1. Recognising the Deteriorating Patient
Lyell Brougham NEF
Operating Room Services
Royal Adelaide Hospital

2. RECOGNISING the DETERIORATING PATIENT

3. POSTANAESTHETISIA RECOVERY UNIT
The primary purpose of the recovery room is the critical evaluation of the postoperative patient with the emphasis on the anticipation and prevention of complications. Drain and Shipley 1987

4. RECOGNISING the DETERIORATING PATIENT
How we educate and how we clinically practice, effects competence!

5. RECOGNISING the DETERIORATING PATIENT
50% of what we know is probably wrong, our problem is which 50%?

6. RECOGNISING the DETERIORATING PATIENT
Standard 9: Recognising and responding to the Deteriorating Patient

9. DETERIORATING PATIENT
A = AIRWAY B = BREATHING C = CIRCULATION D = DISABILITY E = EXPOSURE

10. WHAT IS THE ESSENCE OF INFECTION CONTROL?
QUESTION
WHAT IS THE ESSENCE OF INFECTION CONTROL?

11. WHAT IS THE ESSENCE OF INFECTION CONTROL? A: Transmission Prevention
QUESTION
WHAT IS THE ESSENCE OF INFECTION CONTROL? A: Transmission Prevention

12. WHAT IS THE ESSENCE OF DETERIORATING PATIENT?
QUESTION?
WHAT IS THE ESSENCE OF DETERIORATING PATIENT?

13. NURSING the DETERIORATING PATIENT
ASSESSMENT?

14. NURSING the DETERIORATING PATIENT
ASSESSMENT? OR ASSESSING?

15. THE NURSING PROCESS
ASSESSMENT PLANNING IMPLEMENTATION EVALUATION

16. MANAGEMENT MODEL
STRUCTURE PROCESS OUTCOME

17. MANAGEMENT MODEL
STRUCTURE + PROCESS = OUTCOME

18. EVALUATION MODEL
STRUCTURE  PROCESS  OUTCOME

19. MEDICAL MODEL
2 Steps
ASSESSMENT
CURING

20. CLINICAL INTERVENTION
PARU NURSING MODEL
2 Steps
ASSESSING
CLINICAL INTERVENTION

21. RECOGNISING the DETERIORATING PATIENT
Standard 9: Recognising and responding to the Deteriorating Patient

24. DETERIORATING PATIENT
A = AIRWAY B = BREATHING C = CIRCULATION D = DISABILITY E = EXPOSURE

25. A = AIRWAY
Check for loose dentures, teeth etc Is the airway clear?

26. B = BREATHING
Respiratory rate SpO2 Observation CXR ABG Auscultation

27. C = CIRCULATION
Heart Rate Rhythm BP 12 lead ECG Capillary Return > 3 seconds Bloods IV Access Fluids Urinary Output Fluid Balance Chart

28. D = DISABILITY
BSL AVPU (Alert, Voice, Pain, Unresponsive) GCS MEDICATION CHART Anything else that doesn’t fit into ‘ABC’

29. E = EXPOSURE
Pull back the blankets and look!

30. RECOGNISING the DETERIORATING PATIENT

31. NURSING the DETERIORATING PATIENT
ASSESSMENT OR ASSESSING?

32. POSTANAESTHETISIA RECOVERY UNIT
The primary purpose of the recovery room is the critical evaluation of the postoperative patient with the emphasis on the anticipation and prevention of complications. Drain and Shipley 1987

33. CLINICAL INTERVENTION
QUESTION
You walk into a 6 bed bay.
There are 5 patients asleep and
one who has had a cardiac arrest!
HOW CAN YOU TELL WHICH PATIENT HAS ARRESTED?
CLINICAL INTERVENTION

34. Monitor the Patient not the machines!
ICU Mantra
Monitor the Patient not the machines!

35. WHAT WE NEED TO UNDERSTAND?
We need to learn to read the patient like a book.

36. WHAT WE NEED TO UNDERSTAND?
We need to learn to read the patient like a book.
EVERYTHING HAS MEANING?

37. CLINICAL INTERVENTION
PARU NURSING MODEL
2 Steps
ASSESSING
CLINICAL INTERVENTION

38. What is the most valuable vital sign of a deteriorating patient?
QUESTION
What is the most valuable vital sign of a deteriorating patient?

39. QUESTION
What is the most valuable vital sign in a deteriorating patient? A: STATE OF CONSCIOUSNESS

40. State of Consciousness Movement Colour Skin Vital signs
OBSERVATIONS
State of Consciousness Movement Colour Skin Vital signs

41. STATE OF CONSCIOUSNESS
Problem: No scales that accurately reflect the SOC!

42. Awareness – Face, eyes Arms Legs Seizure / TIA
MOVEMENT
Awareness – Face, eyes Arms Legs Seizure / TIA

43. Awareness – Face, eyes Arms Legs Seizure / TIA
MOVEMENT
Awareness – Face, eyes Arms Legs Seizure / TIA

44. The trend is of more value than the number!
COLOUR
The trend is of more value than the number!

45. Movement Colour Temperature Moisture (dry – clammy)
SKIN
Movement Colour Temperature Moisture (dry – clammy)

46. Respiratory rate SpO2 Observation CXR ABG Auscultation
OBSERVATIONS
Respiratory rate SpO2 Observation CXR ABG Auscultation

47. 83 yrs #NOF 36 hrs from fall Aramine throughout theatre
VIGNETTE
83 yrs #NOF 36 hrs from fall Aramine throughout theatre

48. 83 yrs #NOF 36 hrs from fall Aramine throughout theatre
VIGNETTE
83 yrs #NOF 36 hrs from fall Aramine throughout theatre

49. POSTANAESTHETISIA RECOVERY UNIT
The primary purpose of the recovery room is the critical evaluation of the postoperative patient with the emphasis on the anticipation and prevention of complications. Drain and Shipley 1987

53. References The Australian Resuscitation Guidelines, December 2010
Thanks also to Kym Mart (NEF SDD)