nursing profession & the coming wave of healthcare disruption

21st June 2019

Nursing Department KCMH

Nursing Profession &

The Coming Wave of

Healthcare Disruption

Hypovolemic shock: Assessment,

Treatment & Consequences

Ong-orn JaichaiyaphumCNE,MNS, RN

Nursing Professional Development CenterNursing Department KCMH

Role of ICU nurses to assess

Signs & Symptomps of Shock

Signs and symptoms of hemorrhage by class

Parameter Class I Class II (mild) Class III (moderate) Class IV (severe)

Approximate blood loss (ml) < 15% (< 750) 15-30% (750-1,500) 31-40% (1,500-2,000) > 40% (>2,000)

Heart rate

Blood pressure

Pulse pressure

Respiratory rate

Urine output

Glasgow Coma Scale

Base deficite 0 to -2 mEq/L -2 to -6 mEq/L -6 to -10 mEq/L -10 mEq/L or Less

Need for blood products Monitor Possible Yes MTP

LOC slightly

anxious

mildly

anxious

anxious

confused

confused

lethargic

Hypovolemic

shock assessment

Clinical

parameter

LOC

Urine output

BP

HR

Skin

Hemodynamic

parameter

CO/CI

SVR

SV/SVV

EDV

Perfusion

parameter

SvO2

ScvO2

Base deficit

Lactate

Assessment vs Resuscitation Endpoints

Init

ial A

ss

es

sm

en

t

Resu

scit

ati

on

E

nd

po

ints

Traditional vs. New

Acute vs. Ongoing

Static vs. Dynamic

Global vs. End Organ

• Mentation

• Skin Perfusion

• Pulse

• Blood Pressure

• Pulse Pressure

• Shock Index

• Urine Output

• pH• Serum Lactate• Base Deficit• Arterial Wave Analysis• ScvO2

Arterial Waveform

Static & Dynamic

Measurement

Passive leg raising test

Importance of Occult Hypovolemia

Nursing assessment

Nurses commonly experience

scenarios where hemodynamic

monitoring is focused on

hypovolemia (see case study)

in clinical practice.

Limitation of conventional assessment

Classic sign & symptom of shock

• Changing mentation

• Tachycardia

• Cool, clammy, skin

• Prolonged capillary refill

• Narrowed pulse pressure

• Decreased urine output

• Hypotension

Pulse Contour Analysis

Pulse

Contour

Analysis

Performance of Nursing Care

Assessment

- ABCD Approach

- Clinical Approach

EGDPT

- Minimization of

crystalloid

- 1:1:1 Product

ratio

- Permissive

hypotension

- Avoid

hypothermia

- Effective

collaboration

Hemodynamic

Monitoring

- Conventional

- Advanced

End Point of

Resuscitation

- Monitor organ

perfusion

The SVO Algorithm: Putting It All Together

You can Resize without

losing quality

You can Change Fill

Color &

Line Color

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PPT

TEMPLATES

Nursing care delivery

ABCD Approach

Clinical

assessment

Early hemorrhage

control

Keep warm nursing

Hemodynamic

monitoring

Balance

resuscitation

Effective

Collaboration

End organ perfusion

Thank you for your attention