Acute care Assessment and Management

Airway Obstruction because of…  CNS depression  Blood, vomit, foreign body  Trauma  Infection, inflammation  Laryngospasm

Airway…….. Symptoms and signs  Difficulty breathing, distressed, choking  Shortness of breath  Stridor, wheeze, gurgling  See-saw respiratory pattern

Breathing Inadequacy because of...  Pulmonary disorders infection infection collapse collapse pneumothorax pneumothorax asthma asthma  Decreased respiratory drive CNS depression CNS depression  Decreased respiratory effort muscle weakness muscle weakness restrictive chest defect restrictive chest defect

Breathing…….. Symptoms and signs  Short of breath, anxious, irritable  Decrease in conscious level  Tachypnoea  Cyanosis

Circulatory/cardiac inadequacy Primary Cause  Ischaemia  Myocardial infarction  Hypertensive heart disease  Valve disease  Drugs  Electrolyte abnormalities Secondary Cause  Asphyxia  Hypoxaemia  Blood loss  Septic shock  Any Shock

Circulation………. Symptoms and signs  Tachycardia  Bradycardia  Hypotension  Poor perfusion (CRT)  Poor cerebration  Poor urine output

Disability/CNS Abnormality Primary  Trauma  CVA  Infection  Poisons Secondary  Hypoxia  Metabolic

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

Aim of assessing acutely ill patients  Ensure early anticipation and detection of disordered physiology at a stage before organ failure is established.  Initiate simple/preventative therapies to the limit of your capabilities, and call for senior help early.  Patients who do not make a prompt and sustained response to these measures should be considered for early referral to a HDU or ICU facility.

Assessing the Sick Patient Elementary Skills (History Examination and Investigations) & a Systematic approach  Airway  Breathing  Circulation  Disability  Exposure

Assessing the Sick Patient Airway Upper airway obstruction Chin lift,head tilt Protect c spine Suction Airway adjuncts + Do you need help now ?

Assessing the Sick Patient Rate Rhythm/Symmetry Depth Auscultate/Percuss WOB Colour O2 saturations Breathing Do you need help now ?

Assessing 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 Patient Disability AVPU Pupils/posture Blood glucose “DEFG” Recovery position Do you need help now ?

Assessing the Sick Patient Exposure Examination vs Environment Consider Hypothermia & Dignity Looking For………

Do you need to call for help now? help now?

Any Questions?