1. 1.3B
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2. Management of Surgical Emergencies Part 1 : Critical Care
Patient Assessment
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3. Learning Outcomes You learn FOUR critical steps in assessment.
You will understand that ABCDE is important to support tissue oxygenation and organ function.
You will learn a structured approach to thorough secondary assessment.
You will learn to make decisions and plan management depending on your assessment of whether the patient is stable or unstable.
You will learn a flowchart that guides assessment.
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4. Four Essential Steps Primary Survey Resuscitation Secondary Survey
Decide
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5. Primary Assessment = ABCDE
A = Airway (protect C-spine as necessary) B = Breathing with adequate ventilation and oxygenation C = Circulation including haemorrhage control D = Disability (Central Nervous System) E = Exposure as appropriate
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6. B
A — C — T
An important ETCC concept: ABC exist to support tissue oxygenation and organ function.
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7. To be addressed in next session
RESUSCITATION
BLS / ALS
To be addressed in next session
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8. Secondary Assessment A: History:
Check the case notes: current notes, previous history, drug history.
Speak to the patient.
Speak to nurses/guardian if an in-patient or to relatives/ambulance staff/police.
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9. Secondary Assessment B: Check the Charts:
Observation chart/HDU/A&E Charts.
Fluid balance chart: Intake-Output; think of unrecorded or hidden losses.
Check the trends, not single values.
Drug chart: Did the patient receive the prescribed drugs? At the correct time? Is the dose correct? What is the risk of interaction or side effects (look it up in the formulary!).
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10. Secondary Assessment C: Examination:
Examine the patient systematically (head to toe) yourself.
Remember spinal column and rectal examination in trauma.
Remember to look at drains and bags.
Think what you are looking for and why.
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11. Secondary Assessment D: Extra Information:
Check on all results yourself (Imaging, biochem, haematology, microbiology).
Speak to colleagues: microbiology, labs, radiology, pharmacy.
Recheck the charts for missing information.
If things don’t fit, re-examine the patient or ask for senior review.
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12. 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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13. 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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14. If STABLE: You must write a management plan for the day
e.g. Diet, fluids, drugs, mobilisation
Other health team members
Discharge planning
Where you will be or whom to contact if necessary
AND
YOU MUST TELL THE PATIENT/GUARDIAN WHAT IS HAPPENING NEXT
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15. If UNSTABLE or if you are UNSURE:
1. Make a Diagnosis: i.e. WHY is the patient unstable or are things not clear?
Get the quickest and simplest investigation to give a definite answer.
Ask for help: senior review, other specialties.
2. Definitive Treatment: Drugs/Surgery/Drainage/Refer/Transfer.
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16. Questions
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17. 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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18. 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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