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Assessing the critically ill patient

Assessing the critically ill patient. REACT Course. Don’t forget. You are part of a team So work as a team If in doubt call for HELP. Assessing Patients. Observe Listen Ask relevant questions Examine Special investigations. If critically unwell. A irway B reathing C irculation

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Assessing the critically ill patient

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  1. Assessing the critically ill patient REACT Course

  2. Don’t forget • You are part of a team • So work as a team • If in doubt call for HELP

  3. Assessing Patients • Observe • Listen • Ask relevant questions • Examine • Special investigations

  4. If critically unwell • Airway • Breathing • Circulation • Disability • Exposure

  5. If critically unwell A B C D E Always A > B > C > D > E

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

  7. 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 ?

  8. Central and Peripheral Cyanosis

  9. Oxygen Sats

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

  11. Blood Pressure

  12. Minijets

  13. Capillary Refill

  14. IV Access and Fluids

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

  16. AVPU for assessing level of consciousness

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

  18. Do you need to call for HELP?

  19. Assessment of sick patient • ABCDE • If patient looks sick CALL FOR HELP

  20. Look at the Charts at the end of the bed • BP, HR • Temp • Urine output • Balance / weight • Sats • Respiratory rate Pic of chart

  21. Modified Early Warning System (MEWS)

  22. Special Investigations • ECG • CXR • ABG • BM • FBC, U&E, LFT, Clotting • Do you need to call for HELP ?

  23. 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

  24. 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 ?

  25. Don’t Forget • Write it in the notes • Communicate with your colleagues

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