Assessment, monitoring and ward skills

Critical-care referral and daily review

Overview and approach

ICU care is organ support and repeated reassessment with a clear diagnosis and goals.

From your hub notes: ICU provides intensive monitoring and organ support (cardiovascular, respiratory, renal), invasive monitoring, airway interventions and end-of-life care, with documentation, teaching and quality assurance.

Assessment and clinical features

Assess ABCDE, trajectory, baseline function, frailty, treatment limitations and reversible causes.

Admission triage: monitoring needs, diagnosis or syndrome-based criteria, baseline factors and comorbidities, physiological criteria (e.g. shock) and need for organ support (respiratory failure, multi-organ failure).
Consider sepsis in any acutely ill or deteriorating patient with possible infection; use the locally approved decision support tool plus lactate. In older people, fever may be absent and delirium or falls may be the presentation (1).

Differentials and investigations

Use trend observations/labs and review every device, drug and organ system.

Full observation set including respiratory rate, SpO2, heart rate, systolic BP, temperature, mentation, perfusion and lactate (1).

Management and follow-up

Provide early referral, structured handover and daily airway/breathing/circulation/neuro/renal/nutrition review.

Suspected sepsis: use the local pathway; escalate to a clinician experienced in sepsis (review within 48 hours and beyond); documented handover at each transition (1).
Ethics: end-of-life care, advance directives, organ donation and family communication; see the Goals of care page.

Red flags and clinical pearls

Do not delay escalation until a scoring threshold is reached; physiological trajectory matters.

Family or carer concern, deterioration despite treatment and indwelling devices are red flags for sepsis (1).

References

Last updated from Sen’s notes on 9 October 2026.