assessment of critically ill patient Flashcards
ABCDE
A
B
Airway
breathing ventilation RR O2 WOB - work of breathing Accessory Ms use depth CXR ABG listen auscultation cough feel: expansion/ remits pattern/ sub cutaneous emphysema
mechnical ventilated mode of ventilation: mandatory v support mode FiO2 PEEP RR SaO2 TV PiMAX I:E ratio cough reflex suction requirement NO ironing
ABCDE
CV
Blood Pressure
B.P=120/80 (systolic 90 = don’t mobilise/SOOB)
Mean Arterial Pressure (MAP)
Should be maintained 60
Heart Rate (60-100)
↑hypoxaemia, hypotension, pain, anxiety)
↓Arrythmias, heart block, effect of drugs, vagal stimulation from suctioning)
Heart Rhythm
Sinus Rhythm, Tachycardia, Bradycardia, Atrial Fibrillation
Medication support: Inotropes/Vasopressors
Fluid Balance
C: haemodynamic monitoring
The ability of the body to maintain homeostasis and deliveer oxygen to tissues via circulation is essential for healthy organs. Therefore it is essential to be able to assess this status and the effects of our treatments BP CVP Pulmonary Artery Pressure IABP ECG
BP
non invasive vs invasive
invasive via arterial line sited in artery
monitor: systolic, diastolic and MAP
transducer position is important pressure displayed is pressure relative to position of transducer - level of heart
120/80
know MAP limits and targets
MAP = CO x TPR
ECG
An ECG (electrocardiogram) records the electrical activity of the heart. It provides information about heart rate and rhythm
Physiotherapists need to understand common arrhythmias and their implication for treatment/rehab
Linking with medical team very
important
CVP
Central Venous Pressure
Pressure in superior vena cava measured via central line
CVP gives a crude estimate of left atrial pressure (LAP)
LAP approximates to left ventricular end-diastolic pressure (LVEDP) which is related to preload
Assessment of fluid status
5-12 cmH20
PWP
pulmonary artery wedge pressure
CS pressure
pressure measured by wedging a pulmonary catheter with an inflated balloon into a small pulmonary arterial branch.
important in shocked patients to manage fluid balance.
ABCDE
D
disability AVPUS/GCS orientation ICP EVD Power Active range tone sensation reflexes coord prop sedation drugs
sedation RASS scale dexdor morphine midazolam atracurium
ABCDE
E
Exposure / everything else wounds drains dressing overall assessment of limbs peripheral oedema multi trauma fractures dialysis
CPAX
outcome measure
50 point scale of disability and function in ICU patients
Renal function
Bloods
Urea (2.5-7 mmol/L) ↑18-20 dehydration, ↑55 kidney failure
Creatinine (50-100mmol/L )↑ dehydration, ↑ ↑ in septic shock
Sodium (135-145)
(↑may indicate dehydration, 155 suggests kidney failure)
24hr Balance (NO set value +ve 500mls) ↓?dehydration, ↑ ? pulmonary oedema
Haematological
Haemoglobin (Hb): Male 14-18 g/dl Female 11.5-15.5 g/dl
decrease Anaemia, increase polycythaemia
< 8 or 9 ? transfusion
White Cell Count (WCC): 4-11109 /L
increase Sign of infection
decrease Susceptible to infection i.e. chemotherapy
Platelets: 150-400 109 /L
decrease risk of spontaneous bleeding i.e. sepsis
< 30 minimum suctioning
other relevant lab results
CRP: > 10 mg/L
Marker for inflammation
INR: 0.9-1.2
describes the clotting tendency of blood
if raised there is in increased risk of bleeding (=5 = high chance of bleeding)
INR = 0.5 high chance of having a clot
Potassium: 0.8-1.4 mmol/L
decrease may lead to arrythmias
increase suggests kidney failure
increase or decrease can cause cardiac arrest
sepsis
Hyperthermia >38.3 or Hypothermia <36 Tachycardia >90bpm Altered Mental Statis Raised WCC Tachypnoea RR >20 Hyperglycaemia
Severe Sepsis
Organ Dysfunction
medications in ICU
CNS Analgesics Sleep / anti anxiety Tranquillisers Antipsychotics Antidepressants Anaesthetics Neuromuscular blocking agents Anticonvulsants
Cardiovascular Treatment of heart failure Anti-arrhythmic Treatment of hypotension Treatment of hypertension
Control of Infection
Antibiotics
Antivirals
Antifungals
Respiratory Meds
Bronchodilators
Steroids
Blood Glucose Control
Sedation (e.g propofol, midazolam)
Paralysing Agents (e.g atracurium)
Inotropes (e.g adrenaline, noradrenaline, dobutamine)
Antiarrhythmic Agents (e.g amiodarone)
Respiratory Meds (e.g salbutamol, combivent)
Pain Meds (e.g paracetamol, morphine, fentanyl, Epidural, PCA)
Blood Glucose Control (e.g actrapid)
