1.3B Copyright UKCS #284661815

Management of Surgical Emergencies Part 1 : Critical Care Patient Assessment Copyright UKCS #284661815

Learning Outcomes You learn FOUR critical steps in assessment. You will understand that ABCDE is important to support tissue oxygenation and organ function. You will learn a structured approach to thorough secondary assessment. You will learn to make decisions and plan management depending on your assessment of whether the patient is stable or unstable. You will learn a flowchart that guides assessment. Copyright UKCS #284661815

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

Primary Assessment = ABCDE A = Airway (protect C-spine as necessary) B = Breathing with adequate ventilation and oxygenation C = Circulation including haemorrhage control D = Disability (Central Nervous System) E = Exposure as appropriate Copyright UKCS #284661815

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

To be addressed in next session RESUSCITATION BLS / ALS To be addressed in next session Copyright UKCS #284661815

Secondary Assessment A: History: Check the case notes: current notes, previous history, drug history. Speak to the patient. Speak to nurses/guardian if an in-patient or to relatives/ambulance staff/police. Copyright UKCS #284661815

Secondary Assessment B: Check the Charts: Observation chart/HDU/A&E Charts. Fluid balance chart: Intake-Output; think of unrecorded or hidden losses. Check the trends, not single values. Drug chart: Did the patient receive the prescribed drugs? At the correct time? Is the dose correct? What is the risk of interaction or side effects (look it up in the formulary!). Copyright UKCS #284661815

Secondary Assessment C: Examination: Examine the patient systematically (head to toe) yourself. Remember spinal column and rectal examination in trauma. Remember to look at drains and bags. Think what you are looking for and why. Copyright UKCS #284661815

Secondary Assessment D: Extra Information: Check on all results yourself (Imaging, biochem, haematology, microbiology). Speak to colleagues: microbiology, labs, radiology, pharmacy. Recheck the charts for missing information. If things don’t fit, re-examine the patient or ask for senior review. 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

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

If STABLE: You must write a management plan for the day e.g. Diet, fluids, drugs, mobilisation Other health team members Discharge planning Where you will be or whom to contact if necessary AND YOU MUST TELL THE PATIENT/GUARDIAN WHAT IS HAPPENING NEXT Copyright UKCS #284661815

If UNSTABLE or if you are UNSURE: 1. Make a Diagnosis: i.e. WHY is the patient unstable or are things not clear? Get the quickest and simplest investigation to give a definite answer. Ask for help: senior review, other specialties. 2. Definitive Treatment: Drugs/Surgery/Drainage/Refer/Transfer. Copyright UKCS #284661815

Questions Copyright UKCS #284661815

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