Approach to the critically ill patient Flashcards
management in a critically ill patient
management cannot be delayed until a diagnosis is made
treatment is instituted whilst assessment is ongoing
if there is no pulse what do you do
BLS algorithm CPR: chest compressions and ventilations
if there is a pulse what steps do you take
- primary assessment
- AMPLE history
- secondary assessment
primary assessment
A- airway
B- breathing
C- circulation
D- disability
E- exposure
SAMPLE history
S- signs and symptoms
A- allergies
M- medication
P- past medical history
L- last oral meal
E- events leading up
Hello: AVPU
A- Alert
V- voice
P- pain
U- unresponsive
airways (C- spine control)
- look in mouth if unconscious
- listen
airway: stridor
upper airway obstruction
airway: gurgling sounds
secretions
how to open airway if no C- spine problem
head tilt chin
how to open airway if trauma
jaw thrust
to clear airway for secretions
suctioning
to clear airway for large objects
magills forceps
to maintain open airway
OPA (if tolerates)
NPA
LMA
to protect airway
ETT
Cric
airway drugs: adrenaline
airway swelling e.g. Anaphylaxis
airway drugs: RSI agents
ETT placement
breathing: presence of breathing
respiratory rate
breathing: effort of breathing
I- inspection
P- palpation
P- percussion
A- auscultation
breathing: efficacy of breathing
colour
level of consciousness
sats monitor
ETCO2
breathing: management
- BVM
- give oxygen if critically unwell
*intubate and ventilate if needed
breathing: tension pneumothorax management
needle decompression
breathing: drugs
oxygen
breathing: drugs if wheezing
beta agonists
breathing: drugs if asthma
steroids
circulation: assessment
- heart rate
- blood pressure
*organ perfusion
circulation: organ perfusion on skin
capillary refill time
circulation: organ perfusion on brain
level of conscious
circulation: organ perfusion on kidneys
urine output
circulation: management option
attach 3 lead ecg
Circulation: if patient has arrhythmia / chest pain
do a 12 lead ECG
circulation management
IV lines
fluid
manage arrhythmias (SCV- supraventricular arrhythmia )
catheter and NGT
*take blood whilst putting up lines
Circulation: drugs
fluid
anti- arrhythmias
inotropes if needed
ACS drugs
Diuretics if fluid overloaded
disability options
- GCS
*Pupil response
*gross neurological state- are all the limbs moving normally
*glucose check
disability : if glucose is low
dextrose/ glucose
disability: seizures
benzos and anti-epileptics
overdose of opiate
narcian (naxolone)- reverses respiratory depression
exposure
*look for trauma/ injury/ rashes
*take temperature
*prevent hypothermia
exposure: intervention
warm up if cold
cool down if hot
investigations
*radiology: CXR
*other investigations : that where not done when blood was taken
secondary assessment
head to toe survey
back and front of patient
prepare for transport
*prepare the patient
*prepare the receiving facility
*prepare the documentation
*prepare the transportation system
