د/ماجد الوراقي
Structured approach for critically ill patient
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Structured approach for critically ill patient
1.
2. 1)Who is the critically ill patient
2)Importance of early recognition of the
critically ill pt.
3)Causes of cardiac arrest
4)Identify and treat pt. at risk of cardiac arrest
using the ABCDE approach
Objectives
6. Early recognition of critically ill pt.
• Most arrests are
predictable
• Deterioration prior to
50 - 80% of cardiac
arrests
• Hypoxia and
hypotension are
common antecedents
• Delays in referral to
higher levels of care
8. Rules of this approach
• Complete initial assessment
• Treat first what kills first
• Assess effects of treatment/interventions
• Reassessment
• Call for help early
9. The ABCDE approach
to the deteriorating patient
Airway
Breathing
Circulation
Disability
Exposure
17. • Airway
• Oxygen
• Treat underlying cause
– e.g. drain pneumothorax
• Support breathing if inadequate
– e.g. ventilate with bag-mask
• Establish continuous monitoring
ABCDE approach: Breathing
Treatment of breathing problems
SpO2
23. Treatment
• ABC
• Treat underlying cause
• Blood glucose
– If < 72 mg/dcl ( 4 mmol/L) give glucose
ABCDE approach: Disability
24. • Remove clothes to enable examination
– e.g. injuries, bleeding, rashes
• Avoid heat loss
• Maintain dignity
ABCDE approach: Exposure
Sheet
25. Item Recognition Intervention Aid
A
Look , Listen , Feel
Patent & Clear
At risk
Obstructed
Nothing
Suction + Maintain
Open + Maintain O2 Supply
Titrate 94% - 99/&
B
Inspection RR
Expansion
Wounds , Bruises, Etc….
Palpation Confirm Expansion
Tenderness , surgical emphysema
Percussion Note
Equality
Auscultation Equality
Additional Sounds
Consider Assisted Ventilation
SpO2
C
Pulse Central
Central-to-Peripheral
Peripheral-to-Peripheral
HR
Volume
Regularity
BP Hypertensive
Normotensive
Hypotensive
CRT
Fluids Cannula
( Draw Samples first )
ECG Monitor
D
Consciousness GCS
AVPU
Pupil
RBG
(bedside)
E
Affected area Full Exposure Unexplained
Polytrauma Pt.
Sheet
to cover the pt.
ABCDE approach
26. Handover
SBAR
Situation Doctor & Pt. data
Background History
Assessment ABCDE approach
Interventions
Investigations
Recommendation what I want from you
27.
28. 1)Who is the critically ill patient
2)Importance of early recognition of the
critically ill pt.
3)Causes of cardiac arrest
4)Identify and treat pt. at risk of cardiac arrest
using the ABCDE approach