The first hour of ICU management sets the trajectory for the patient’s entire admission. Delays in establishing control of the airway, achieving haemodynamic stability, and identifying the underlying diagnosis are all associated with worse outcomes. The ICU environment provides the monitoring and support capabilities to detect and respond to physiological derangements rapidly — but only if the clinical team uses those capabilities effectively.

Every new ICU admission should be approached in the same systematic way, regardless of the admitting diagnosis. The ABCDE framework provides this structure and ensures that life-threatening problems are identified and treated in order of priority. In the ICU, the consequences of missing an airway problem are no less severe just because the patient is in a monitored environment — if anything, the false reassurance of monitoring can occasionally lead to delayed recognition of a problem that a vigilant bedside clinician would have caught immediately.