Unstable or critically ill patients

The recognition and management of unstable and critically ill patients is a crucial clinical skill. Any clinicians who care for unwell patients should have the skills to recognise deterioration and manage it appropriately and quickly.

All patients who are unstable or deteriorating require a comprehensive assessment, completion of full set of vital signs, and ongoing reassessment with monitoring trends in vital signs. When medical or nurse practitioner support is delayed or unavailable, use the appropriate Emergency care assessment and treatment (ECAT) protocol.

Early consultation is recommended with intensive care, retrieval, anaesthetics, surgery, interventional radiology, cardiology and trauma teams as the situation dictates and context allows.

Considerations for the critically ill patient

The Checklist for adult patient waiting for retrieval or urgent transfer (PDF 211.6 KB) includes guidance for managing critically ill patients waiting for retrieval or urgent transfer.

Related adult ECAT protocols

• Anaphylaxis (adult)
• Compromising bradycardia
• Chest pain
• Hypoglycaemia
• Seizures (adult)
• Sepsis (adult)
• Shortness of breath
• Shortness of breath with a history of asthma
• Shortness of breath with a history of cardiac disease
• Shortness of breath with a history of chronic obstructive pulmonary disease
• Stroke or transient ischaemic attack (suspected)
• Traumatic injury
• Unconscious person
• Unwell immunocompromised person (adult)

Related paediatric ECAT protocols

• Anaphylaxis (paediatric)
• Seizures (paediatric)
• Sepsis (paediatric)
• Wheeze (including viral-induced or suspected asthma)
• Recognition of a seriously unwell child
• Recognition of a seriously unwell neonate
• Unwell immunocompromised person (paediatric)

Related clinical tools

• Airway management
• Angioedema (NSW Health login required)
  Source: Therapeutic Guidelines
• Angioedema
  Source: entsho.com
• Anaphylaxis
• Chronic obstructive pulmonary disease
• Sepsis pathways
  Source: Clinical Excellence Commission
• Tracheostomy

Institute of Trauma and Injury Management tools

• Closed head injuries
• Fibrinogen concentrate
• Foam cervical collars
• Freeze-dried plasma
• Inter-hospital major trauma transfer
• Trauma code crimson pathway
• Traumatic pneumothorax
• Trauma services model of care

Paediatric tools

• Managing a high acuity child outside of a tertiary children’s hospital: Key principles
• Paediatric resources

Paediatric improvement collaborative (PIC)

• Emergency airway management
• Care of the seriously unwell child
• Recognition of the seriously unwell neonate and young infant
• Trauma - primary survey

Other useful resources

Between the Flags
A 'safety net system' designed to assist clinicians to recognise when patients are deteriorating and to respond appropriately when they do.
Source: Clinical Excellence Commission

Recognition and management of patients who are deteriorating (PD2025_014)
Describes the local systems, structures and processes needed to recognise, respond to and appropriate ly manage patient physiological and mental state deterioration.
Source: NSW Ministry of Health

Useful apps

CIAP: Mobile apps (NSW Health staff only)
A curated list of clinical apps.

Emergency Procedures Emergency pro
Instructions and demonstration videos of common procedures.
Source:  Emergency Procedures Ltd
Emergency procedures

iResus Google iResusApple
Access the United Kingdom resuscitation and anaphylaxis algorithms.
Source: Resuscitation Council (UK)

iTransfuse
Information about prescribing red cells and platelets, and transfusion reactions.
Source: Lifeblood

Westmead ECMO Westmead ECMOGoogle Westmead ECMOApple
Algorithms to assist clinician and patient decisions regarding the healthcare of extracorporeal membrane oxygenation and cardiac arrest patients.
Source: Western Sydney Local Health District