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
What does NP suction involve?
- Bypasses mouth & gag reflex
- Inserted through nostril angling towards opposite eyeball past nasal septum
- Allows long suction catheter to be inserted deep into trachea to remove secretions
What are the disadvantages of NP suction?
- Lubricant essential, nose bleeds possible
- Uncomfortable on insertion for the patient
How long can NP suction remain in situ?
24 hours (advisable if ongoing suction likely)
What does Guedel’s airways involve?
- Keeps airway open by holding tongue out of the way
- Inserted facing upwards then rotated 180 degrees to arch over tongue
- Allows long suction catheter to be inserted deep into trachea to remove secretions
What are the disadvantages of Guedel’s airways?
- Uncomfortable
- Triggers gag reflex in many patients
- Should be removed between suction passes for patient comfort
What is the optimal positioning for suction?
High sitting with cervical spine extended (rolled up towel behind neck)
What did Mitchell et al 2010 find regarding deteriorating patients?
- Prospective controlled trial of adults in medical & surgical wards
- A multi-faceted intervention to detect clinical deterioration may benefit patients through increased monitoring of vital signs & medical review
