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FCCS > 1. Recog, assess seriously ill patient > Flashcards

1. Recog, assess seriously ill patient Flashcards

- Early identification - Early signs and symptoms - Initial assessment and early stabilization

1
Q

DIRECT

A

Detectie: VG, LO, lab
Interventie: behandel/corrigeren, minimaliseren mordbiditeit/mortaliteit
Reassessment: check effect behandeling
EffectiveCommunication: fout = grootste oorzaak morb/mort
Teamwork: synergie

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2
Q

Tekenen van zieke patient

A

Verwardheid, prikkelbaarheid, bewustzijn, onheil

Kortademig, sympathisch, misselijkheid, zwakte

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3
Q

Verhoogd risico critical illness

A 
Spoedopname
Hoge leeftijd
Comorbiditeit
Fysiologische abnormaliteit
Chirurgisch
Bloedverlies
Immunodeficientie
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4
Q

Assessment acutely ill patient (HEDIT)

A 
History
Examination
Documentation
Investigations
Treatment
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5
Q

Primary Survey (HISTORY)

A
  • Getuigen, personeel, familie
  • Main symptoms: pain, dyspnoe, bewustzijn, zwakte
  • Trauma +/-?
  • Chirurgisch?
  • Medicatie/toxinen
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6
Q

Primary Survey (EXAMINATION)

A

LOOK/LISTEN/FEEL

  • Airway
  • Breathing
  • Circulation
  • Disability
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7
Q

Primary Survey (DOCUMENTATION)

A

ESSENTIAL PHYSIOLOGY

  • Hartslag, ritme
  • RR
  • AF, SpO2
  • Bewustzijn
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8
Q

Primary Survey (INVESTIGATIONS)

A

ABG (ven/art), Glucose, ECG?

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9
Q

Primary Survey (TREATMENT)

A
  • Luchtweg + oxygenatie
  • IV toegang
  • Noodzaak tot resuscitatie
  • ASSISTENTIE
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10
Q

Secondary Survey (HISTORY)

A

Huidige klacht, VG, opname beloop, sociaal, medicatie, FG, behandelbeperking!

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11
Q

Secondary Survey (EXAMINATION)

A
  • Neurologisch
  • Respiratoir
  • Cardiovasculair
  • Urogenitaal
  • Abdomen
  • Endocrien/hematologisch
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12
Q

Secondary Survey (DOCUMENTATION)

A

Status, diagnose, documenteren

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13
Q

Secondary Survey( INVESTIGATIONS)

A

Lab, radiologie, ECG, microbiologie

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14
Q

Secondary Survey (TREATMENT)

A

Organ system support

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15
Q

Symptoms associated met critical illness

A
  • Inadequate cardiac output
  • Respiratoire compensatie
  • Verminderd/veranderd bewustzijn
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16
Q

Belangrijkste indicator van critical illness

A

Tachypnoe

Metabole acidose

17
Q

Airway (Assessment)

  • Oorzaak
  • L, L, F
A
  • Causes of obstruction: trauma, bloed, vomitus, C.A., CNS, infectie, laryngospasme

Look: Cyanose, AF en patroon, hulpademhalings, trachea tug/midline, paradoxaal (abd/thorax), bewustzijn
Listen: luide ademhaling, afwezige ademhaling
Feel: airflow

18
Q

Breathing (Assessment)

  • Oorzaak
  • L, L, F
A
  • Oorzaken inadequate oxygenatie:
    – resp. drive: CNS
    – resp effort: zwakte, zenuwschade, thorax afwijkingen, pijn
    resp aandoeningen: zie kaartje

Look: Cyanose, bewustzijn, tracheale tug/midline, hulpademhaling, AF en patroon, saturatie
Listen: Dyspnoe, volzinnen, luide ademhaling, percussie + auscultatie
Feel: symmetrische thorax, positie trachea, abdominale distensie

19
Q

Respiratoire aandoeningen (– oxygenatie)

A 
Pneumothorax
Hematothorax
Aspiratie
COPD
Astma
LE
Long contusie
ALI (acute lung injury)
ARDS (acute respiratory distress syndrome)
Oedeem
Rib fractuur --> flail chest
20
Q

Cheyne-stokes breathing

A

Afwisselend apneu/hypopneu - hyperpneu

- Herenstam aandoening

21
Q

Kussmaul-breathing

A

Diepe ademhaling/grote teugen

- Metabole acidose

22
Q

Ataxic breathing (Biot ademhaling)

A

Hyperneu - apneu

Ernstige neurologische schade (slechte prognose)

23
Q

Symptomen hypoxemie

A

Agitatie en verwardheid

24
Q

Symptomen hypercapnie

A

Verminderd bewustzijn

25
Q

Circulation (ASSESSMENT)

  • Oorzaken
  • L, L, F
A
  • Oorzaken inadequate circulatie
    Primair: ischemie, arritmie, kleplijden, cardiomyopathie, tamponade
    Secundair: medicatie/drugs, hypoxemie, electrolyten, dehydratie, sepsis, bloedverlies, anemie

Look: Perfusie(bleekheid), CRT <3s, bloeding (BBBBB), bewustzijn, dyspnoe, oligurie, CVD+
Listen: hartgeluiden, carotis souffle
Feel: precordiale pulsatie, pols, extremiteiten (temp)

26
Q

Externe examinatie

A

Bleekheid, cyanose, zweten, icterus, erythema, flushing

Clubbing vingenagels, splinterbloedinkjes

27
Q

Onderzoek abdomen

A

Pijnlijke gebieden, palpeerbare massas, rigiditeit, distensie, loslaatpijn
Omvang lever, milt.
Cave intrauterine/ectopische zwangerschap

28
Q

Pols clue’s

  1. Zwakke pols
  2. Bounding pols
  3. Irregulair
  4. Pulsus paradoxus
A
  1. hypovolemie, lage CO
  2. hyperdynamische circulatie (ondervulling)
  3. meestal AF
  4. (>10mmHg daling RR bij inspiratie): hypovolemie, COPD/astma, pericarditis constrictiva, tamponade
29
Q

Key points - seriously ill patient (5)

A
  • Snelle identificatie cruciaal minimaliseren critical illness
  • Tachypnoe + metabole acidose meest belangrijke indicatoren/voorspellers critical illness
  • Resuscitatie/stabilisatie komt voor al het andere(diagnose)
  • Gedetailleerde VG noodzakelijk voor diagnose, bepalen functionele reserve en behandelplan
  • RESPONS TO TREATMENT

FCCS (16 decks)

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