Critically ill patient

Written by Dr.Md.Redwanul Huq (Masum)
Thursday, 14 March 2013 06:20

Initial assessment of critically ill patient:

  • A- Airway clearance
  • B- Breathing, respiratory distress, respiratory rate
  • C- Circulation, pulse: rate, rhythm, volume, peripheral pulses, direct arterial pressure, capillary refill
  • D- Disability, Glasgow Coma Scale, responses of pupil, localizing signs

Immediate management of critically ill patient:

A-Airway: Intubation if needed
B-Breathing: Oxygen inhalation, continuous positive airway pressure, non-invasive
or invasive ventilation
C-Circulation: Introducing cannula into vein, IV fluids, vasoactive drugs

Signs of critically ill patient:

Signs in respiratory system:

  1. Respiratory rate less or more than normal
  2. Dyspnea
  3. Incapable to speak in full sentences
  4. Prominent accessory muscles of respiration
  5. Intercostal recession
  6. Airway obstruction
  7. Respiratory arrest.

Signs in cardiovascular system:

  1. Pulse rate- much more or less than normal
  2. Fall of systolic blood pressure
  3. Cardiac arrest
  4. Decreased micturation
  5. Reduced peripheral perfusion.

Signs in neurological system:

  1. Absent gag or cough reflex
  2. GCS – less than 10
  3. Abrupt fall in level of consciousness
  4. Development of seizures.

Initial investigations for critically ill patient:

  1. Complete blood count
  2. Blood Urea
  3. S. creatinine
  4. S. electrolytes
  5. Blood glucose level
  6. Coagulation profile
  7. Blood, urine and sputum for C/S
  8. Chest X-ray
  9. ECG.

Monitoring critically ill patient:

Following factors should be monitored while providing management of critically ill patient

  1. Heart rate
  2. Respiratory rate
  3. Temperature
  4. Arterial BP
  5. Reaction of pupil to light
  6. GCS
  7. Urine output
  8. Central venous pressure
  9. ECG
  10. SpO2.