THE CARE OF THE CRITICALLY ILL SURGICAL PATIENT
- Slides: 23
THE CARE OF THE CRITICALLY ILL SURGICAL PATIENT Dr. K. S. S Ranatunga Consultant Surgeon Base Hospital Panadura
Problems Ageing population q Concomitant disease processes q Complexity of surgery q Greater number of post-operative interventions & therapies q Shortage of experienced staff q Expectations by patients, relatives & staff q
Aim Identification & correction of complications and problems at the earliest stage Prevents critical illness ( multiple organ failure) with overall mortality of 50% q Predict, Prevent and Treat Critically Ill Surgical Patients Successfully
Methods Critical illness is often detectable and can be successfully treated at an initial stage (30 -40)% Of ICU patients had suboptimal ward management q q Prediction – Identifying high risk patients Prevention – Initiate simple remedial measures Prompt identification of problems & initiate early appropriate treatment
Practical Management Clinical Methods – To assess patients & identify problems q Practical Skills – To initiate the appropriate management q Communication & Organizational Skills – To seek help from colleagues or specialists in other fields to tackle a difficult or unfamiliar problems q
Patients at Risk q q q q q Emergencies Elderly Coexisting diseases Non progression Severe illness / complex surgery Massive transfusion Re-operation / re- bleeding Failure / delay to diagnose & treat underlying problems Multiple complications Established shock state
Risk Practices Incomplete or infrequent assessment q Failure to act on abnormal findings q Failure to ensure that interventions have been successful q Failure of continuity of care Poor communication (Clear, Concise, Confident) q Failure of supporting care Lack of expertise / Number of staff / Wrong ward q
Assessing the Critically Ill Surgical Patient q Immediate management - Life threatening illness kills in a predictable & reproducible patterns Systematic evaluation - Assessment and treatment may have to be done simultaneously A – Airway Assessment and Treatment with Cervical Cord Protection q q q Look, listen, feel High flow O 2 / (10 -15)l /mt Secure & protect airway ( Airways , ETT, Surgical Airways)
B – Breathing Assessment & Restoration of Mechanics of Ventilation Look, listen, feel q Clinically identify & treat life threatening conditions Tension pneumothorax, Open pneumothorax, Massive haemothorax, Large flail chest & Pericardial effusion q 80% Of thoracic injuries can be managed with tubethoracostomy q
C – Circulation Assessment and Arrest of Bleeding q Hypovolaemia should be considered as the primary cause of circulatory dysfunction in surgical patients unless proven otherwise. Assessment (LOC, Pulse, BP, Capillary Return, UOP) & arrest of bleeding q Establish & secure adequate venous access. 16 G cannula at antecubital fossa. Send blood for cross matching & investigations q Fluid replacement Fluid challenge – Normotensive 10 ml /kg - Hypotensive 20 ml/kg Fluid requirement > 1500 -2000 ml blood transfusion q Assess adequacy of resuscitation q Appropriate action - Exanguinating Emergency surgery - Unstable Urgent surgery - Stable Monitor q Clear Diagnosis & Plan Mandatory !
D – Dysfunction of the Nervous System q q q A- Alert V- Response to verbal stimuli P- Response to painful stimuli U- Unresponsive Exclude Hypoxia, Hypercapnia, Shock, Hypoglycaemia & Sedative Drugs E – Exposure and Thorough Examination q Prevent Hypothermia and Preserve Dignity
Re-evaluation Vital parameters Signs of improvement q Resuscitative measures IV fluids, O 2, Drugs q Judicial investigations CXR, ECG, ABG q Other procedures Urinary Catheter, CVP q Communications Colleagues, Superiors, Other Specialists, Patient, Relatives and Others q
Full Patient Assessment q q Hx & Ex - Patient, Nurses, Junior Staff, Notes - Repeated clinical examination Chart review - Temperature, Fluid Balance, Absolute values Trends - Drugs Dosage, Frequency, Interactions, Complications
Review of Available Results Biochemistry – Profile, ABG, RBS q Heamatology – FBC, Clotting, Blood film q Microbiology – Cultures and ABST q Radiology – Examine films & review reports q Relate to the Clinical Condition!
Daily Plan q q Problems Remedial Measures Aims - SBP - Sa. O 2 - Fluid Balance Actions - Ix. R - Specialist Opinion - Nutrition Requirement / Route - Fluid Balance / Prescription - Drugs (therapeutic , preventive, routine) & Analgesics - Removal of drains & tubes - Level of care The Patient’s Condition and the Investigations should be Reviewed at least Twice a day !
Accept responsibility for patient management q Adopt a systematic approach to patient management q Appreciate that complications tends to cascade rapidly q Anticipate and prevent problems with simple timely actions q Apply effective communications skills to facilitate care q Ask for appropriate assistance in a timely manner q
THANK YOU
- Care of the critically ill surgical patient
- Surgical metabolism
- Immediate temporary care given to an ill or injured person
- Levels of nursing care primary secondary tertiary
- Patient 2 patient
- Pico cat voorbeeld
- Thinking critically
- Garfield assessment
- What is the aim of antt for all invasive procedures
- Thinking critically with psychological science
- Critical thinking in nursing practice
- Listening critically
- Aseptic fields
- Negative issue
- Shakespeare sonnet 27
- Thinking critically with psychological science
- Thinking critically
- Thinking critically with psychological science answer key
- 3 phases of perioperative nursing
- Patient centered care collaborative
- Qsen project examples
- Patient care experience
- Nursing diagnosis ocd
- Patient driven care