Acute care Assessment and Management

Acute care Assessment and Management

Airway Obstruction because of… • CNS depression • Blood, vomit, foreign body • Trauma • Infection, inflammation • Laryngospasm

Airway…….. Symptoms and signs • Difficulty breathing, distressed, choking • Shortness of breath • Stridor, wheeze, gurgling • See-saw respiratory pattern

Breathing Inadequacy because of... • Pulmonary disorders • infection • collapse • pneumothorax • asthma • Decreased respiratory drive • CNS depression • Decreased respiratory effort • muscle weakness • restrictive chest defect

Breathing…….. Symptoms and signs • Short of breath, anxious, irritable • Decrease in conscious level • Tachypnoea • Cyanosis

Primary Cause Ischaemia Myocardial infarction Hypertensive heart disease Valve disease Drugs Electrolyte abnormalities Secondary Cause Asphyxia Hypoxaemia Blood loss Septic shock Any Shock Circulatory/cardiac inadequacy

Circulation………. Symptoms and signs • Tachycardia • Bradycardia • Hypotension • Poor perfusion (CRT) • Poor cerebration • Poor urine output

Primary Trauma CVA Infection Poisons Secondary Hypoxia Metabolic Disability/CNS Abnormality

Disability….. Any CNS depression can lead to severe airway, breathing and circulatory problems (and vice versa)

Aim of assessing acutely ill patients • Ensure early anticipation and detection of disordered physiology at a stage before organ failure is established. • Initiate simple/preventative therapies to the limit of your capabilities, and call for senior help early. • Patients who do not make a prompt and sustained response to these measures should be considered for early referral to a HDU or ICU facility.

Assessing the Sick Patient Elementary Skills (History Examination and Investigations) & a Systematic approach • Airway • Breathing • Circulation • Disability • Exposure

+ Chin lift,head tilt Protect c spine Suction Airway adjuncts Assessing the Sick Patient Airway Upper airway obstruction Do you need help now ?

Assessing the Sick Patient Breathing • Rate • Rhythm/Symmetry • Depth • Auscultate/Percuss • WOB • Colour • O2 saturations Do you need help now ?

Capillary refill time • Limb temperature • Peripheral pulses • Central pulses • Heart rate & rhythm • BP • O2 saturation • Urine output Assessing the Sick Patient Circulation Do you need help now ?

Recovery position Assessing the Sick Patient Disability • AVPU • Pupils/posture • Blood glucose • “DEFG” Do you need help now ?

Assessing the Sick Patient Exposure Examination vs Environment Consider Hypothermia & Dignity Looking For………

Do you need to call for help now?

Any Questions?

Acute care Assessment and Management