1. 2.15
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2. Management of Surgical Emergencies Part 1 : Critical Care
Final Course Summary
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3. Learning Outcomes: Did you learn something about?
1. Defining and recognising critically ill patients in Surgery.
2. A system of assessment based on ABCD-T.
3. A system for rapid but systematic decision making and management.
4. Principles of management applicable to all categories of surgical patients.
5. Emergency procedures to support the critically ill surgical patient.
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4. Most of us manage unexpected events badly
Introduction lecture 2003
08/09/2018
Most of us manage unexpected events badly
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5. Prompt, simple actions save lives and prevent complications.
Introduction lecture 2003
08/09/2018
Prompt, simple actions save lives and prevent complications.
A systematic approach maximises success.
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6. For ALL patients – Prevention is Better than Cure
Introduction lecture 2003
08/09/2018
For ALL patients – Prevention is Better than Cure
Prevent morbidity by:
prediction
repeated clinical assessment
early detection of deterioration or failure to progress
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7. Pathophysiology
In patients who had major surgery, with serious trauma or surgical sepsis the physiological pathways of deterioration are the same and therefore the principles of physiological support is similar.
Physiology is different in pregnancy, young children and the elderly.
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8. What is Critical Care? Good clinical observations.
Rapid clinical assessment of deteriorating patients, using ABCDE.
Emergency support of ABCD to allow time for more thorough assessment and treatment.
Thorough further assessment using all available information.
Effective decision making at different levels.
Specific interventions to support critical organ function and prevent physiological deterioration.
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9. Four Essential Steps Primary Survey Resuscitation Secondary Survey
Decide
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10. Is this patient STABLE or UNSTABLE? And manage accordingly
DECIDE and PLAN:
Is this patient STABLE or UNSTABLE? And manage accordingly
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11. Re-assess the ABCs If at any time the patient’s condition deteriorates
Assessment lecture 2003
If at any time
the patient’s condition deteriorates
you must go back to the start
and
Re-assess the ABCs
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12. Assessment Checklist A:
Did I complete primary survey (ABCDE)?
Have I completed resuscitation?
O₂?
IV fluids?
Did I complete secondary assessment?
History (Notes; Reports)?
Thorough examination?
Chart review (Vital signs/MEWS; Fluid balance; Drugs)
Results?
Anyone I still wanted to speak to?
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13. Assessment Checklist B:
Is my patient…
STABLE?
UNSTABLE?
Am I unsure?
Is the problem…
Diagnostic
Therapeutic
Both
Do I need to intervene…
Diagnostic?
Therapeutic?
Ask for help?
Meanwhile, am I supporting ABC-T optimally?
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14. B
A — C — T
An important ETCC concept: ABC exist to support tissue oxygenation and organ function.
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15. NO more Questions please!!
Thank You Very Much
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