Module 1 · Resuscitation & emergencies

Deteriorating patient and ICU triage

NewPhase 2

Recognise and respond to the deteriorating ward patient: ABCDE assessment, NEWS2 and qSOFA, rapid response calls, ICU admission and discharge criteria from the 2023 DGHS-ISCCM guideline, and fair bed triage when beds are short.

5 topics

Drugs in this module

Doses written for this module's context. The same drug may read differently in another module.

Oxygen

Medical gas

Indications
Hypoxaemia in the deteriorating patient
Adult dose
Titrate to SpO2 94-98% (88-92% if at risk of hypercapnic failure, e.g. COPD, obesity hypoventilation, neuromuscular disease). Start 15 L/min via non-rebreather in peri-arrest/shock, then titrate down.
Preparation (India)
Central pipeline or cylinders (check cylinder size and contents before transfer); non-rebreather, Venturi (24-60%), nasal cannula 1-4 L/min.
Cautions
Avoid hyperoxia once stable; hypercapnic patients need controlled oxygen and ABG within 30-60 min.

Balanced crystalloid (Ringer lactate / Plasma-Lyte)

Isotonic crystalloid

Indications
Hypotension or hypoperfusion while the cause is found
Adult dose
250-500 mL bolus over 15 min, reassess after each bolus (HR, BP, CRT, urine, lung crackles); usual first 30 mL/kg only if sepsis-induced hypoperfusion.
Preparation (India)
Ringer lactate 500 mL and 1 L bags widely available in India; Plasma-Lyte A / Sterofundin in tertiary centres.
Cautions
Stop if no response, crackles, rising JVP or B-lines on ultrasound. Use smaller 250 mL boluses in heart failure, ESRD or elderly.

Dextrose 25% (or 50%)

Carbohydrate

Indications
Hypoglycaemia (capillary glucose < 70 mg/dL) found in the D of ABCDE
Adult dose
25 g IV = 100 mL of 25% dextrose (or 50 mL of 50%), recheck glucose in 15 min; repeat if still < 70 mg/dL, then 10% dextrose infusion.
Preparation (India)
25% dextrose 25 mL ampoules and 100 mL bottles; 50% dextrose 25 mL vials in many Indian hospitals.
Cautions
Give thiamine 100-200 mg IV first or together in malnourished or alcohol-dependent patients; 50% dextrose is a vesicant, use a large vein.

Module references (12)

  1. 1

    Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315:801-10.

  2. 2

    Prescott HC, Antonelli M, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026. Intensive Care Med. 2026;52(5):863-936. Co-published in Crit Care Med. 2026 (doi:10.1097/CCM.0000000000007075)

  3. 3

    Royal College of Physicians. National Early Warning Score (NEWS) 2: standardising the assessment of acute-illness severity in the NHS. London: RCP; 2017.

  4. 4

    Cecconi M, De Backer D, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med 2014;40:1795-815.

  5. 5

    Directorate General of Health Services (MoHFW, Government of India) with ISCCM. Guidelines for Intensive Care Unit Admission and Discharge Criteria. New Delhi: DGHS; 2023.

  6. 6

    Thim T, Krarup NH, Grove EL, Rohde CV, Lofgren B. Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. Int J Gen Med 2012;5:117-21.

  7. 7

    Resuscitation Council UK. The ABCDE approach (adult). London: RCUK; current version.

  8. 8

    Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation 2013;84:465-70.

  9. 9

    Hillman K, Chen J, Cretikos M, et al. Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial (MERIT). Lancet 2005;365:2091-7.

  10. 10

    Nates JL, Nunnally M, Kleinpell R, et al. ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research. Crit Care Med 2016;44:1553-602.

  11. 11

    Christian MD, Hawryluck L, Wax RS, et al. Development of a triage protocol for critical care during an influenza pandemic. CMAJ 2006;175:1377-81.

  12. 12

    Chalfin DB, Trzeciak S, Likourezos A, Baumann BM, Dellinger RP. Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Crit Care Med 2007;35:1477-83.