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Phase 2; Year 2; G-I Block

Phase 2; Year 2; G-I Block. Acute Patient Assessment Acute Care Theme Topic Prof J A W Wildsmith. Dundee U/G Medical Curriculum. Phase 1: Basic Sciences Phase 2: Systems Blocks Phase 3: Clinical Practice Outcomes: Integration Development Patient Management: Acute Care.

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Phase 2; Year 2; G-I Block

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  1. Phase 2; Year 2; G-I Block Acute Patient Assessment Acute Care Theme Topic Prof J A W Wildsmith

  2. Dundee U/G Medical Curriculum • Phase 1: Basic Sciences • Phase 2: Systems Blocks • Phase 3: Clinical Practice • Outcomes: Integration Development Patient Management: Acute Care

  3. Management: Acute Care Practical Training (GMC) • Resuscitation Skills • Emergency Medicine • Practical Experience • Supportive Rx: O2 Fluids Pain Anxiety

  4. Acute Situations • Gross: Airway Obstruction Respiratory Arrest Cardiac Arrest Circulatory Shock • Subtle: Precursor States Stop Deterioration

  5. Acute Situations • Model: Acute Abdomen • Review: Presenting Problem Secondary Effects Intercurrent Disease Severity of Illness • Ask (& Answer) 4 Questions

  6. Four Vital Questions • How ill is this patient? • How quickly must I act? • Do I need (senior) help? • What is the physiological problem threatening life?

  7. Physiology of O2 Transport • Respiration Airways Lung Integrity Chest Wall Central Control • Circulation Heart Action Blood Volume Vessel Tone Control Systems • Haemoglobin concentration

  8. Acute Abdomen: O2 Transport • G-I Bleeding: Anaemia • Obstruction: Fluid Depletion Electrolyte Loss Abdo Distension • Jaundice: Fluid / Electrolyte Coagulation Nutrition / Drugs

  9. Acute Patient Assessment Methodology • History • Physical Examination • Investigations Skill is in Compression Appropriate to Situation

  10. Dealing with Emergencies – 1 & 2 Assess Reassure Manage 1 - Danger A - Airway 2 - Situation B - Breathing 3 - Response C - Circulation Sixty Second Survey P, BP, R, T, SpO2 Signs shock Obvious ‘Injury’ A V P U

  11. Dealing with Emergencies – 1 & 2 • No Response, Breathing or Pulse Cardiopulmonary Resuscitation • Pulse, no Response or Breathing Expired Air Ventilation • Pulse & Breathing, No Response • Pulse, Breathing & Response • All need further Assessment

  12. Dealing with Emergencies - 3 • Focus on Relevant System(s) • Identify +ve&-ve indicators of CVS, RS & Fluid Status • Start appropriate action • Record findings regularly • Re-assess at intervals

  13. Fluid & Electrolyte Balance • Assessment of requirements Normal Requirement + Existing Deficit + Anticipated Loss • Water, Potassium, Sodium, H+

  14. Fluid & Electrolyte Balance • Normal Daily ‘Requirement’ 70 kg Adult: H20 circa 2 L K+ 40-80 mM Na+ Minimal Ambient Temperature Level of Activity

  15. Fluid & Electrolyte Balance • Existing Deficit History: Failure of Intake External Loss Internal ‘Loss’ Examination: Tongue Eyes; Skin Blood Volume Lab Tests: Hb; U&E; (ABG)

  16. Fluid & Electrolyte Balance • Anticipate Losses Continued Failure of Intake Urine Output Sweat (Pyrexia) Surgical Wound Bleeding Tissue & Wound Oedema Fistulae

  17. Action: Generic Aspects • High flow oxygen therapy • Position: Shock: Head down • Dyspnoea: Sitting • Venous Access & Therapy • Get HELP early • Primum non nocere

  18. Fluid & Electrolyte Regimen • Assess Volume Requirement • Consider Content Needed Blood Plasma ECF ICF • Expand Blood Volume Stat • 25 % of deficit in 2 hr or so • Monitor Urine (> 20 ml/hr) • Monitor Hb; U&E; (ABG)

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