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Consult: ICU for Respiratory Failure

Call the ICU fellow to advocate for a higher level of care for a patient with worsening respiratory distress, justifying the need for an ICU bed.

Time Limit

10 minutes

Patient

Dr. Chen (ICU Fellow)

Type

Phone Call

How This Works

This is an interactive phone call simulation. You'll speak with Dr. Chen in a realistic clinical communication scenario.

1. Begin Call

Click "Begin Call" when you're ready. Speak naturally as you would on a real call.

2. Have the Conversation

10 minutes to complete the call. The AI responds in real-time to what you say.

3. Get Feedback

End the call when finished. You'll receive AI-powered feedback on your communication.

💡 Tip: Speak clearly and at a natural pace. If you need a moment to think, it's okay to pause briefly - just as you would in a real conversation.

Pre-Call Knowledge Check

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Learning Objectives

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Briefing Details

Consult Briefing

Your Objective

You are the medical resident on the floor. Your patient with pneumonia is getting worse and you believe they are no longer safe on the medical ward. Your objective is to call the ICU fellow, Dr. Chen, to request an ICU bed. ICU fellows are the gatekeepers for a limited resource. You must present a clear, compelling case demonstrating that the patient's needs exceed what can be safely provided on the floor.

Patient: Eleanor Vance, 82F

  • Room: 1204
  • Code Status: Full Code

Case Summary & Data

History: 82F with a history of COPD admitted yesterday with community-acquired pneumonia. She was initially stable on 2L nasal cannula.

Hospital Course: Over the past 6 hours, she has had a steady increase in her oxygen requirement. She was placed on a non-rebreather mask, and is now on high-flow nasal cannula (HFNC) at 60L and 80% FiO2.

Pertinent Exam/Vitals:

  • Vitals: Temp 100.5°F, BP 105/60, HR 115, RR 32. Her SpO2 is 90% on 60L/80% HFNC.
  • Exam: She is awake but anxious. She is using accessory muscles to breathe and can only speak in 2-3 word sentences.

Initial Workup:

  • ABG (on HFNC): pH 7.32 / pCO2 50 / pO2 65. (Showing acute-on-chronic hypercapnic respiratory failure with hypoxia).

The Clinical Question

You have a patient who is on the maximum level of non-invasive oxygen support available on the medical floor and is still hypoxic, tachycardic, tachypneic, and showing signs of increased work of breathing. She is tiring out.

Your "Ask": Your specific request for the ICU fellow is: "I have a patient in worsening respiratory failure who has maxed out our floor-level support. I am worried she is going to tire out and require intubation. I'd like to transfer her to the ICU for closer monitoring and potential escalation of care."

Make sure you are in a quiet environment with a good internet connection

You are preparing to call the ICU for your patient with pneumonia and worsening hypoxia. Which of the following findings is the STRONGEST justification for an ICU level of care?

When using the SBAR framework to call the ICU fellow, which component should include your explicit request for an ICU bed?

After you present your SBAR, what is the MOST LIKELY question the ICU consultant will ask to quickly assess the situation's severity and next steps?

After completing this scenario, you will be able to:

  • Synthesize patient data to formulate a clear and concise clinical justification for ICU admission.
  • Structure a consultation call using the SBAR framework to effectively communicate patient status and needs.
  • Identify key clinical indicators of impending respiratory failure that necessitate a higher level of care.