ICU and You · Mind Map Series · Number 36
Eighteen to thirty — the most reserve you will ever treat, and the narrowest margin once it is spent
An adult body, and not an adult. Almost every error in this age group comes from applying one of those and quietly forgetting the other.
The physiology has finished arguing. The airway is adult, the circulation is adult, the front of the neck is adult, and the doses have converged. What has not converged is everything else: who may consent, who may be told, what they will admit to with a parent in the room, and whether the person in the bed regards the illness or the consequences of the illness as the emergency.
The epidemiology turns with it. The threats of childhood came from a small body meeting a large world. These come from a person doing things on their own — travelling, choosing, forgetting, taking something, stopping something — and from a few diseases that have waited until now. This map is deliberately shorter than the last one: four stations rather than six. What has changed, what brings them in, what hides, and what outlasts the admission.
Do not read it like a chapter. Scan it. Let your eye go where it wants, read three boxes that catch it, and stop. You are not trying to finish it and you are certainly not trying to memorise it.
Then come back. Before a shift on which you might meet one of these children, or after a case that went a particular way, or while waiting for a retrieval team. Thirty seconds at a time, often, beats an hour once.
It works the way a painting in a corridor works. Nobody sits down and studies the painting they walk past every morning, and yet after a year they could tell you what is in it, where the light falls, and exactly what is on the left-hand side — and they would notice at once if something had changed. That noticing is the point. These maps are not built to be recalled on demand; they are built so that when the thing in front of you does not fit, something quietly objects.
On a phone: turn it sideways, or scroll the map across. Pinch to zoom on any section.
One sentence, back to me: what is the youngest patient you have watched compensate right up until they did not?
I am after the moment rather than the case — the observation you now make earlier because of it, or the number you stopped trusting. This age group is the one where experienced people still get caught, because everything looks survivable until very suddenly it is not.
How you are credited is entirely your call — by name, by initials, or not at all — whether you write the piece or I do, and whether I quote you or simply say who sent something in; nothing of yours goes up with your name on it unless you have said yes.
The button opens a reply straight to me. If your device blocks it, write to icuandyou@icloud.com instead.