Acute care Assessment Acute care Assessment and Managementand Management

Airway Obstruction because of…Airway Obstruction because of…

CNS depression CNS depression Blood, vomit, foreign bodyBlood, vomit, foreign body TraumaTrauma Infection, inflammationInfection, inflammation LaryngospasmLaryngospasm

Airway……..Airway……..

Symptoms and signsSymptoms and signs

Difficulty breathing, distressed, chokingDifficulty breathing, distressed, choking Shortness of breathShortness of breath Stridor, wheeze, gurgling Stridor, wheeze, gurgling See-saw respiratory patternSee-saw respiratory pattern

Breathing Inadequacy because of...Breathing Inadequacy because of...

Pulmonary disordersPulmonary disorders infectioninfection collapsecollapse pneumothoraxpneumothorax asthmaasthma

Decreased respiratory driveDecreased respiratory drive CNS depressionCNS depression

Decreased respiratory effortDecreased respiratory effort muscle weaknessmuscle weakness restrictive chest defectrestrictive chest defect

Breathing……..Breathing……..

Symptoms and signsSymptoms and signs

Short of breath, anxious, irritableShort of breath, anxious, irritable Decrease in conscious levelDecrease in conscious level TachypnoeaTachypnoea CyanosisCyanosis

Circulatory/cardiac inadequacyCirculatory/cardiac inadequacy

Primary CausePrimary Cause

IschaemiaIschaemia Myocardial infarctionMyocardial infarction Hypertensive heart Hypertensive heart

diseasedisease Valve diseaseValve disease DrugsDrugs Electrolyte Electrolyte

abnormalitiesabnormalities

Secondary CauseSecondary Cause

AsphyxiaAsphyxia HypoxaemiaHypoxaemia Blood lossBlood loss Septic shockSeptic shock Any ShockAny Shock

Circulation……….Circulation……….

Symptoms and signsSymptoms and signs

TachycardiaTachycardia BradycardiaBradycardia HypotensionHypotension Poor perfusion (CRT)Poor perfusion (CRT) Poor cerebrationPoor cerebration Poor urine outputPoor urine output

Disability/CNS AbnormalityDisability/CNS Abnormality

PrimaryPrimary TraumaTrauma CVACVA InfectionInfection PoisonsPoisons

SecondarySecondary HypoxiaHypoxia MetabolicMetabolic

DisabilityDisability…..…..

Any CNS depression can lead to Any CNS depression can lead to severe airway, breathing and severe airway, breathing and circulatory problems (and vice circulatory problems (and vice versa)versa)

Aim of assessing acutely ill Aim of assessing acutely ill patientspatients

Ensure early anticipation and detection of Ensure early anticipation and detection of disordered physiology at a stage before organ disordered physiology at a stage before organ failure is established.failure is established.

Initiate simple/preventative therapies to the limit Initiate simple/preventative therapies to the limit of your capabilities, and call for senior help early.of your capabilities, and call for senior help early.

Patients who do not make a prompt and Patients who do not make a prompt and sustained response to these measures should be sustained response to these measures should be considered for early referral to a HDU or ICU considered for early referral to a HDU or ICU facility.facility.

Assessing the Sick PatientAssessing the Sick Patient Elementary Skills Elementary Skills (History Examination and (History Examination and

Investigations)Investigations) & a Systematic & a Systematic approachapproach

AAirwayirway

BBreathingreathing

CCirculationirculation

DDisabilityisability

EExposurexposure

Assessing the Sick PatientAssessing the Sick Patient

AAirwayirway

Upper airway obstructionUpper airway obstruction

Chin lift,head tiltChin lift,head tilt

Protect c spineProtect c spine

SuctionSuction

Airway adjunctsAirway adjuncts +Do you need help now ?

Assessing the Sick PatientAssessing the Sick Patient

•Rate•Rhythm/Symmetry•Depth•Auscultate/Percuss•WOB•Colour•O2 saturations

Breathing

Do you need help now ?

Assessing the Sick PatientAssessing the Sick Patient

Circulation•Capillary refill time•Limb temperature•Peripheral pulses•Central pulses•Heart rate & rhythm•BP•O2 saturation•Urine output

Do you need help now ?

Assessing the Sick PatientAssessing the Sick Patient

Disability

•AVPU•Pupils/posture•Blood glucose

“DEFG”

Recovery position

Do you need help now ?

Assessing the Sick PatientAssessing the Sick Patient

Exposure

Examination vs EnvironmentConsider Hypothermia & DignityLooking For………

Do you needDo you needto call forto call for

help now?help now?

Any Questions?Any Questions?