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Questions

A 62-year-old man presents to your Emergency Department with fever, confusion, and hypotension.

 He has a history of type 2 diabetes and hypertension.

On arrival:

 Vital signs: HR 122 bpm, BP 78/44 mm Hg, RR 28 /min, Temp 39.2 °C, SpO₂ 91 % RA.

 Examination: cool peripheries, mottled skin, reduced urine output.

Your ST3 registrar initiates the sepsis pathway — broad-spectrum IV antibiotics, 30 mL/kg crystalloid bolus, and peripheral noradrenaline via metaraminol bridge.

 Point-of-care lactate: 6.2 mmol/L.

 Repeat BP remains low despite fluids.

The ICM registrar and ICM consultant attend; they perform intubation and commence central noradrenaline infusion.

 The patient stabilises with a MAP of 68 mm Hg.

 After multidisciplinary discussion, the decision to admit to ICU is documented by the ICM consultant at 12:00 pm.

At 14:45 pm, the patient is still in resus awaiting transfer, as ICU reports bed pressure.

According to the Better together: Collaborative working between Emergency Medicine and Intensive Care  “Better Together” Framework, within what time frame should this patient be admitted to the Intensive Care Unit from the time the decision to admit was made?

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