المصدر: ADMISSION CRITERIA TO ICU في منتدى : كتب طبية ADMISSION CRITERIA TO ICU The Intensive Care Unit is an expensive resource area and should be reserved for patients with reversible medical conditions with a reasonable prospect of substantial recovery. Patients with the following conditions are candidates for admission to the General Intensive Care Unit. The following conditions include, but are not limited to A- Respiratory 1- Acute respiratory failure requiring ventilatory support 2- Acute pulmonary embolism with haemodynamic instability 3- Massive haemoptysis 4- Upper airway obstruction B- Cardiovascular 1- Shock states ( ex. Cardiogenic shock ) 2- Life-threatening dysrhythmias 3- Dissecting aortic aneurysms 4- Hypertensive emergencies 5- Need for continuous invasive monitoring of cardiovascular system ( arterial pressure, central venous pressure, cardiac output) 6- Acute myocardial infarction with complications 7- Unstable angina, particularly with dysrhythmias, hemodynamic instability, or persistent chest pain 8- Acute congestive heart failure with respiratory failure and/or requiring hemodynamic support 9- Cardiac tamponade or constriction with hemodynamic instability C- Neurological 1- Severe head trauma 2- Status epilepticus 3- Meningitis with altered mental status or respiratory compromise 4- Acutely altered sensorium with the potential for airway compromise 5- Progressive neuromuscular dysfunction requiring respiratory support and / or cardiovascular monitoring (myasthenia gravis, Gullain-Barre syndrome) 6- Brain dead or potentially brain dead patients who are being aggressively managed while determining organ donation status 7- Coma: metabolic, toxic, or anoxic 8- Intracranial hemorrhage with potential for herniation 9- Acute subarachnoid hemorrhage D- Renal 1- Requirement for acute renal replacement therapies in an unstable patient 2- Acute rhabdomyolysis with renal insufficiency E- Endocrine 1- Diabetic ketoacidosis complicated by haemodynamic instability, altered mental status 2- Severe metabolic acidotic states 3- Thyroid storm or myxedema coma with haemodynamic instability 4- Hyperosmolar state with coma and/or haemodynamic instability 5- Adrenal crises with haemodynamic instability 6- Other severe electrolyte abnormalities, such as: - Hypo or hyperkalemia with dysrhythmias or muscular weakness - Severe hypo or hypernatremia with seizures, altered mental status - Severe hypercalcemia with altered mental status, requiring haemodynamic monitoring - Hypo or hypermagnesemia with hemodynamic compromise or dysrhythmias - Hypophosphatemia with muscular weakness F- Gastrointestinal 1- Life threatening gastrointestinal bleeding including hypotension, angina or continued bleeding 2- Acute hepatic failure leading to coma, haemodynamic instability (Fulminant hepatic failure) 3- Severe acute pancreatitis 4- Esophageal perforation with or without mediastinitis G- Haematology 1- Severe coagulopathy and/or bleeding diasthesis 2- Severe anemia resulting in haemodynamic and/or respiratory compromise 3- Severe complications of sickle cell crisis 4- Haematological malignancies with multi-organ failure H-Obstetric 1- Medical conditions complicating pregnancy 2- Severe pregnancy induced hypertension/eclampsia 3- Obstetric haemorrhage 4- Amniotic fluid embolism I- Multi-system 1- Severe sepsis or septic shock 2- Multi-organ dysfunction syndrome 3- Polytrauma 4- Dengue haemorrhagic fever/dengue shock syndrome 5- Drug overdose with potential acute decompensation of major organ systems ( Hemodynamically unstable drug ingestion, Seizures following drug ingestion, Drug ingestion with significantly altered mental status with inadequate airway protection ) 6- Environmental injuries (lightning, near drowning, hypo/hyperthermia) 7- Severe burns J- Surgical 1- High risk patients in the peri-operative period 2- Post-operative patients requiring continuous haemodynamic monitoring/ ventilatory support, usually following: - vascular surgery - thoracic surgery - airway surgery - craniofacial surgery - major orthopaedic and spine surgery - general surgery with major blood loss/ fluid shift - neurosurgical procedures Objective Parameters Vital Signs * Pulse < 40 or > 150 beats/minute * Systolic arterial pressure < 80 mm Hg or 20 mm Hg below the patient's usual pressure * Mean arterial pressure < 60 mm Hg * Diastolic arterial pressure > 120 mm Hg * Respiratory rate > 35 breaths/minute * SaO2< 88% with O2 supply Laboratory Values (newly discovered) * Serum sodium < 110 mEq/L or > 160 mEq/L * Serum potassium < 2.5 mEq/L or > 7.0 mEq/L * PaO2 < 50 mm Hg * pH < 7.1 or > 7.7 * Serum glucose > 600 mg/dl * Serum calcium > 15 mg/dl * Toxic level of drug or other chemical substance in a hemodynamically or neurologically compromised patient Radiography/Ultrasonography/Tomography (newly discovered) * Cerebral vascular hemorrhage, contusion or subarachnoid hemorrhage with altered mental status or focal neurological signs * Ruptured viscera, bladder, liver, esophageal varices or uterus with hemodynamic instability * Dissecting aortic aneurysm Electrocardiogram * Myocardial infarction with complex arrhythmias, hemodynamic instability or congestive heart failure * Sustained ventricular tachycardia or ventricular fibrillation * Complete heart block with hemodynamic instability Physical Findings (acute onset) * Unequal pupils in an unconscious patient * Burns covering > 10% BSA * Anuria * Airway obstruction * Coma * Continuous seizures * Cyanosis * Cardiac tamponade
