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WELCOME TO REACT!

R ecognition of E mergency signs, A ssessment of C ause and T reatments. WELCOME TO REACT!. OUTCOMES OF REACT TRAINING. Multidisciplinary Team approach to Patient Care Sharing of knowledge and skills All singing from the same hymn sheet Use of the MEWS scoring system within HCA

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WELCOME TO REACT!

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  1. Recognition of Emergency signs, Assessment of Cause and Treatments WELCOMETO REACT!

  2. OUTCOMES OF REACT TRAINING Multidisciplinary Team approach to Patient Care Sharing of knowledge and skills All singing from the same hymn sheet Use of the MEWS scoring system within HCA Healthcare

  3. Why REACT

  4. The facts! NCEPOD (2005) report: ‘An acute problem’ Reviewed 1,677 pts admitted to medical ICU’s in the UK • 560 pts died during the study period; 47%(252) of those pts received care which was classified as poor! • 41 of these pts received care which contributed to their death

  5. The facts! NPSA (2007) report: ‘Safer care for the acutely ill patient: learning from serious incidents’ Reviewed 1,804 serious incidents that result in death. 576 deaths could be interpreted as potentially avoidable! • 425 occurred in acute/general wards • 71 were reported to diagnostic errors • 64 related to patient deterioration not recognised or not acted upon. • 43 involved a problem with resuscitation after cardiac arrest

  6. The reasons! Key theme 1: clinical or physiological deterioration not recognised or not acted upon Key theme 2: resuscitation after cardiopulmonary arrest

  7. Modified Early Warning Scoring

  8. What are the clinical signs that this patient is sick?What interventionsshould have been done? Who is responsible?

  9. Assessing the Critically Ill Patient Airway Breathing Circulation Disability Exposure

  10. SYSTEMATIC APPROACH A & B : Treat what kills first! A B C D E systematic assessment: • Look • Listen • Feel Communicate results, and document Achieves a comprehensive & universal approach to caring for sick patients

  11. Modified EARLY WARNING SYSTEM (MEWS) • MEWS >4 is a warning sign = RED FLAG • Call for help early! • Consider oxygen and fluids!

  12. Any questions?

  13. Summary: the REACT Course Aims to assist the MDT improve the quality of care provided by: • Promoting the track and trigger concept; • Promote timely admissions to Intensive Care • Units • Reduce / avoid preventable patient deaths • Promotes the ABCDE concept of a structured • approach to patient assessment • Assess the need for Oxygen and Fluids • Knowing the RED FLAG means get help!!!

  14. Is it clear? Is it open? AIRWAY What do we want to know?

  15. Effort ? Effects ? Breathing What do we want to know?

  16. Assessing Breathing Look Rate, colour, depth, chest movement, agitation, accessory muscle use ListenSpeech, Noises, Cough, Auscultation. FeelExpansion, Pulse, Percussion, Palpation Other Tests: SpO2, CO2, PaO2, Blood Gases

  17. Breathing Management Consider: • High flow • Oxygen • Physiotherapy • Positioning • Medication • Suction

  18. If assessment raises concern! Respiratory rate <8 WHY? Respiratory rate >20 WHY? Is this a red flag? Give high flow oxygen Call expert help!

  19. Practical Demonstration

  20. Any questions?

  21. Summary: A & B • Airway & Breathing is the beginning of the structured approach to patient assessment • If concerned call for help early • Always assess need for Oxygen • Watch out for the RED FLAG!

  22. C is for Circulation

  23. Aim To revise the principles of circulatory physiology and place into context for practice.

  24. Components of circulation To maintain hemodynamic stability we need to maintain perfusion, transportation and excretion. Therefore we require a healthy: Volume Together Heart determine Vessels Blood Pressure

  25. 3 reasons for a low blood pressure Reduced filling due to hypovolaemia (Preload) Reduced muscle power due to a heart muscle damage (Contractility) Reduced vessel tone, vasodilatation (SVR)

  26. Assessing circulation: Look: • Fluid balance • Urine output • Overall balance • Weight • JVP • MEWS • Blood results • Skin Colour Feel: • CRT • Skin Tone • Bounding Pulse • Peripheral Oedema • Temperature Listen: • Is patient thirsty • Confused/ agitated • Cardiac sounds (if within • remit) • Manual BP, HR

  27. Treating circulation- depends upon results of assessment • Cannula inserted • Volume challenge • Give 250-500mls crystalloid IV, monitor result • Send bloods • Urinary catheter inserted if applicable • Bladder scanner • Fluid balance chart commenced • 12 lead ECG • Re-assess frequently: • Repeat Vital signs • CVP (if applicable) • Urine output

  28. Any questions?

  29. Summary… CONSIDER THE CIRCULATION AS A WHOLE Heart / peripheries / volume • Gather as much information as possible • Treat effectively and monitor your interventions • BLOOD PRESSURE MAY BE NORMAL EVEN IN THE PRESENCE OF SHOCK, DUE TO COMPENSATORY MECHANISMS – TRENDS! • DO NOT allow a low hourly urine volume (<0.5mls/kg/hr) to go untreated for more than two consecutive hours

  30. Dis for Disability DON’T FORGET… Assessing the patient’s level of consciousness (LOC)

  31. Altered Levels of Consciousness Direct (Neuro) Causes • Epilepsy • Meningitis • Tumour • Head Injury • CVA

  32. Indirect (Hidden) Causes The 5 H’s: • Hypoxia • Hypoxaemia • Hypercapnia • Hypotension • Hypoglycaemia 1-3 result in cerebral oedema which leads to cerebral ischemia.

  33. Indirect (Systemic) Causes Other Possibilities: • Hypothyroidism • Uraemia • Drugs • Renal Failure • Liver Failure

  34. AVPU • Eyes open/ talking. • Responds to verbal commands. • Which methods are used? • No response to pain Awake - Verbal, responds to voice - Pain. Responds to painful stimuli - Unresponsive -

  35. AVPU If a patient is only responding to : Pain Or is Unresponsive Call for help immediately regardless of any other observation Pain Or is Unresponsive

  36. Blood Sugar Levels Check blood sugar level! What can cause an altered blood sugar level?

  37. D…Summary Don’t forget to assess the patients conscious level… AVPU ( Newly confused) PEARL BSL

  38. Eis for EXPOSURE Following A…B…C…D… Fully examine your patient

  39. Physical Examination Look Top to toe (remember privacy/ dignity) • Wounds • Drains/ Catheters • Injuries / Swelling • Skin Colour / Rashes • Temperature (CRT) • Pain

  40. Following ABCDESecondary Assessment • Patient History • Baseline levels • Check Notes • DOCUMENT EVERYTHING • Meditech • Routine Investigations • 12 Lead ECG • CXR • Blood Test Results U’s & E’s FBC Clot G&S XM BSL

  41. Any questions?

  42. ABCDE SUMMARY ANY QUESTIONS? Airway Breathing Circulation Disability Exposure

  43. Adding MEWs Assessment to Meditech To be completed when ever a patient triggers a MEWs of 4 of more

  44. Select 1. Assessment

  45. Enter Patient Name

  46. Right arrow on Enter form

  47. Scroll down to MEWs Trigger Assessment

  48. Complete form

  49. F12 File

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