Recognising and Responding to Acute Patient Illness and Deterioration
- Life threatening problems must be treated before moving on
- Regularly reassess
- Call for help early
Airway - Can Be Protected by Themselves?
- Look- vomit secretions, trauma swelling foreign body
- Listen - abnormal sounds, complete obstruction will be silent
- Feel - airflow from nose/mouth, misting of Oxygen
Response to obstruction
- Call for help
- Oxygen 15L/min via non-rebreathing mask
- If COPD with chronic retainment aim for 88-92% not 94%
- Basic airway manoeuvres
- Head tilt
- Jaw thrust (if C-Spine injury possible)
- Possible basic airway support: oropharyngeal/nasopharyngeal tube
- Remove foreign body or suction visible secretions
Breathing - Difficulty?
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Pulmonary oedema
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Exacerbation of COPD
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Chest Trauma
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Look - RR, central cyanosis, working to breath, chest injury, ability to clear secretions by coughing, sweating
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Listen - noisy breathing, ability to talk, percussion, bilateral air entry, breath sounds/ crepitations wheeze rub
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Feel - symmetry, heart rate, tracheal deviation, chest expansion
Response
- Give Oxygen
- Sit the patient up
- Treat the underlying cause
- nebulisers, antibiotics, chest drain
- Order further investigations
- chest X-ray, arterial blood gas
Circulation
- Volume loss
- Pump failure
- Obstruction/reduced filling
- Vasodilation
Shock - a state of inadequate tissue perfusion
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Check BP, RR, urine output, lactic acidosis
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Look - source of blood/fluid loss, pallor, JVP, sweating, agitation, reduced consciousness
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Listen/Feel - pulse, cold peripheries (except in septic shock), prolonged cap refill time, heart sounds
Response to circulation problem
- Attach monitoring
- IV access
- Give a fluid challenge and assess response (500mL of .9 saline over 15 mins)
- Cautious if evidence of cardiogenic shock
- Treat underlying cause
Disability - Evaluation of a patient’s Neurological System
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Metabolic
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Hypoglycaemia, hypothermia, hypoxia
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Drugs
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opioids, benzodiazepines
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Seizures
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Raised intracranial pressure
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head injury
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Intracranial infection
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Assess conscious level
- AVPU
- GCS - if <9 contact anaesthetics
- Examine pupils
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Check glucose
Response
- Treat reversible causes of reduced consciousness
- glucose, opioid overdose and seizures
- Consider further investigations
- CT head, urine for toxicology or thyroid function tests
Exposure
- EVERYTHING ELSE
- Head to toe exam
- Check temperature
- Take full history and review notes/charts/investigations
SBARR Communication
Method of communication to get all info necessary
Situation - who is the patient and where are they Background - why where they admitted Assessment - what’s the current problem Recommendations - what should be done? - get things ready and what might be needed Readback - check that everything is correct