Care?
The definition that the Intensive Care National Audit & Research Centre (ICNARC) give is:
“Critical Care provides support for patients whose conditions are potentially life-threatening. These patients need: constant and close monitoring; support for their organ systems from specific equipment; and medication to keep the body functioning normally while they recover.”
Traditionally critical care medicine is synonymous with intensive care medicine and happens on ICUs or high dependency units (HDUs). Unfortunately sick patients have no respect for geographical boundaries and often require their critical care initiating in areas outside of the ICU. Critical care medicine is now moving away from this traditional model and moving towards the idea of “ICU without walls” with the development of critical care outreach teams and having staff in numerous specialities also trained in critical care.
Emergency Medicine clinicians are the experts in the resuscitation and management of seriously ill or injured patients and routinely provide the initial critical care for all sick patients arriving in hospital. Some of us have also received additional training in critical care to ensure a smooth transition of care between the ED and ICU.
So perhaps a more contemporary definition of critical care is:
“Critical Care is taking care of sick patients, that’s what it is about, and anyone who does that IS critical care….We are critical care!”
— Dr. Scott Weingart. ED Intensivist.
During your time in the ED you will be exposed to many critically ill patients, and with the support of senior staff will gain experience and confidence in the early recognition and management of critically ill patients.
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