Nine Key Observations in Suspected Critical Illness
| Observation | Signs of critical illness | Action |
|---|---|---|
| Airway | Evidence of upper airway obstruction (Table 1.3) | See Table 1.3 and Chapter 112 for management of the airway |
| Respiratory rate | Respiratory rate <8 or >30/min | Give oxygen (initially 60–100%) Connect a pulse oximeter Check arterial oxygen saturation and blood gases See Chapter 11 for management of respiratory failure |
| Arterial oxygen saturation | SaO2<90% | Give oxygen (initially 60–100% if there are other signs of critical illness) Check arterial blood gases (Chapter 118) |
| Heart rate | Heart rate <40 or >130/minwith signs of impaired organ perfusion | Give oxygen 60–100% Connect an ECG monitor and obtain IV access See Chapters 39, 40, 41, 42, 43, 44 for management of cardiac arrhythmias |
| Blood pressure | Systolic BP <90 mmHg or fall in systolic BP by more than 40 mmHg, with signs of impaired organ perfusion | Give oxygen 60–100% Connect an ECG monitor and obtain IV access See Chapter 2 for management of hypotension/shock |
| Perfusion | Signs of impaired organ perfusion: cool/mottled skin with capillary refill time >2s; agitation/reduced conscious level; oliguria | Give oxygen 60–100% Connect an ECG monitor and obtain IV access See Chapter 2 for management of hypotension/shock |
| Conscious level | Reduced conscious level (unresponsive to voice) | Stabilize airway, breathing and circulation Endotracheal intubation if GCS 8 or less Exclude/correct hypoglycaemia Give naloxone if opioid poisoning is possible See Chapter 3 for further management of the patient with reduced conscious level |
| Temperature | Core temperature <36 or >38°C, with hypotension, hypoxaemia, oliguria or agitation/reduced conscious level | See Chapter 35 for further management of sepsis syndrome |
| Blood glucose | Blood glucose <4 mmol/L with signs of hypoglycaemia (sweating, abnormal behaviour, reduced conscious level, seizures) | Give 100 mL of 20% glucose or 200 mL of 10% glucose over 15–30 min IV, or glucagon 1 mg IV/IM/SC See Chapter 81 |
GCS, Glasgow Coma Scale score
AVPU scale: alert = GCS 14 or 15; voice responsive = GCS 12; pain responsive = GCS 8; unresponsive = GCS 3.