1.2 Copyright UKCS #284661815

Management of Surgical Emergencies Part 1 : Critical Care Introduction to Critical Care Copyright UKCS #284661815

INTRODUCTION 2 DAYS Covers some advanced concepts in managing critically ill surgical patients. Teaching material has been adapted from the RCSEd’s ETCC and FSCC, and CCrISP (©RCSEng), with permission. Developed since 2009 (7 CC courses) Related to CC series on www.ptolemy.ca Dec 2012 to April 2013. Relax and Enjoy: This is a tie-free zone. Copyright UKCS #284661815

Learning Outcomes: In these two days we will discuss: 1. How to define and recognise aspects of critical illness in surgical patients. 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

Methods Interactive Lectures: Q’s & A’s – Participate!! Open discussion on aspects of CC that surgeons feel uncomfortable with. Practice in e.g. CPR and Communication. Discuss images. Discuss case studies. Role play. Frank and open discussion regarding everyone’s strong and weak points (including faculty!). Copyright UKCS #284661815

Assessment Attendance all 4 sessions. Satisfactory CPR practice. Active participation and openness. Satisfactory continuous assessment scores. Written test (Complex MCQs, EMQs). YOU WILL PASS THE CRITICAL CARE MODULE IF YOU MEET THESE ASSESSMENT CRITERIA. 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

For ALL patients – Prevention is Better than Cure Introduction lecture 2003 23/06/2019 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

Which patients are we talking about? Trauma Multiple injuries e.g. RTA Burns Penetrating injuries to body cavities Extensive soft tissue injuries Post-operative after major surgery Entry of thorax, abdomen or pelvis Major limb surgery (orthopaedics or reconstructive) Obstetric and Paediatric patients need special attention due to differences in physiology Surgical sepsis Copyright UKCS #284661815

REMEMBER The physiological pathway of deterioration is the same in all these patients. The principles of physiological support is therefore similar. Questions: What is the physiological pathway? What are the principles of physiological support? Questions: 1. (Depends on the level of participants; in my experience even the Hawassa health officers new these pathways) Briefly check that they know the triggers of tissue injury, chemical mediators and pathways, rest inflammatory response, importance of WBC and steroids, fluid and electrolyte shifts, pathways to organ damage, results of organ damage. 2. Mention ABCD, i.e. As we resuscitate in the sequence ABCD, we also support organ systems and institute definitive therapy in the sequence ABCD, simply because the systems “below” do not work without the ones “above”. This is an important paradigm of emergency care thinking that we have to drive home. Copyright UKCS #284661815

Most of us manage unexpected events badly Introduction lecture 2003 23/06/2019 Most of us manage unexpected events badly Copyright UKCS #284661815

Prompt, simple actions save lives and prevent complications. Introduction lecture 2003 23/06/2019 Prompt, simple actions save lives and prevent complications. A systematic approach maximises success. Copyright UKCS #284661815

Introduction lecture 2003 23/06/2019 The course should Help you to think straight under pressure in the clinical arena. Provide you with knowledge, skills and communication to facilitate successful care. Copyright UKCS #284661815

Any Questions? Copyright UKCS #284661815

SUMMARY Basic Critical Care = good clinical observation and effective decision making, leading to rapid intervention to support organ function and prevent further physiological deterioration. 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