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Critical care is a specialised form of healthcare, usually a department within a hospital (often called the intensive care unit or ICU), which can provide organ support and invasive monitoring for a patient while treating a reversible illness. Working in ICU can be rewarding and challenging. The aim of this introduction is to give you a brief overview of critical care with an idea of what it can and cannot offer, and its context within the hospital. Although the life-saving possibilities are often remarkable, many of the techniques used for providing critical care support can be aggressive, with the potential to cause discomfort and psychological distress for both the patient and their family. In addition, critical care is resource heavy, has limited availability and is expensive to deliver. For these reasons, the ‘reversibility’ of a patient’s condition is an important consideration when deciding whether or not to admit. A risk versus benefit assessment is always appropriate – risk being the degree of harm you may cause the patient through applying your organ support interventions, and benefit being the likelihood that you will be able to reverse the acute illness and return the patient to an acceptable quality of life. Throughout the book, we will often use the terms ‘critical care’, ‘intensive care’ and ‘ICU’ interchangeably. Although different hospitals may draw practical distinction between areas, for the purposes of this book, HDU (high-dependency unit) or level 2 care can be assumed to be included as part of critical care unless otherwise specified. It is worth noting that medical knowledge inevitably advances over time. Conditions which were terminal 20 years ago may well be considered reversible now. So, one must be cautious when discussing patient selection. It is not usually acceptable to refuse admission based on advanced age alone or the presence of cancer. Sometimes you may wish to admit a patient for a lower level of critical care with an ‘escalation plan’ in place, ensuring that, should the patient’s condition deteriorate, there would be no progression to more invasive and ultimately futile treatments. For instance, a physically frail 85 year old with urosepsis and hypotension might be an excellent candidate for vasopressors and antibiotics but may not benefit from intubation and ventilation in the context of multiorgan failure secondary to severe pneumococcal sepsis. Approximately 15–20% of patients in critical care in the UK will die before leaving hospital. ICU mortality is usually higher for patients with acute medical pathologies compared with high-risk elective postoperative patients. Recognising when a patient is dying is an important skill but identifying when efforts are futile is not always easy or possible. Timely acknowledgment that the patient is in the terminal phase of life, combined with sensitive and frank communication, allows carers to consider changing the focus of care from aggressive resuscitation to prioritising comfort, dignity and time with family.