Recognising the Sick Patient Flashcards
(19 cards)
What is the definition of shock?
Reduction of effective blood flow and inadequate tissue perfusion with decreased delivery of oxygen to the capillary exchange bed.
What is dysoxia?
A condition in which tissues cannot make full use of available oxygen
When you are in this, the only way to buffer in the immediate time is to start breathing faster. One of the first signs of something is not right is if you increase the respiratory rate.
What is the ABCDE approach?
A - Airways and oxygenation B - Breathing and ventilation C - Circulation and Management of shock D - Disability E - Exposure, environment, events
What is the approach to airway and oxygenation in the emergency management of a patient?
Signs: • Ability to speak • Difficulty with breathing • Noisy/silent breathing - Stridor, wheezing, gurgling, snoring • "see-saw" breathing pattern
Treatment: • Airway opening - Head tilt-chin lift • Removing foreign object • Suctioning • Simple adjuncts - OP, NP, airways • Advanced airway LMA, intubation
What is the approach to breathing and ventilation in the emergency management of a patient?
Signs: • Respiratory rate • Work of breathing - Accessory muscles, distress • Lung sounds - Rales, creps, wheezing • Oxygenation - Cyanosis, SpO2
Treatment:
• Oxygen
• Treating the cause:
- E.g. draining a PTX
• Assisting ventilation
- CPAP, NIV
• Nebulizers for wheeze (steroids, magnesium)
• ? Decompression for pneumothorax, haemothorac etc
• NIV for hypercarbic respiratory failure?
What is the approach to circulation and management of shock in the emergency management of a patient?
Signs: • Pulse - Heart rate, volume • Blood pressure • Signs of heart failure: - Neck veins, oedema, creps • Perfusion: - LOC, diuresis, CRT • Bleeding, fluid loss • ECG: rhythm analysis • aBG/vBG - lactate
Treatment: • IV line, blood tests • Fluid • Monitor • Electric cardioversion • Bleeding control - Vasopressors
What is the approach to disability in the emergency management of a patient?
Signs: • AVPU or GCS • Pupils • Blood sugar (BM) • Fast neurologic assessment
Treatment:
• IV glucose
- BM < 3mmol/l
IV thiamine
What is AVPU?
• Alert
• Voice
• Pain
Unresponsive
What is the Glasgow Coma scale?
Eyes: 1 - Eyes do not open 2 - Opens eyes in response to painful stimuli 3 - Opens eyes in response to voice 4 - Opens eyes spontaneously
Verbal 1- Makes no sound 2 - incomprehensible sounds 3 - utters inappropriate words 4 - Confused, disorientated 5 - Orientated, converses normally
Motor
1 - Makes no movements
2 - Extension to painful stimuli (decerebrate response)
3 -Abnormal flexion to painful stimuli (decorticate response)
4 - Flexion / withdrawal to painful stimuli
5 - Localizes painful stimuli
5 - Obeys commands
What is the approach to Exposure in the emergency management of a patient?
Signs: • Remove clothes to enable thorough examination (maintain dignity) • Detailed history • Medications • Allergies
Treatment:
• Take temperature
• Avoid heat loss
What are the 4 different types of shock?
- Decrease in venous return
- Failure of the pump function
- Obstruction
- Loss of vascular tone
What causes shock due to decrease in venous return?
due to a loss of circulating volume
- Due to internal or external loss of fluids
What causes shock due to failure of the pump function of the heart?
results from a loss of contractility
Ischaemia, infarction, myopathy, myocarditis or a major arrhythmia
What causes shock due to obstruction?
- Pulmonary embolism, tension, pneumothorax or cardiac tamponade
What causes shock due to the loss of vascular tone?
results in maldistribution of blood flow
Sepsis, anaphylaxis or spinal injury
What is a positive results of a fluid challenge?
• A positive response is an increase in cardiac output in response to the increased volume
- Heart rate decreases - Mean arterial pressure increases - Arterial pulse pressure increases - Urine output increases - Lactate clearance increases - Cardiac output or stroke volume increases
What is Frank Starling’s law of the heart?
• The greater the heart muscle is stretched, the greater the force generated and the output from the ventricle.
The heart needs to pump all the venous return
What is the early warning score?
The EWS aids the detection and response to clinical deterioration in adult patients and is a key element of patient safety and improving patient outcomes. • Temperature • Heart rate • Blood pressure (systolic scores) • Respiratory rate • Peripheral oxygen saturation • Flow rate • AVPU/ New confusion
Each physiological observation will give a score form 0-3
Add them together to give you a score from 0-21
What is SBAR in terms of communicating emergencies?
A way of communicating information that is important in a rapid way.
- S - Situation (a concise statement of the problem)
- B - Background (pertinent and brief information related to the situation
- A - Assessment (analysis and considerations of options - what you found/think)
R - Recommendation (action requested/ recommended - what you want)
