critically ill patients day Flashcards
airway criteria for calling the medical emergency team (PERT/OUTREACH)
airway patency is threatened
breathing criteria for calling the medical emergency team (PERT/OUTREACH)
resp arrest or RR is less than 8 or over 25
circulatory criteria for calling the medical emergency team (PERT/OUTREACH)
cardiac arrest
PR under 50 or over 125
systolic bp under 90 or over 200
oliguria for over 4 hours
neurological criteria for calling the medical emergency team (PERT/OUTREACH)
sudden fall in GCS by more than 2 points
acronym for immediate assesement of patient
DRABCDE
D- danger R - response A- airway B - breathing C - circulation D - disability (CNS - ) E - exposure for top to toe examination
for each letter of DRABCDE what do you do
look, feel, listen, measure, treat, reassess. do each letter sequentially as a problem with breathing will kill before circulation problems.
airway assesement - what do you do
look - resp pattern, effort
feel - presence of air
listen - resp sounds, stridor wheeze gurgle
action - suction, position, BLS, advanced airway intervention
breathing assesement - what do you do
look - sweating or cyanosis, pattern of breathing, aux muscles
feel - tracheal deviation, asymmetrical chest movement
listen - breath sounds
measure - resp rate, pulse oximetry
action - high flow oxygen 15litres/min, aim to keep sats 94-98%, monitor blood gases. treat underlying cause , the patient may require ventilation
circulation assesement - what do you do
look - cap refill, peripheral cyanosis, decreased consciousness, signs of haemorrhage, jvp, peripheral oedema.
feel - pulse, peripheral temp
listen - heart sounds, lung bases
measure - BP, HR, urine output
action - fluids, give as fast as possible, crystalloid 500ml over 15 min or gelofusin 250ml over 20min.
angina or MI can lead to cardiogenic shock or arrest. what do you do to prevent
MONA morphine or diamorphine oxygen nitroglycerine spray or tablet aspirin 300mg orally crushed or chewed
refer for immediate thrombolysis
disability CNS assessement
AVPU alert responds to voice responds to pain unresponsive
P or U requires an anesthetist due to risk of loss of airway patency
handover method?
SBAR s - situation b - background a - assessment r - recommendation
explain s of sbar
identify yourself and location and patient name and why youre calling.
explain b of sbar
what happened to the patient up untill now. why and when they were admitted. relevant medical history. when did they start to deteriorate. why are you worried about the patient and a brief summary of what youve given to treat.
a of sbar
i think the problem is this…
report ABCDE findings and observations chart trigger level.
