The Deteriorating Patient Flashcards
What is one of the most consistent factors in the causation of patient adverse events?
Failure to recognise & appropriately manage deteriorating patients on the general ward
What are adverse events often preceded by?
Significant unrecognised physiological disturbances
What are some of the reasons why there may be a delay in assistance for deteriorating patients?
- Staff don’t recognise the patient is deteriorating (didn’t record/interpret obs correctly)
- Staff discouraged from calling a MET
What makes a person at risk?
Abnormal oxygen delivery to tissues
- Oxygen delivery = CO x arterial oxygen content
- Difficult to measure directly on the ward
What are the indirect markers of oxygen delivery?
- HR (stroke volume)
- BP
- Temperature (infection, increased metabolic rate)
- RR
What did Goldhill et al 1999 find regarding RR?
- 76 unplanned admissions to ICU
- RR >25 was the most common physiological abnormality
What did Buist et al 2004 find regarding RR?
RR >30 or <6 associated with high odds ration for risk of mortality
What may be the best predictor of an ICU admission?
RR > 25
What is the seagull sign?
- Combination of low blood pressure and high heart rate
- Sign of difficulty meeting oxygen delivery demand
What are the MET criteria?
- HR: <40 or >140
- BP: SBP <90
- RR: <5 or >36
- Sudden fall in consciousness, drop in Glasgow Coma Scale (GCS) > 2 points or repeated/prolonged seizures
- Anyone you are seriously worried about that doesn’t fit the criteria
- Some patients may have modified MET critera
What is a modified early warning score (MEWS)?
- Scoring system to determine appropriate management of critical patients
- Each parameter gets a score (0-3)
- Total MEWS score calculated for each set of ons
- MEWS score directly links to action
How can a physio recognise a deteriorating patient?
- Always check obs chart prior to assessment
- Use obs & clinical assessment to decide if the patient’s condition is better, the same or worse than expected
- Communicate with relevant team & document
What are the three types of invasive suction for deteriorating patients?
- Yankauer suction (back of throat)
- Guedels (oropharyngeal) suction (mouth)
- Nasopharyngeal (NP) suction (nose)
What does Yankauer suction involve?
- Non-sterile (mouth only)
- Triggers cough reflex at back of throat
- Can assist to clear secretions when coughed into mouth, but difficult to expectorate
What are the benefits of Yankauer suction?
- Easy to use
- Patient can use independently if able
