2.15 Copyright UKCS #284661815

Management of Surgical Emergencies Part 1 : Critical Care Final Course Summary Copyright UKCS #284661815

Learning Outcomes: Did you learn something about? 1. Defining and recognising critically ill patients in Surgery. 2. A system of assessment based on ABCD-T. 3. A system for rapid but systematic decision making and management. 4. Principles of management applicable to all categories of surgical patients. 5. Emergency procedures to support the critically ill surgical patient. Copyright UKCS #284661815

Most of us manage unexpected events badly Introduction lecture 2003 08/09/2018 Most of us manage unexpected events badly Copyright UKCS #284661815

Prompt, simple actions save lives and prevent complications. Introduction lecture 2003 08/09/2018 Prompt, simple actions save lives and prevent complications. A systematic approach maximises success. Copyright UKCS #284661815

For ALL patients – Prevention is Better than Cure Introduction lecture 2003 08/09/2018 For ALL patients – Prevention is Better than Cure Prevent morbidity by: prediction repeated clinical assessment early detection of deterioration or failure to progress Copyright UKCS #284661815 4

Pathophysiology In patients who had major surgery, with serious trauma or surgical sepsis the physiological pathways of deterioration are the same and therefore the principles of physiological support is similar. Physiology is different in pregnancy, young children and the elderly. Copyright UKCS #284661815

What is Critical Care? Good clinical observations. Rapid clinical assessment of deteriorating patients, using ABCDE. Emergency support of ABCD to allow time for more thorough assessment and treatment. Thorough further assessment using all available information. Effective decision making at different levels. Specific interventions to support critical organ function and prevent physiological deterioration. Copyright UKCS #284661815

Four Essential Steps Primary Survey Resuscitation Secondary Survey Decide Copyright UKCS #284661815

Is this patient STABLE or UNSTABLE? And manage accordingly DECIDE and PLAN: Is this patient STABLE or UNSTABLE? And manage accordingly Copyright UKCS #284661815

Re-assess the ABCs If at any time the patient’s condition deteriorates Assessment lecture 2003 If at any time the patient’s condition deteriorates you must go back to the start and Re-assess the ABCs Copyright UKCS #284661815 18

Assessment Checklist A: Did I complete primary survey (ABCDE)? Have I completed resuscitation? O₂? IV fluids? Did I complete secondary assessment? History (Notes; Reports)? Thorough examination? Chart review (Vital signs/MEWS; Fluid balance; Drugs) Results? Anyone I still wanted to speak to? Copyright UKCS #284661815

Assessment Checklist B: Is my patient… STABLE? UNSTABLE? Am I unsure? Is the problem… Diagnostic Therapeutic Both Do I need to intervene… Diagnostic? Therapeutic? Ask for help? Meanwhile, am I supporting ABC-T optimally? Copyright UKCS #284661815

B A — C — T An important ETCC concept: ABC exist to support tissue oxygenation and organ function. Copyright UKCS #284661815

NO more Questions please!! Thank You Very Much Copyright UKCS #284661815