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Acute Patient Assessment and Management in Care: A Comprehensive Approach

This guide focuses on acute patient assessment and management within acute care settings, emphasizing resuscitation skills, emergency medicine, and practical experience. It outlines critical methodologies for evaluating patients, dealing with emergencies, and addressing issues such as airway obstruction, respiratory and cardiac arrest, and fluid-electrolyte balance. The document encourages strong assessment techniques, encourages timely interventions, and underscores the integration of supportive therapies while managing acute situations. The goal is to equip healthcare professionals with essential skills for effective patient management.

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Acute Patient Assessment and Management in Care: A Comprehensive Approach

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  1. Phase 2; Year 2; G-I Block Acute Patient Assessment Acute Care Theme Topic Prof J A W Wildsmith

  2. Dundee U/G Medical Curriculum • Phase 1: Basic Sciences • Phase 2: Systems Blocks • Phase 3: Clinical Practice • Outcomes: Integration Development Patient Management: Acute Care

  3. Management: Acute Care Practical Training (GMC) • Resuscitation Skills • Emergency Medicine • Practical Experience • Supportive Rx: O2 Fluids Pain Anxiety

  4. Acute Situations • Gross: Airway Obstruction Respiratory Arrest Cardiac Arrest Circulatory Shock • Subtle: Precursor States Stop Deterioration

  5. Acute Situations • Model: Acute Abdomen • Review: Presenting Problem Secondary Effects Intercurrent Disease Severity of Illness • Ask (& Answer) 4 Questions

  6. Four Vital Questions • How ill is this patient? • How quickly must I act? • Do I need (senior) help? • What is the physiological problem threatening life?

  7. Physiology of O2 Transport • Respiration Airways Lung Integrity Chest Wall Central Control • Circulation Heart Action Blood Volume Vessel Tone Control Systems • Haemoglobin concentration

  8. Acute Abdomen: O2 Transport • G-I Bleeding: Anaemia • Obstruction: Fluid Depletion Electrolyte Loss Abdo Distension • Jaundice: Fluid / Electrolyte Coagulation Nutrition / Drugs

  9. Acute Patient Assessment Methodology • History • Physical Examination • Investigations Skill is in Compression Appropriate to Situation

  10. Dealing with Emergencies – 1 & 2 Assess Reassure Manage 1 - Danger A - Airway 2 - Situation B - Breathing 3 - Response C - Circulation Sixty Second Survey P, BP, R, T, SpO2 Signs shock Obvious ‘Injury’ A V P U

  11. Dealing with Emergencies – 1 & 2 • No Response, Breathing or Pulse Cardiopulmonary Resuscitation • Pulse, no Response or Breathing Expired Air Ventilation • Pulse & Breathing, No Response • Pulse, Breathing & Response • All need further Assessment

  12. Dealing with Emergencies - 3 • Focus on Relevant System(s) • Identify +ve&-ve indicators of CVS, RS & Fluid Status • Start appropriate action • Record findings regularly • Re-assess at intervals

  13. Fluid & Electrolyte Balance • Assessment of requirements Normal Requirement + Existing Deficit + Anticipated Loss • Water, Potassium, Sodium, H+

  14. Fluid & Electrolyte Balance • Normal Daily ‘Requirement’ 70 kg Adult: H20 circa 2 L K+ 40-80 mM Na+ Minimal Ambient Temperature Level of Activity

  15. Fluid & Electrolyte Balance • Existing Deficit History: Failure of Intake External Loss Internal ‘Loss’ Examination: Tongue Eyes; Skin Blood Volume Lab Tests: Hb; U&E; (ABG)

  16. Fluid & Electrolyte Balance • Anticipate Losses Continued Failure of Intake Urine Output Sweat (Pyrexia) Surgical Wound Bleeding Tissue & Wound Oedema Fistulae

  17. Action: Generic Aspects • High flow oxygen therapy • Position: Shock: Head down • Dyspnoea: Sitting • Venous Access & Therapy • Get HELP early • Primum non nocere

  18. Fluid & Electrolyte Regimen • Assess Volume Requirement • Consider Content Needed Blood Plasma ECF ICF • Expand Blood Volume Stat • 25 % of deficit in 2 hr or so • Monitor Urine (> 20 ml/hr) • Monitor Hb; U&E; (ABG)

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