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Case History

Image not available. The patient discussed in Chapter 5 is now confirmed to have sepsis, and despite initial resuscitation and care on the ward has not improved. He is requiring increasing amounts of oxygen to maintain his saturations, has a high respiratory rate (>21 breaths/minute) and his breathing is laboured. His systolic blood pressure remains below 90 mmHg.

What should be done for this patient next?


What should be done for this patient next?

Image not available. This patient will have a score on an early warning system that will trigger review by senior medical staff and staff regularly involved in the care of critically ill patients.1,2 Pending the introduction of a national early warning system,3 many systems are currently used, all aimed at identifying acutely unwell patients and instituting prompt care. If a score is low but there is clinical concern about a patient it is appropriate that senior and skilled staff are involved at an early stage. Many young, previously fit patients are able to compensate and then deteriorate rapidly. It is invariably easier and more effective to deal with patients before they decompensate and organ dysfunction becomes established.

The severity of the illness at this point will require more intensive monitoring above the level of normal ward care. The frequency of observations of the patient should increase and standard physiological parameters should be monitored at least 12 hourly; as the patient becomes more unwell this frequency should increase appropriately. In a critical care unit the observations will usually be at least hourly and often continuously. As a patient's condition improves the frequency of observations should be reduced.

Image not available. The team looking after the patient in consultation with the critical care team and the patient determine that the patient should be moved to a high-dependency unit (HDU).

The discussion will be the same as for any patient admitted to critical care - their desires and wishes and their potential for recovery, future life expectancy and underlying disease will play a part in this. High-dependency care is often referred to as 'Level 2 Care'; the levels of care come from the UK Department of Health document, Comprehensive Critical Care, and are outlined in Table 6.1.4

Table 6.1Levels of care

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