ABSTRACT
Critically ill patients may be encountered in all areas of the
hospital, from the Accident and Emergency department to
medical or surgical wards, operating theatres, recovery wards
or critical care units. Patients may be referred by other doc-
tors, ward nurses, physiotherapists or critical care outreach
teams. Some may be acutely unwell to the point of requiring
immediate resuscitation, whereas others may be relatively
stable and require assessment and the formulation of a man-
agement plan to ensure continued progress towards full
recovery. In either case the aim is to use a systematic approach
to assessment to ensure that all immediately life-threatening
problems are recognized and the correct treatment is started
immediately. Critically ill patients often have multiple prob-
lems, and the use of a systematic approach reduces the risk of
missed diagnoses and provides a framework for treatment
when working under stressful conditions. You are interested
in all the patient’s problems and their responses to the treat-
ments instigated. Documentation is vital, as shift working and
frequent handovers provide ample opportunity for failures in
communication. Each entry in the notes should be dated and
timed, and the person making the entry should sign it legibly.
Several systems have been recommended for use with particu-
lar types of patient, such as the Advanced Trauma Life
