Makindo Medical Notes

⚠️ Escalation to HDU/ICU: Always ask yourself – "What can Level 2/3 care do that the ward cannot?". Look for evolving organ failure 🫁❤️🧠 and involve ICU early.

📖 Levels of Critical Care

📌 Before Calling ICU

• Know obs trends 📊 (NEWS2, BP, HR, RR, O₂ sats).
• Have notes, drug chart & latest bloods ready (FBC, U&E, ABG, coagulation, lactate).
• Recent imaging 📷 (CXR, CT head/abdomen).
• Comorbidities, frailty, premorbid state 🧓.
• Patient’s wishes on escalation/ventilation if known (💬 involve family if unclear).
• Clearly state ➡️ what you want ITU to provide (ventilation, RRT, inotropes, monitoring).

🫁 Indications for HDU/ICU

• Respiratory failure – NIV/CPAP, intubation, mechanical ventilation.
• Renal failure – fluid overload, hyperkalaemia, access to RRT.
• Sepsis & Shock – invasive monitoring, inotropes, ARDS support.
• Cardiogenic shock – inotropes, balloon pump, advanced monitoring.
• Neurological coma (GCS <9) – airway protection, ventilation, raised ICP management, post-arrest, GBS, myasthenia, status epilepticus.
• Liver failure – encephalopathy, coagulopathy, hepatorenal syndrome.
• Metabolic emergencies – refractory DKA, HHS, severe electrolyte derangement.

🔪 Surgical Indications

• Perforated / infarcted bowel 🩸.
• Acute pancreatitis.
• Sepsis (GI, biliary, urinary tract).
• Respiratory/cardiac failure post-op.
• Major surgery in frail/comorbid patients.

🩺 Medical Indications

• Severe pneumonia / COVID with hypoxia.
• Acute severe asthma / COPD exacerbation 🫁.
• Sepsis with hypotension and rising lactate.
• Cardiovascular collapse: severe LVF, post-MI shock ❤️.
• GI bleed with haemodynamic instability.
• Coma / large stroke with compromised airway.
• Poisoning/OD with airway or haemodynamic risk.

💡 Tip: ICU may send a Critical Care Outreach Team – often senior nurse + ICU reg. They help stabilise, escalate, and plan care while a bed is arranged.