Assessing the critically ill patient

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Assessing the critically ill patient
REACT Course
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Dont forget

• You are part of a team
• So work as a team
• If in doubt call for HELP

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Assessing Patients

• Observe
• Listen
• Ask relevant questions
• Examine
• Special investigations

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If critically unwell

• Airway
• Breathing
• Circulation
• Disability
• Exposure

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If critically unwell
A
B
C
D
E
Always A gt B gt C gt D gt E
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Airway

• Chin Lift
• Suction
• Guidal airway
• Oxygen mask / Reservoir
• Do you need to call for HELP ?

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Breathing

• Rate
• Laboured
• Use of Accessory muscles
• Symmetrical chest expansion
• Colour
• O2 Sats
• Bag and mask, CPAP, intubate
• Do you need to call for HELP ?

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Central and Peripheral Cyanosis
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Oxygen Sats
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Circulation

• BP, pulse
• Capillary refill
• Limb temperature
• Minijets, Volume
• Do you need to call for HELP ?

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Blood Pressure
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Minijets
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Capillary Refill
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IV Access and Fluids
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Disability

• AVPU
• Pupils
• Check BM
• Do you need to call for HELP ?

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AVPU for assessing level of consciousness
A Alert
V Respond to Voice
P Respond to Pain
U Unresponsive
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Exposure

• Wounds
• Drains
• Always respect patient
• Do you need to call for HELP ?

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Do you need to call for HELP?
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Assessment of sick patient

• ABCDE
• If patient looks sick CALL FOR HELP

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Look at the Charts at the end of the bed

• BP, HR
• Temp
• Urine output
• Balance / weight
• Sats
• Respiratory rate

Pic of chart
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Modified Early Warning System (MEWS)
Score 3 2 1 0 1 2 3
Respiratory Rate lt 8 9 - 15 16 - 24 25 - 29 gt30
CNS Conscious Level Non Compliance New agitation or confusion A Alert V Voice P Pain U Unresponsive
HR lt 40 41 - 50 51 - 100 101 - 129 gt 130
BP Systolic lt 70 71 - 80 81 - 100 101 - 180 gt 180-200 Any significant change
Urine Output mL/Kg/Hr lt 0.5 for 2 hours lt 1 gt 1 Not Pud 8-10 hours Not Pud 10-12 hours
Temperature lt 35 35 37.9 38-38.5 gt 38.5
SaO2 () lt 88 88 - 89 90 - 94 gt 95
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Special Investigations

• ECG
• CXR
• ABG
• BM
• FBC, UE, LFT, Clotting
• Do you need to call for HELP ?

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Special Investigations

• Never unnecessarily put patient in a dangerous
  environment eg CT scanner
• Portable CXR, not departmental
• Monitor if transport anywhere
• Appropriate resuscitation equipment during
  transfers eg drugs, defib, airway, and
  appropriate personnel

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Management Plan

• ABCDE
• Do they need transfer to ITU ?
• Start treatment
• Patient position in bed,
• Fluids,
• Nebs,
• iv diuretics,
• Analgesia
• Start investigations if appropriate
• Do you need to call for HELP ?

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Dont Forget

• Write it in the notes
• Communicate with your colleagues