Critical Care

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Critical illness is a potentially reversible state of ill health with vital organ dysfunction and high risk of death. It is the most severe form of acute illness and can be due to any underlying condition, in any patient, irrespective of age.

Effective assessment of patients with suspected critical illness requires systematic evaluation of vital organ functions. Health workers should focus on the airway, respiratory, cardiovascular and neurological systems using an ABCD approach (see emergencies section). Evaluation and treatment should be conducted in parallel to rapidly stabilise the patient. The presence of any severely deranged vital sign indicates critical illness. The renal, gastro-intestinal, hepatic, dermatological and hematological systems should then be assessed to determine the type and extent of multi-organ failure. The more organs failing, the more serious the critical illness is likely to be. Critical care specific scoring systems. 

Critical care aims to restore and maintain safe (not necessarily normal) physiology to promote patient recovery and organ function. This involves titrated escalation and de-escalation of supportive therapies (e.g. oxygen, fluids, and antibiotics) and early recognition if care modification is required (e.g. medication change or surgery). Setting physiological targets facilitates this aim and promotes nurse- led titration (e.g. adjustment of oxygen according to saturation). Goals should be individualized for each patient and their current condition. To achieve set goals, systematic approaches should be used, incorporating the views of the multidisciplinary team.  The underlying cause of disease must be managed.