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

RECOGNISING the DETERIORATING PATIENT

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

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

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

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

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

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

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

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

NURSING the DETERIORATING PATIENT ASSESSMENT?

NURSING the DETERIORATING PATIENT ASSESSMENT? OR ASSESSING?

THE NURSING PROCESS ASSESSMENT PLANNING IMPLEMENTATION EVALUATION

MANAGEMENT MODEL STRUCTURE PROCESS OUTCOME

MANAGEMENT MODEL STRUCTURE + PROCESS = OUTCOME

EVALUATION MODEL STRUCTURE  PROCESS  OUTCOME

MEDICAL MODEL 2 Steps ASSESSMENT CURING

CLINICAL INTERVENTION PARU NURSING MODEL 2 Steps ASSESSING CLINICAL INTERVENTION

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

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

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

B = BREATHING Respiratory rate SpO2 Observation CXR ABG Auscultation

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

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

E = EXPOSURE Pull back the blankets and look!

RECOGNISING the DETERIORATING PATIENT

NURSING the DETERIORATING PATIENT ASSESSMENT OR ASSESSING?

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

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

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

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

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

CLINICAL INTERVENTION PARU NURSING MODEL 2 Steps ASSESSING CLINICAL INTERVENTION

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

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

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

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

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

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

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

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

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

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

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

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

References The Australian Resuscitation Guidelines, December 2010 www.resus.org.au Thanks also to Kym Mart (NEF SDD)