ICU Assessment Review of systems Current diagnosis Pertinent lab data Pertinent physical examination findings Allergies/sensitivities Airway Assessment Surgical/anesthesia history Medication history Social history Other

Patient History: General state of well-being Daily activity level The patient’s understanding of: Medical condition Coexisting medical conditions Review of old records

Present Illness: Diagnostic studies Presumptive diagnosis Treatments Responses to treatments Review available vital sign data Review available fluid balance data

Coexisting medical conditions: Evaluate in a systems approach Assess recent changes in symptoms Assess current treatment regimens Specialty consultation when needed

Medications: Review medications, doses, schedules Cardiac Seizure Endocrine Anticoagulants Antidepressants Decision to continue/discontinue

Allergies and drug reactions: True allergic reactions Non-allergic responses Adverse reactions Side effects Drug-drug interactions

Social History: Smoking Alcohol Recreational drug use

Smoking: Productive Cough Hemoptysis How many pack years?

Alcohol: Self-reporting of use typically underestimates actual use Withdrawal Increase anesthetic requirements Hypertension Tremors Delirium Seizures

Review of Systems: (continued) Respiratory Asthma Recent history of URI

Review of systems: (continued) Cardiac HTN

Review of Systems: (continued) Gastro/intestinal / hiatal hernia Increased risk of pulmonary aspiration

Review of Systems: (continued) Pregnancy All women of childbearing age should be questioned regarding last menses and the likelihood of current pregnancy.

Physical Exam: Direct attention to: Airway Heart Lungs Neuro

Physical Exam: (continued) Baseline Vital Signs: Height and weight Blood pressure Resting pulse Respirations

Physical Exam: (continued) Airway assessment Size of oral opening and tongue Observe/document loose or chipped teeth, “caps”, dentures, other orthodontic devices, piercings Observe/document range of cervical motion in flexion, extension, and rotation Observe/document tracheal deviation, masses

Airway Assessment

The loose tooth

Normal Airway Anatomy

The larynx

Difficult airways

Physical Exam: (continued) Heart Murmur Pericardial rub

Physical Exam: (continued) Lungs Wheezes Rhonchi Rales Correlate what you hear with observation of how patient is breathing…. easy vs. labored Use of accessory muscles

Physical Exam: (continued) Abdomen Distention Ascites Predisposition to regurgitation

Physical Exam: (continued) Extremities Clubbing Cyanosis Cutaneous infection

Physical Exam: (continued) Neuro Document neuro status Cranial nerve function Cognition Peripheral sensorimotor function

labs: Hematocrit and Hemoglobin Evaluate each pt. individually for the etiology and duration of their anemia

labs: Serum Chemistry Hypokalemia/hyperkalemia Coagulation Screen When indicated

EKG: All patients over 40 years old New Q waves ST-segment depression/elevation T-wave inversions Rhythm disturbances PVC’s A-fib, a-flutter LBBB 2 nd or 3 rd degree AV block