At 02:15 I was the only ACNP on, ED boarder in undifferentiated shock: I intubated, placed a cordis, started norepi at [redacted]/kg/min, and called ICU without waiting on CT. For those running solo nights, what’s your hard line for escalating to ICU and what first-5-minute playbook do you stick to when diagnostics lag?
But at 02:15 my hard line is: ‘airway + vasoactive = ICU now’ — if I’ve intubated and I’m nudging norepi past about [redacted]/kg/min (or thinking second agent), I escalate without waiting on CT… First five minutes I run a quick RUSH while the cordis is going in and set NIBP to q1min if an A-line will slow me down; only caveat is obvious hemorrhage where I flip to MTP first — does your shop let you ultrasound ED boarders?