Module 6; Critical Care

Emergency Care v/s Critical Care

Emergency care: Initial stabilisation + initiation of definitive care. 

It is rapid, problem-focused, and prioritises immediate threats to life.

Critical care: Continuous, comprehensive care of patients with potential organ failure.

Critical care begins where initial resuscitation continues into sustained organ support

The module focuses on 

• Organ support, 

• Mechanical ventilation, 

• Hemodynamic monitoring, 

• Sedation and analgesia, 

• Sepsis care, 

• Nutrition, 

• Fluid and electrolyte management, and 

• Prevention of ICU-related complications

• Structured bedside tools

ICU Scoring systems/bedside tools

• FAST HUGS BID Daily ICU care

• GCS Level of consciousness

• RASS Sedation/agitation

• CPOT Pain in non-verbal/intubated patient

• CAM-ICU Delirium screening

• NEWS2 Recognition of clinical deterioration 

• SOFA Organ dysfunction/severity

• KDIGO AKI staging Acute kidney injury severity

• Berlin Score (P/F ratio)  Oxygenation impairment/ARDS severity

• ROX index HFNC failure prediction

• Shock Index HR/SBP; circulatory compromise 

• RSBI Ventilator weaning

VAP/VAE prevention bundle 

CAUTI prevention bundle

CLABSI prevention bundle

John Hopkins Fall Risk Assessment

Braden Scale;  Assessing pressure injury risk

VTE (medical); Padua prediction score

VTE (surgical); Caprini score

Pain (children); Wong-Baker faces

Pain (conscious); Numeric Rating Scale

ICU mortality: Apache 2

Child-pugh; Severity of CLD

West haven criteria; hepatic encephalopathy grading

King's college criteria for acute liver failure (referrel for transplant)

MELD-Na; transplant-related risk assessment

Theory: ICU assessment, ventilation, sedation, FAST

HUGS BID, sepsis, ICU bundles, delirium.

Competencies: Systematic ICU assessment; ventilator

observations/settings; RASS/CPOT; fluid balance;

infusion preparation; enteral feeding care; VAP/CAUTI

bundles.

• Sedation score: Richmond Agitation Sedation Scale (RASS)

• Delirium assessment in non-verbal patients: Confusion Assessment Method for icu (CAM-ICU). If RASS −4 or −5, the patient is too deeply sedated/unresponsive to assess for delirium. Intensive Care Delirium Screening Checklist (ICDSC)-this is more of an observation based checklist

• Critical-care Pain Observation Tool (CPOT)