Acute Care Flashcards
When should you consider making a DNACPR decision
Cardiac/respiratory arrest likely to be part of dying process and CPR will not be successful > advanced decision.
Last hours/ days spent in their preferred place of care
CPR may be successful, clinical outcomes may still be bad – consider risk/benefit
of treatment.
May want CPR even if unlikely to be successful
Issues with capacity surrounding CPR
If they have capacity, they can refuse CPR
If not, can be judged that CPR would not be overall beneficial to them.
Judgements about CPR should be made as early as possible.
If lack capacity, inform legal proxy or others close to patient about DNACPR decision and reasons for it
What do you do about CPR in the acute situation
no time for assessment, if no DNACPR in place/ find out their view, CPR should be attempted, unless certain there is sufficient information about patient to judge that it will not be successful
What are the 3 levels of critical care
0: Hospitalisation on the ward (IV therapy, observation 4hr)
1: Recently discharged from high level care/additional monitoring and interventions (4 hrly observation, continuous O2, IV fluid, analgesia)
2: 1 nurse to 2 pts, step down from level 3 (basic resp, CV, renal and neuro support)
3: Advanced resp support, min 2 organs supported, 1:1 care
Fasting guidelines for anaesthesia
Clear liquid (water, fruit juices, clear tea, black coffee) – 2 hours
Breast milk – 4 hours
Infant formula/ nonhuman – 6h
Light meals – 6h
In diabetes: minimize number of meals missed to 1, guidance on meds.
ASA Grades
- 1: normal healthy patient
- 2: mild systemic disease
- 3: severe systemic disease
- 4: severe systemic disease with constant threat to life
Which drugs should you stop before anaesthesia
OCP (4w)
Hypoglycemics, Warfarin (5d)
Clopidogrel (7d)
ACEI (on the day) (exaggerate hypotension), other antihypertensives can be continued
Recovery and discharge after anaesthesia
Ensure no need for airway support, breathing spontaneously; monitor pulse ox, ECG, BP
Discharge if awake, responsive; analgesia; stable CV; normal resp; temp acceptable; records up to date
Assessment for soft palate
LEMON: look, evaluate mouth opening, mallampati score I: can see soft palate II: can see uvula III: only base of uvula IV: soft palate not visible at all
What is a major trauma centre and the 3 types
all the services available to receive and manage seriously injured adults and/or children.
3 types: those that treat adults, children, and both
What are the 5 levels of the triage system
1 immediate (red): immediately seen by doctor 2 very urgent (orange): within 5-10 minutes 3 urgent (yellow): within 1 hour 4 standard (green): within 2h 5 non-urgent (blue): within 4h
Who initially triages
Local ambulance service to the appropriate destination
What are major trauma centres linked to
MTCs linked to local trauma units working with local emergency hospitals, specialist rehabilitation providers and local general rehabilitation services
Key points from the NHS clinical advisory group trauma report
Each region has one hospital which is MTC, supported by LTUs.
All major trauma/ <45 minutes away > MTC
If > 45 minutes then stabilize in ambulance > LTU.
Acute hemorrhage control needs to be in operating room/intervention in 1h
Aims for MTCs
System based pathway of care from pre-hospital > rehab
Reduce avoidable deaths
Reduce injuries through prevention program
Improve quality of life/ functionality
Monitored system and subjected to continuous quality improvement
