4. asseement in icu
- 1. CENTER FOR PHYSIOTHERAPY AND REHABILITATION SCIENCE JAMIA MILLIA ISLAMIA SUBMITTED TO: DR. JAMAL ALI MOIZ SUBMITTED BY: FARZANA KHATOON MPT 3RD SEM
- 2. ASSESSMENT OF CRITICALLY ILL PATIENTS IN ICU
- 3. who are critically ill • Critical illness is any disease process which cause physiological instability leading to disability or death within minutes or hours. • A critically ill patients is one at imminent risk of death • The severity of illness must be recognized early and appropriate measures taken promptly to assess, diagnos and manage the illness.
- 5. AIRWAY • The aim of the airway assessment is to establish the patency of the airway and assess the risk of deterioration in the patient’s ability to protect their airways. The patient’s airway can be clear (if the patient is talking) Partially obstructed (if air entry is diminished and often noisy) or Completely obstructed (if there are no breath sounds at the mouth or nose) (Resuscitation Council (UK) 2020).
- 6. Causes of Airway Obstruction(Mallet 2013; Thim et al. 2012) • inhaling or swallowing a foreign object. • small object lodged in the nose or mouth. • allergic reaction. • trauma to the airway from an accident. • vocal cord problems.
- 7. Assessing the Airway- • Observe patient for signs of airway obstruction: such as paradoxical chest and abdominal movements.(Resuscitation Council (UK) 2020) Treatment of airway obstruction • According to Resuscitation Council (UK) (2020), airway obstruction is a medical emergency. untreated airway obstruction can rapidly lead to cardiac arrest, hypoxia, damage to the brain, heart, kidneys and even death. • Once airway obstruction has been identified, treat appropriately. For example: suction if required, administration of oxygen and moving the patient into a lateral position (Jevon 2012).
- 8. Breathing (B) • Breathing function should only be assessed and managed after the airway management. Assessing Breathing • Look for the general signs of respiratory distress such as sweating, the effort needed to breathe, abdominal breathing and central cyanosis. • Count patient’s respiratory rate: the normal respiratory rate in adults is between 12 – 20 breaths/minute (Prytherch et al. 2010). • The respiratory rate should be measured by counting the number of breaths that a patient takes over one minute through observing the rise and fall of the chest. A high respiratory rate is a marker of illness (Resuscitation Council (UK) 2020).
- 9. • Measure patient’s peripheral oxygen saturation • Blood gas analysis • Assess air entry using a stethoscope
- 10. Circulation (C) - Assessment of circulation should be undertaken only once the airway and breathing have been assessed and appropriately treated. • The aim of assessing the circulatory system is to determine the effectiveness of the cardiac output. Cardiac output is the volume of blood ejected from the heart each minute (Mallet 2013). Assessing Circulation • Blood pressure (BP): is an indication of the effectiveness of the cardiac output. • Assess the patient’s heart rate • Patient’s temperature: normal temperatures range from 36.8Oc to 37.9Oc
- 11. Disability (D) • This assessment involves reviewing the patient’s neurological status, and its assessment should only be undertaken once A, B and C factors have been optimised. Assessing Neurological Function Level of consciousness: It is rapid assessment of the patient’s level of consciousness using the AVPU system (Smith 2003).
- 12. AVPU stands for A = Awake- • Observe if the patient can open his/her eyes, takes interest and responds normally to his/her environment. This would be assessed as ‘awake’. V = voice • if the patient has his/her eyes closed and only opens them when spoken to, this would be assessed as ‘voice’ P = pain • The patient who doesn’t respond to voice should be shaken gently to try to elicit a response. If there is still no response, then painful stimuli should be applied. If the patient responds to painful stimuli, then the level of consciousness is assessed as ‘responds to pain U = Unresponsive • Patient not responding to pain is ‘unresponsive
- 13. Exposure (E) • By the time the assessment reaches this stage (exposure), there should be a good understanding of the patient’s problems (Mallet 2013)
- 14. References • Centre for Clinical Practice 2019, Acutely Ill Patients in Hospital, National Institute for Health and Clinical Excellence (NICE), London, viewed 20 March 2020. • Jevon, P & Ewens, B 2012, Monitoring The Critically Ill Patient, 3rd Edn, Wiley-Blackwell, Oxford. • Mallet, J, Albarran, J, Richardson, R 2013, Critical care Manual of Clinical Procedures and competencies, Wiley-Blackwell, Oxford. • Mangione, S 2008, Physical Diagnosis Secrets, 2nd edn., Mosby/Elsevier, US
- 15. • O’Driscoll, BR, Howard, LS, Earis, J, Mak, V & British Thoracic Society 2017, ‘BTS Guideline for Oxygen Use in Adults in Healthcare and Emergency Settings’, Thorax, vol. 72, no. 1, viewed 20 March 2020. • Prytherch, DR, Smith, GB, Schmidt, P & Featherstone, PI 2010, ‘ViEWS – towards a national early warning score for detecting adult inpatient deterioration’, Resuscitation, vol. 81, no. 8, pp. 932-7, viewed 29 March 2018. • Resuscitation Council (UK) 2020, The ABCDE Approach, Resuscitation Council (UK), viewed 20 March 2020 • Smith, G 2003, ALERT Acute Life-Threatening Events Recognition and Treatment, 2nd Edn, University Of Portsmouth, Portsmouth