Basics of emergency critical care and bridging of critically ill patients in the emergency department to intensive care unit admission

The decision of the Federal Joint Committee (GBA) on a staged system of emergency structures in hospitals from 2018 stipulates that in hospitals with extended and comprehensive care, patients requiring mechanical ventilation should be transferred from the emergency department within 60 min of admission. In practice, however, depending on the structure of the hospital, the workload of the intensive care unit, the nurse shortage, the time of year and the type of emergency, patients requiring monitoring and intensive care may remain in the emergency department for longer. Emergency physicians are therefore increasingly required to provide extended emergency medical treatment in the emergency department as a bridge until an appropriate monitoring or intensive care unit is available within the hospital or by transfer to an external hospital. In addition, for a selected patient population, short-term "emergency critical care" measures can stabilize the patient's condition to the point where ICU treatment is no longer necessary, with corresponding relief of scarce ICU resources. The acronym "OSKARinED", presented here for the first time, summarises the emergency medical priorities of oxygenation and ventilation, sedation and analgesia, catecholamine and volume therapy as well as catheter management, anti-infective therapy, positioning, ulcer and thrombosis prophylaxis, nutrition and blood sugar control, delirium prophylaxis and management.