CME on Approach to Critical Patients: When to Refer

Approach to Critical Patients: When to Refer

• If the patient in V,P,U scale or GCS is <=14, then check the vitals and sugar and refer this patient to the critical care unit.
• If the sugar of the patient remains low even after therapy, or the patient does not regain consciousness, or has had seizure due to low sugar then refer.
• If the patient is breathless or drowsy and has high sugars, do not give insulin first, start with iv hydration and refer this patient. Sugar can be controlled later, first IV hydration is the crucial step.
• If you suspect a patient is in sepsis and has hypotension and qSOFA score is >1, then start initial resuscitation and refer the patient.
• If a patient has high blood pressure with signs of stroke, do not lower the BP if BP is not >220/120mmHg. Refer immediately as the patient may be in the window period for thrombolysis or thrombectomy.
• If patients have high blood pressure with signs of end organ damage, do not lower the BP drastically. Refer immediately
• If the patient has presented with head trauma, do not send the patient for Brain imaging first. Refer this patient to the critical care unit as he may require airway protection and ventilation first then brain imaging.
• If the patient has presented with some drug/compound ingestion, put in a Ryle's Tube and do a gastric lavage, then refer the patient immediately.
• If the patient has a seizure, then perform first aid, give IM lorazepam and refer this patient as patient can have seizure again and needs to be observed and evaluated in ICU.