Acute care: Recognising critical illness
BMJ 2004; 328 doi: https://doi.org/10.1136/sbmj.040112 (Published 01 January 2004) Cite this as: BMJ 2004;328:040112
- Nicola Cooper, specialist registrar in general internal medicine and care of elderly people1
- 1St James's University Hospital, Leeds LS9 7TF
“In the beginning of the malady it is easy to cure but difficult to detect, but in the course of time, not having been either detected or treated it becomes easy to detect but difficult to cure.”
Niccolo Machiavelli, The Prince
Doctors are trained to take a history, do a thorough examination, and make a diagnosis. Unsurprisingly, when faced with a critically ill patient, our focus is on making a diagnosis to do something about it. Most of us learn how to deal with emergencies from the recipes we carry in our pocket handbooks. Few of us are trained to deal with the generic altered physiology that accompanies acute illness. Lots of studies show that the result is suboptimal care.
Some arrests can be avoided
Surprisingly, most cardiac arrests in hospital are predictable. One study found that 84% of patients had documented observations of clinical deterioration or new complaints within eight hours of arrest.1 In another study, two thirds of patients had documented physiological deterioration within 6 hours of arrest, which was not acted on.2 The predominantly respiratory and metabolic derangements which precede cardiac arrest--hypoxaemia, hypo- tension, and acidosis--are not rapidly fatal. But earlier intervention would be better when the abnormalities were potentially reversible, rather than at the time of cardiac arrest, which has poor prognosis.2
Other studies have considered emergency admissions to intensive care. In one study …
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