Acute care: Recognising critical illness
In the first part of our series about acute medicine, Nicola Cooper describes how to recognise a critically ill patient
“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.
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