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Recognising the Deteriorating Patient
Lyell Brougham NEF Operating Room Services Royal Adelaide Hospital
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RECOGNISING the DETERIORATING PATIENT
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POSTANAESTHETISIA RECOVERY UNIT
The primary purpose of the recovery room is the critical evaluation of the postoperative patient with the emphasis on the anticipation and prevention of complications. Drain and Shipley 1987
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RECOGNISING the DETERIORATING PATIENT
How we educate and how we clinically practice, effects competence!
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RECOGNISING the DETERIORATING PATIENT
50% of what we know is probably wrong, our problem is which 50%?
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RECOGNISING the DETERIORATING PATIENT
Standard 9: Recognising and responding to the Deteriorating Patient
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DETERIORATING PATIENT
A = AIRWAY B = BREATHING C = CIRCULATION D = DISABILITY E = EXPOSURE
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WHAT IS THE ESSENCE OF INFECTION CONTROL?
QUESTION WHAT IS THE ESSENCE OF INFECTION CONTROL?
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WHAT IS THE ESSENCE OF INFECTION CONTROL? A: Transmission Prevention
QUESTION WHAT IS THE ESSENCE OF INFECTION CONTROL? A: Transmission Prevention
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WHAT IS THE ESSENCE OF DETERIORATING PATIENT?
QUESTION? WHAT IS THE ESSENCE OF DETERIORATING PATIENT?
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NURSING the DETERIORATING PATIENT
ASSESSMENT?
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NURSING the DETERIORATING PATIENT
ASSESSMENT? OR ASSESSING?
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THE NURSING PROCESS ASSESSMENT PLANNING IMPLEMENTATION EVALUATION
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MANAGEMENT MODEL STRUCTURE PROCESS OUTCOME
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MANAGEMENT MODEL STRUCTURE + PROCESS = OUTCOME
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EVALUATION MODEL STRUCTURE PROCESS OUTCOME
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MEDICAL MODEL 2 Steps ASSESSMENT CURING
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CLINICAL INTERVENTION
PARU NURSING MODEL 2 Steps ASSESSING CLINICAL INTERVENTION
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RECOGNISING the DETERIORATING PATIENT
Standard 9: Recognising and responding to the Deteriorating Patient
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DETERIORATING PATIENT
A = AIRWAY B = BREATHING C = CIRCULATION D = DISABILITY E = EXPOSURE
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A = AIRWAY Check for loose dentures, teeth etc Is the airway clear?
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B = BREATHING Respiratory rate SpO2 Observation CXR ABG Auscultation
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C = CIRCULATION Heart Rate Rhythm BP 12 lead ECG Capillary Return > 3 seconds Bloods IV Access Fluids Urinary Output Fluid Balance Chart
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D = DISABILITY BSL AVPU (Alert, Voice, Pain, Unresponsive) GCS MEDICATION CHART Anything else that doesn’t fit into ‘ABC’
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E = EXPOSURE Pull back the blankets and look!
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RECOGNISING the DETERIORATING PATIENT
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NURSING the DETERIORATING PATIENT
ASSESSMENT OR ASSESSING?
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POSTANAESTHETISIA RECOVERY UNIT
The primary purpose of the recovery room is the critical evaluation of the postoperative patient with the emphasis on the anticipation and prevention of complications. Drain and Shipley 1987
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CLINICAL INTERVENTION
QUESTION You walk into a 6 bed bay. There are 5 patients asleep and one who has had a cardiac arrest! HOW CAN YOU TELL WHICH PATIENT HAS ARRESTED? CLINICAL INTERVENTION
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Monitor the Patient not the machines!
ICU Mantra Monitor the Patient not the machines!
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WHAT WE NEED TO UNDERSTAND?
We need to learn to read the patient like a book.
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WHAT WE NEED TO UNDERSTAND?
We need to learn to read the patient like a book. EVERYTHING HAS MEANING?
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CLINICAL INTERVENTION
PARU NURSING MODEL 2 Steps ASSESSING CLINICAL INTERVENTION
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What is the most valuable vital sign of a deteriorating patient?
QUESTION What is the most valuable vital sign of a deteriorating patient?
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QUESTION What is the most valuable vital sign in a deteriorating patient? A: STATE OF CONSCIOUSNESS
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State of Consciousness Movement Colour Skin Vital signs
OBSERVATIONS State of Consciousness Movement Colour Skin Vital signs
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STATE OF CONSCIOUSNESS
Problem: No scales that accurately reflect the SOC!
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Awareness – Face, eyes Arms Legs Seizure / TIA
MOVEMENT Awareness – Face, eyes Arms Legs Seizure / TIA
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Awareness – Face, eyes Arms Legs Seizure / TIA
MOVEMENT Awareness – Face, eyes Arms Legs Seizure / TIA
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The trend is of more value than the number!
COLOUR The trend is of more value than the number!
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Movement Colour Temperature Moisture (dry – clammy)
SKIN Movement Colour Temperature Moisture (dry – clammy)
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Respiratory rate SpO2 Observation CXR ABG Auscultation
OBSERVATIONS Respiratory rate SpO2 Observation CXR ABG Auscultation
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83 yrs #NOF 36 hrs from fall Aramine throughout theatre
VIGNETTE 83 yrs #NOF 36 hrs from fall Aramine throughout theatre
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83 yrs #NOF 36 hrs from fall Aramine throughout theatre
VIGNETTE 83 yrs #NOF 36 hrs from fall Aramine throughout theatre
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POSTANAESTHETISIA RECOVERY UNIT
The primary purpose of the recovery room is the critical evaluation of the postoperative patient with the emphasis on the anticipation and prevention of complications. Drain and Shipley 1987
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References The Australian Resuscitation Guidelines, December 2010
Thanks also to Kym Mart (NEF SDD)
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