Professional Documents
Culture Documents
19/8/10
GENERAL APPROACH
Introduction
Cubicle
Infusions
Ventilator
Monitor
Equipment
Question specific examination
GENERAL QUESTIONS
Brain
Cough
Nerves
NMJ
Respiratory Muscles
Pleura
Airways (large and small)
Parenchymal
Chest wall
Ventilator asynchrony
Cardiac failure
Abdominal distension/failure
“This patient has Respiratory Failure for multiple reasons. These include… “
Brain
Cough
Nerves
NMJ
Respiratory Muscles
Pleura
Airways (large and small)
Parenchymal
Chest wall
Ventilator asynchrony
Cardiac failure
Abdominal distension/failure
Distributive – SIRS, septic, anaphylaxis (signs: WWP, dilated, bounding pulse, low
diastolic pressure, wide pulse pressure, pressors, low CVP, high Q, low SVRI, active
praecordium)
Cardiogenic – myocardia, valves, rhythm, pericardium, left and right sided (signs:
cool peripherally, shut down, bounding pulse, narrow pulse pressure, inotropes, high
CVP, low SvO2, low Q, crackles in chest, oedema)
Why is this patient not waking up? OR Why has this patient got a decreased LOC?
Abscess
CVA
Trauma
Bleed
Non-structural - global
Brain
Spinal cord
Peripheral nerves
NMJ
Muscles
Diagnosis
Exclusion of treatable causes
Preconditions
Responsiveness
Brainstem reflexes
Apnoea
Imaging
Other relevant information – second assessment by suitably trained doctor
Infectious
- community acquired
- nosocomial (surgical site, lines, chest, urine, sinusitis)
Non-infectious
- head injury
- DVT -> PE
- drug/toxin
- SIRS (post surgery, trauma, aspiration, pancreatitis)
- Hypermetabolic syndromes
-> thyroid storm
-> NMS
-> MH
-> heat stroke
-> phaeo
-> liver failure
-> burns
Stage of illness
Primary, secondary or tertiary survey (examine from head to toe)
Rehabilitation phase
Complications of stay
“My assessment follows a primary and secondary survey. Injuries from head to toe
including relevant injuries are…”
Cause
Volume status
Complications
Treatment
Brain
Cough
Nerves
NMJ
Respiratory Muscles
Pleura
Airways (large and small)
Parenchymal
Chest wall
Ventilator asynchrony
Cardiac failure
Abdominal distension/failure
Type of surgery
Emergency or Elective
Post-operative complications (bleeding, bleeding, tamponade, graft occlusion, CVA)
Shock assessment
Causes and type of heart disease
Prognositication
Rhythm
CPR (time to and quality)
Time to ROSC
Cause of arrest – ability to treat cause
Therapeutic hypothermia
Coma -> need to wait until 72 hrs
Assessment @ 72 hours – pupils, corneal reflexes, motor response, SSEPs (N20 peak
absence), iso-electric EEG, burst suppression, status myoclonus
Other issues
Why did this young patient have an out of hospital cardiac arrest?
Cause
Treatment (source control)
Nutrition
Complications – ACS, fungal sepsis
How to move forward?
Emergency or Elective
End-organ damage
Complications
- brain injury
- spinal cord ischaemia
Hemisphere
Site
Territory
Complications
Neurological – bleeding, seizure, hydrocephalus, vasospasm, increased ICP
Respiratory – aspiration, neurogenic pulmonary oedema
Cardiovascular – AMI
Electrolytes – SIADH, CSW, DI
Treatment done
Management
Phase of injury
Acute: ileus, cardiovascular, ventilation
Sub-acute: recurrent atelectasis and segmental collapse
Chronic: pain, psychological issues, infection (uro, resp, pressure areas),
autonomic dysreflexia, spasm.
Other injuries/issues
Burn
Site
Depth
Extent
Phase of Burn
Resuscitation (Day 1)
Post-resuscitation (Day 2-6)
Complications
TYPE
CAUSES (DAVE)
Quick examination where neuro not the focus – GCS or responsiveness, pupils,
movement of limbs, tone, reflexes.