⚠️ 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
| Level | Description | Nursing Ratio |
|---|
| 1️⃣ Level 1 | Ward-based care. Patient requires monitoring but no organ support (e.g. IV fluids, oxygen by mask). | 1 nurse : 8–12 pts |
| 2️⃣ Level 2 (HDU) | Single organ support (excluding invasive ventilation) – e.g. inotropes, CVP/arterial monitoring, haemofiltration. | 1 nurse : 2 pts |
| 3️⃣ Level 3 (ITU) | Two or more organ supports, or mechanical ventilation alone. Doctor present 24/7. | 1 nurse : 1 pt |
📌 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.
