Table 4.
Description of patients requiring transfer to ICU within 24 hours of admission to IMCU
| Patient | IMCU Admit Dx | Additional Clinical Picture | Trigger for ICU Transfer | ICU Care |
|---|---|---|---|---|
| 1 | Sepsis | Bacteremia hypoxic respiratory insufficiency with ALI vs. CHF | High nursing needs. Worsening hypoxemia. | Intubated |
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| 2 | Alcohol Withdrawal | Hypoxemia. Mental status change. | High nursing needs. Worsening Hypoxemia. Not handling secretions. | Intubated |
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| 3 | Hypertensive Urgency | Hypertensive urgency | Intraparenchymal hemorrhage reclassified patient as hypertensive emergency. | Frequent titration of intravenous anti-hypertensives. |
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| 4 | COPD Exacerbation | Trialed on BIPAP | High nursing needs. Progressive hypercapnia. | Intubated |
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| 5 | Pneumonia | Progressive hypoxemia | Frequent nursing needs. High oxygen requirement and high respiratory rate. Aggressive fluid resuscitation. Frequent nebulized bronchodilators. |
Intubated |
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| 6 | COPD Exacerbation | Persistent respiratory insufficiency and hypotension | Frequent nursing needs. High oxygen requirement, respiratory rate, aggressive fluid resuscitation. Frequent nebulized bronchodilators. |
Hourly nebulized bronchodilators |
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| 7 | Hypercapnia | Femur fracture, narcotic therapy for pain. Trialed on BIPAP. | Frequent nursing needs. Failed extubation post fixation of femur. | Intubated |
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| 8 | DKA, Hypertensive Urgency | Hypertensive urgency | Labile blood pressure. Acute left iliac artery dissection reclassified patient as hypertensive emergency. | Frequent titration of intravenous anti-hypertensives. |
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| 9 | Pneumonia | Volume overload, left ventricular ejection fraction 15%, tachycardia, progressive hypoxemia. | Frequent nursing needs, progressive hypoxemia, initiation of intravenous anti-hypertensives. BIPAP. | Diuresis, frequent titration of intravenous antihypertensives. |
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| 10 | Alcohol Withdrawal | Escalation of intravenous benzodiazepines. | Frequent nursing needs and benzodiazepine titration. Delirium Tremens. | Deep sedation and Intubation. |
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| 11 | COPD Exacerbation | Trialed on BIPAP | Frequent Nursing needs. Progressive hypercapnic respiratory failure. | Intubated. Placed on vasopressors. |
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| 12 | COPD Exacerbation | Trialed on BIPAP | Low respiratory rate, progressive hypercapnia. Mental status change. | Cardiac arrest peri-intubation. |
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| 13 | Sepsis | Progressive hypotension and acidosis despite fluid resuscitation and antibiotics. Trialed on BIPAP. | Frequent nursing needs, mental status change, progressive respiratory failure, and pH 7.10. | Intubation, vasopressors, inotropes. |
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| 14 | Sepsis | Progressive hypotension, Ejection Fraction 15% | Frequent nursing needs. Hypotension unresponsive to fluid. | Vasopressors. |
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| 15 | Sepsis | Progressive hypotension and acidosis despite fluid resuscitation and antibiotics. | Frequent nursing needs. Progressed to septic shock despite aggressive fluid resuscitation and antibiotics. PEA Arrest. | Intubated. Vasopressors. |
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| 16 | NSTEMI | Dyspnea | Troponin > 30 | None |
ALI: Acute Lung Injury
BIPAP: Biphasic positive airway pressure
Dx: Diagnosis
CHF: Congestive Heart Failure
COPD: Chronic Obstructive Pulmonary Disease
DKA: Diabetic Ketoacidosis
NSTEMI: Non-ST-Elevation Myocardial Infarction
PEA: Pulseless Electrical Activity