Tiêu đề JMP Year 5 Crit Care Notes.pdf ✅

JMP YEAR 5 CRIT CARE NOTES | Eunice Tsang c3358581 RECOGNITION AND MANAGEMENT OF THE DETERIORATING PATIENT Perform basic and advanced life support. Basic Life Support Goals of BLS Allows a trained individual to recognise a medical emergency, activate emergency response systems and provide immediate care in an out-of-hospital setting. - Activate emergency services before proceeding to provide resuscitation - Initiate chest compressions with good technique and minimise interruptions to the compressions ® if diagnosis of cardiac arrest is uncertain, initiating CPR is preferable to withholding CPR - Use an automated external defibrillator (AED) as soon as one in available - BLS Duration: continue until patient responds / you are unable to continue / a healthcare professional arrives and takes over care or directs cessation Danger, Response and Sending for Help - Quickly assess the situation ensuring safety for the rescuer, person in need and bystanders ® check surrounding environment - Call out, stimulate patient and assess for signs of life for 10 seconds - Call emergency services (or delegate this role to a someone else) - Request an AED if available Airway Airway management takes precedence over any other injury including spinal. - Ideally leave the person in need in the position they are found unless they are demonstrating signs of an obstructed airway ® be gentle with handling patient - Open the mouth and turn head to allow drainage to clear airway (use suction if available) - If airway becomes compromised in resuscitation, roll onto side to allow clearance and then reassess for responsiveness - Utilise airway opening manoeuvres ® head tilt and chin lift in adults, neutral position in infants (see below for more detailed explanations) Breathing - Look, listen and feel for effective breathing for 10 seconds ® if absent, declare cardiac arrest Rescue Breath Technique: - Open the airway using head tilt and chin lift manoeuvre or jaw thrust - Place mouth over open mouth with nostrils pinched - Give one breath of 1 second duration to give adequate volume to give chest rise CPR - Compressions should be started if person in need is unresponsive and has abnormal breathing including agonal respirations (pulse check not required) - 30 Compressions:2 Rescue Breaths in 2 Minute Rounds in adults or 15:2 in paediatrics Chest Compression Technique: - Lower half of sternum, 100-120bpm, depth of 5-6cm in adults or generally 1/3 depth of chest, allow for chest recoil and minimise interruptions

JMP YEAR 5 CRIT CARE NOTES | Eunice Tsang c3358581 Rhythm Recognition Shockable Rhythms ® ensure safety, deliver shock and straight to CPR for 2 minutes - Ventricular Tachycardia – rapid, regular ventricular rate along with pulselessness ® insufficient cardiac output due to high heart rate - Ventricular Fibrillation – arrhythmic and unsynchronised high-frequency contraction of the ventricles ® no cardiac output Non-Shockable Rhythms ® ‘dump’ the charge and continue CPR for 2 minutes - Pulseless Electrical Activity – rhythmic electrical activity (commonly low rate, wide, distorted QRS complexes) without a detectable central pulse - Asystole – no electrical activty ® no ventricular mechanical activity, output or pulse Consider Reversible Causes 4 H’s and 4 T’s Hyper/Hypokalaemia (Metabolic Disorders) Hyper/Hypothermia Hypovolaemia Hypoxia Thrombosis (Pulmonary and Coronary) Tension Pneumothorax Tamponade Toxins/Tablets - Fluid Administration – fluids sould be infused if hypovolaemia is suspected ® hypovolaemic shock would normally require the administration of at least 20mL/kg - Thrombolytics – fibrinolytics should be considered in adult patients with cardiac arrest with proven or suspected pulmonary embolism - Needle Decompression -2nd ICS mid-clavicular line for tension pneumothorax +chest drain - Pericardiocentesis – cardiac needle between xiphisternum and left costal margin at 45° pointing towards left shoulder with ultrasound guidance to drain tamponade Cessation of CPR Return of Spontaneous Circulation (ROSC): - Indications of ROSC – clear signs of life (e.g. breathing, coughing or movement); return of palpable pulse and blood pressure or presence of arterial waveform with intraarterial monitoring; an abrupt and sustained increase in expiratory CO2 on capnography - Management: begin post-resuscitation care, identify and treat complications of CPR and/or cardiac arrest Termination of Resuscitation ® take into account patient’s wishes and advanced care directive Post-Resus Care - Oxygen – titrate oxygen saturation to 94-98%, check an ABG to ensure iatrogenic hypocapnia is not present (cerebral vasoconstriction) - Glucose – maintain BSL <10mmol/L but avoid hypoglycaemia - Manage Seizures – manage with IV midazolam or diazepam ® follow guidelines - Transfer to ICU or CCU – if requiring vasopressors or increased care - Investigations ® CXR, ECG, CT Brain and or Chest - Cardiology Referral – if cardiac cause of arrest suspected - NGT Insertion – decompression of the stomach following CPR - Ongoing Observations and Monitoring for at least 24 Hours Recognise the deteriorating patient. Demonstrate a structured approach to the deteriorating patient. Clinical Features of Unwell or Deteriorating Patients - Any observation in the yellow or red zone as per the appropriate SAGO chart - Evidence of complete or partial airway obstruction - Difficulty breathing - Altered or sudden decrease in consciousness level or fall in GCS by more than 2 points - Repeated or prolonged seizures - Oliguria (urine output less than 0.5mL/kg/hour) - pH less than 7.3 - New onset mental state change ® confusion or change in behaviour - Any patient causing concern for any health professional - Any patient where there is patient/family/carer concern