Who deserves the icu care

WHO DESERVES THE ICU CARE???

THE GOLDEN DECISION

Dr. Subhadip PalMBBS,MD,MRCGP

Physician and IntensivistSHARANYA HOSPITAL, BURDWAN

There is no conflict of interest to disclose.

A comparison between 2 patients with Asthma…..

• Speaks in words• Respiratory Rate 38/m• HR 113 / min• Conscious, obeys

commands• Using accessory

muscles of respiration• SpO2 : 96% on Room air

• Speaks in phrases• Respiration 26/min• HR 158 /min• Conscious, obeys

commands• Using accessory

muscles of respiration• SpO2: 99% on Room air

T h e P r i o r i ti z a ti o n M o d e l

T h e P r i o r i ti z a ti o n M o d e l

T h e P r i o r i ti z a ti o n M o d e l

T H E D I A G N O S I S M O D E L

T H E D I A G N O S I S M O D E L

T H E D I A G N O S I S M O D E L

T H E D I A G N O S I S M O D E L

T H E D I A G N O S I S M O D E L

T H E D I A G N O S I S M O D E L

OBJECTIVE PARAMETERS MODELVital Signs

• Pulse <40 (<50) or > 150 / min• SABP < 80 mm Hg or <20 of patient’s usual BP• Mean Arterial BP < 60 mm Hg• Diastolic BP > 120 mm Hg• Respiratory Rate > 35 / min (30/min)

OBJECTIVE PARAMETERS MODELLaboratory Values

• Serum Sodium <110 or > 170 (160) mEq /L• Serum Potassium <2.0 (2.5) or > 7.0 (6.5)mEq/L• PaO2 < 50 mm Hg and / or PaCO2 > 45 mm Hg• Arterial pH <7.1 (7.3)or >7.7• Serum Glucose > 800 (600) mg / dL• Serum Calcium > 15 mg / dL• Toxic level of drug or any other chemical

substance in haemodynamically or Neurologically compromised patient

OBJECTIVE PARAMETERS MODELPhysical findings of acute onset

1. Burns > 10% BSA 2. Inequal pupils in unconscious patient3. Anuria4. Airway Obstruction5. Continuous / freq & difficult to control

seizures6. Coma7. Cyanosis8. Cardiac Tamponade

OBJECTIVE PARAMETERS MODELImaging

• Cerebral vascular hemorrhage, contusion or subarachnoid hemorrhage with altered mental status or focal neurological signs. Large Strokes, especially with midline shift.

• Ruptured viscera eg. bladder, liver, esophageal varices or uterus with hemodynamic instability

• Dissecting aortic aneurysm• Ectopic Pregnancy with haemodynamic

compromise

OBJECTIVE PARAMETERS MODELECG

• Myocardial infarction with complex arrhythmias

• Sustained ventricular tachycardia or ventricular fibrillation

• Complete heart block• Atrial fibrillation with rates > 130 / min• Persistent Wide QRS regular tachycardia

A comparison between 2 patients with Asthma….. Can you now decide?

• Speaks in words• Respiratory Rate 38/m• HR 113 / min• Conscious, obeys

commands• Using accessory

muscles of respiration• SpO2 : 96% on Room air

• Speaks in phrases• Respiration 26/min• HR 158 /min• Conscious, obeys

commands• Using accessory

muscles of respiration• SpO2: 99% on Room air

T H A N K S F O R B E I N G A L L E A R S