E — Exposure
Full exposure means a thorough head-to-toe examination, looking for injuries or findings that may not have been apparent during the initial assessment. This includes examining the skin for rashes, pressure areas, wounds, or signs of infection; checking all IV lines, arterial lines, central catheters, urinary catheters, and nasogastric tubes for position, patency, and signs of infection or complication; reviewing the drug chart for potentially harmful or unnecessary medications; and measuring temperature.
Fever in the ICU requires systematic assessment. A temperature above 38.3°C in an ICU patient should prompt consideration of new infection (including line-related bloodstream infection, ventilator-associated pneumonia, urinary tract infection, Clostridium difficile, or wound infection), drug fever, transfusion reaction, and non-infectious causes including venous thromboembolism, adrenal insufficiency, and thyroid storm. Blood cultures should be taken before antibiotics are changed whenever a new fever develops.
| Key Targets for ICU Initial Management • MAP ≥65 mmHg (or ≥70–80 if raised ICP or chronic hypertension) • SpO2 94–98% (88–92% in known CO2 retainers); wean FiO2 as soon as safe • Blood glucose 6–10 mmol/L; treat hypoglycaemia immediately and aggressively • Tidal volume 6–8 mL/kg predicted body weight; plateau pressure <30 cmH2O • Use balanced crystalloids for resuscitation; reassess after each 250–500 mL bolus • Temperature 36–37.5°C; treat fever promptly and investigate the cause • RASS target −1 to 0 in most patients; analgesia first, sedation second |