acute care assessment and management. airway obstruction because of… cns depression blood,...
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Acute care Assessment Acute care Assessment and Managementand Management
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Airway Obstruction because of…Airway Obstruction because of…
CNS depression CNS depression Blood, vomit, foreign bodyBlood, vomit, foreign body TraumaTrauma Infection, inflammationInfection, inflammation LaryngospasmLaryngospasm
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Airway……..Airway……..
Symptoms and signsSymptoms and signs
Difficulty breathing, distressed, chokingDifficulty breathing, distressed, choking Shortness of breathShortness of breath Stridor, wheeze, gurgling Stridor, wheeze, gurgling See-saw respiratory patternSee-saw respiratory pattern
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Breathing Inadequacy because of...Breathing Inadequacy because of...
Pulmonary disordersPulmonary disorders infectioninfection collapsecollapse pneumothoraxpneumothorax asthmaasthma
Decreased respiratory driveDecreased respiratory drive CNS depressionCNS depression
Decreased respiratory effortDecreased respiratory effort muscle weaknessmuscle weakness restrictive chest defectrestrictive chest defect
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Breathing……..Breathing……..
Symptoms and signsSymptoms and signs
Short of breath, anxious, irritableShort of breath, anxious, irritable Decrease in conscious levelDecrease in conscious level TachypnoeaTachypnoea CyanosisCyanosis
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Circulatory/cardiac inadequacyCirculatory/cardiac inadequacy
Primary CausePrimary Cause
IschaemiaIschaemia Myocardial infarctionMyocardial infarction Hypertensive heart Hypertensive heart
diseasedisease Valve diseaseValve disease DrugsDrugs Electrolyte Electrolyte
abnormalitiesabnormalities
Secondary CauseSecondary Cause
AsphyxiaAsphyxia HypoxaemiaHypoxaemia Blood lossBlood loss Septic shockSeptic shock Any ShockAny Shock
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Circulation……….Circulation……….
Symptoms and signsSymptoms and signs
TachycardiaTachycardia BradycardiaBradycardia HypotensionHypotension Poor perfusion (CRT)Poor perfusion (CRT) Poor cerebrationPoor cerebration Poor urine outputPoor urine output
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Disability/CNS AbnormalityDisability/CNS Abnormality
PrimaryPrimary TraumaTrauma CVACVA InfectionInfection PoisonsPoisons
SecondarySecondary HypoxiaHypoxia MetabolicMetabolic
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DisabilityDisability…..…..
Any CNS depression can lead to Any CNS depression can lead to severe airway, breathing and severe airway, breathing and circulatory problems (and vice circulatory problems (and vice versa)versa)
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Aim of assessing acutely ill Aim of assessing acutely ill patientspatients
Ensure early anticipation and detection of Ensure early anticipation and detection of disordered physiology at a stage before organ disordered physiology at a stage before organ failure is established.failure is established.
Initiate simple/preventative therapies to the limit Initiate simple/preventative therapies to the limit of your capabilities, and call for senior help early.of your capabilities, and call for senior help early.
Patients who do not make a prompt and Patients who do not make a prompt and sustained response to these measures should be sustained response to these measures should be considered for early referral to a HDU or ICU considered for early referral to a HDU or ICU facility.facility.
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Assessing the Sick PatientAssessing the Sick Patient Elementary Skills Elementary Skills (History Examination and (History Examination and
Investigations)Investigations) & a Systematic & a Systematic approachapproach
AAirwayirway
BBreathingreathing
CCirculationirculation
DDisabilityisability
EExposurexposure
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Assessing the Sick PatientAssessing the Sick Patient
AAirwayirway
Upper airway obstructionUpper airway obstruction
Chin lift,head tiltChin lift,head tilt
Protect c spineProtect c spine
SuctionSuction
Airway adjunctsAirway adjuncts +Do you need help now ?
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Assessing the Sick PatientAssessing the Sick Patient
•Rate•Rhythm/Symmetry•Depth•Auscultate/Percuss•WOB•Colour•O2 saturations
Breathing
Do you need help now ?
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Assessing the Sick PatientAssessing 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 ?
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Assessing the Sick PatientAssessing the Sick Patient
Disability
•AVPU•Pupils/posture•Blood glucose
“DEFG”
Recovery position
Do you need help now ?
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Assessing the Sick PatientAssessing the Sick Patient
Exposure
Examination vs EnvironmentConsider Hypothermia & DignityLooking For………
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Do you needDo you needto call forto call for
help now?help now?
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Any Questions?Any Questions?