Assessment Of The Critically Ill

Assessment of the Critically Ill

Dr Christopher Bowden Frankston Hospital

Airway

Airway  Secured?  Well

positioned?  Tracheostomy?  Cx spine cleared?

Breathing

Breathing  FIO2  Ventilator

settings  Examine chest  ABG’s

Circulation

Circulation  Haemodynamic

stability?  Blood pressure, HR  Monitoring  CVS examination

Drugs

Drugs  Drug

chart  What is the patient on? - inotropes - sedation  Should they be on anything else?

Enteral  TPN

v enteral feeds  Enteral feeds ceased?  General nutrition state?

Fluids

Fluids  Quantity  Quality  Input

v Output – ie balance  Adequate resuscitation?

GIT  Examine  NGT?

abdomen

Haematology  Check

all blood results  Repeat any if necessary  Cross match?

Investigations  Radiology  Any

other appropriate tests

JVP  CVC  CVP

in situ?

Kelvin  Temperature  Correct

hypothermia

Lines  Review

all lines  Adequate IV access  Need for invasive monitoring?

Microbiology  Check

results  Antibiotics?

Neurological  GCS

– document if appropriate  Be aware of pre-existing deficits

Old Notes  Review

history  Previous anaesthetics  Past medical history  Allergies

Pain Relief  Type

of analgesia  Adequate?

Query  Other

specialist involvement/ opinion?

Relatives  Informed  Consent

Skin  Pressure

care

Trauma  Thorough

patients

secondary survey in trauma

You  Must

communicate with appropriate clinicians

Victual  Appropriate

breaks and meals

Where to  Disposition;

overall plan for patient Mx

X-ray  Check

the chest XR

Why  Why

is the patient here?  Why are we doing what we are doing?

Zzzz  Get

the right amount of sleep