How to Present a Critically Ill Patient to the ICU
Use a structured ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure) as your presentation framework, prioritizing airway management and oxygenation as the absolute first priority, followed by hemodynamic status, then neurological assessment. 1, 2
Presentation Structure
A - Airway Assessment
- State airway patency status immediately: Is the airway open and clear, or is there obstruction, tube displacement, or secretion blockage? 1, 3
- For intubated patients, report:
- Identify any known difficult airway history with specific patient-specific strategies for re-intubation or extubation 1
B - Breathing and Oxygenation
- Report current oxygen saturation, respiratory rate, and work of breathing 1, 4
- State severity of hypoxemia if present (SpO₂ <80% occurs in up to 25% of ICU intubations) 1
- For mechanically ventilated patients, provide:
- Note any respiratory distress or increased work of breathing 4
C - Circulation and Hemodynamic Status
- Present vital signs with trends: blood pressure, heart rate, mean arterial pressure 1, 7
- State hemodynamic stability status (significant instability occurs in up to 25% of ICU intubations, with cardiac arrest in ~2%) 1
- Report:
- Identify any signs of shock or inadequate perfusion 2
D - Disability (Neurological Status)
- State level of consciousness using standardized scale 8
- Report Glasgow Coma Scale or equivalent 2
- Note pupillary response and any focal neurological deficits 8
- For neurocritical patients, report intracranial pressure if monitored 6
E - Exposure and Additional Critical Information
Essential Clinical Context
Patient Background
- Primary diagnosis and reason for ICU admission 8
- Relevant past medical history affecting current management 6
- Baseline functional status (previously functionally independent vs. dependent) 6
Current Management Plan
- Ongoing resuscitation measures (damage control resuscitation principles if applicable) 6, 7
- Pain and sedation status using validated scales (BPS or CPOT for non-verbal patients) 7
- Current sedation depth (light vs. deep sedation) 7
- Antibiotic therapy and infection status 1
Risk Stratification
- Intra-abdominal pressure measurement if at risk for abdominal compartment syndrome 6
- Risk factors for clinical deterioration 7
- Coagulopathy status and bleeding risk 6
Transport-Specific Information (If Applicable)
When presenting a patient being transported to ICU:
- Confirm adequate stabilization before transport (patient factors rarely contribute to adverse events when properly stabilized) 6, 7
- Report oxygen reserve calculations (entire transport duration plus 30-minute reserve) 7
- State competency of escort team in airway management and monitoring 7
- Confirm end-tidal CO₂ monitoring for mechanically ventilated patients during transport 7
- Document completion of pre-transport checklist 6, 7
High-Risk Situations Requiring Immediate Escalation
Alert the receiving team immediately if:
- Four or more intubation attempts occurred (dramatically increases cardiac arrest risk) 1
- Severe hypoxemia present (SpO₂ <80%) 1
- Hemodynamic instability requiring high-dose vasopressors 1
- Known difficult airway without documented management plan 1
Documentation Requirements
- All airway management details must be documented at bedside with patient-specific strategies visible 1
- Medical record and relevant laboratory/radiographic studies should accompany patient 6
- COBRA/EMTALA checklist completion for interhospital transfers (in US) 6
Common Pitfalls to Avoid
- Never present vital signs alone without comprehensive assessment context 7, 8
- Do not delay presentation of airway concerns—deterioration may not initially appear to be an airway emergency but often involves airway compromise 1
- Avoid presenting without calculating adequate oxygen reserves for transport 7
- Do not omit pain assessment—treat pain before considering sedation 7