In the corner, a patient is recovering well after a heart operation. Even so, the lights of five infusion pumps are blinking regularly, the ventilator is sighing, the electrocardiograph, several pressures, temperature and oxygen saturation are continuously displayed and massive amounts of data are being generated and recorded, and this is when things are going well!

Elsewhere, another patient may be on an intraaorticballoonpump, athirdmaybe on haemofiltration, a fourth may be on a ventricular assist device and occasionally, behind drawn curtains, a madeyed surgeon maybe performing open heart surgery on the unit due to unexpected complications.

The cardiothoracic critical care area can be a frightening place indeed.

Don't panic!

Managing the critically ill cardiothoracic patient is no different from any other patient. The principles of good clinical practice apply here as they do elsewhere. Knowingthe history helps. Clinical examination, as in every field of medicine, yields valuable information.

However, critical care provides additional, hard clinical data like no other area of medical practice. Continuous and regular monitoring of physiological and haematological parameters makes most diagnoses easy to make. If there is still doubt about the status of the patient, further information is easy to obtain, whether by pulmonary artery flotation catheter, transoesophageal echocardiography or computed tomography. This is one area where most decisions are made on the basis of sound evidence rather on a clinical hunch. All that is required is some basic knowledge, a degree of thoroughness and sound judgment.