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Samenvatting - FCCS
1 Recognition and Assesment of the Seriously Ill Patient
How long does physiological deterioration preceed cardiopulmonary arrest?Several hours
What is the direct methodology?Detection, intervention, reassessment, effective communication and teamwork
1.1 Recognizing the Patient at Risk
Immune compromised patients may not show a vigorous and obvious inflammatory response
1.1.1 Assessing Severity
Acute illness typically causes predictable physiological changes, it is important to recognize these, initiate monitoring and take appropriate action.
Cognitive signs of deteriorationConfusion, irritability, impaired consciousness or sense of impending doom.
Signs of deterioration during inspection (4)Shortness of breath
Sympathetic response: pallor, sweating, cool extremities.
Six most relevant vital signsPulse rate, blood pressure, respiratory rate, oxygenation, temperature and urine output
The main goal of the early stage of assessment (primary survey)
- Recognize existing problems
- Maintaining physiological stability
- Pursuing the cause
- Initiation treatment
Even normal vital signs may be early indicators of impending deterioration if they differ from prior measurements.
Tachycardia in response to physiological abnormalities (ie, fever, low CO) may be increased with pain and anxiety
OR suppressed in patients who have conduction abnormalities or receiving B-blockade.
1.1.2 Making a Diagnosis
Important question: "What physiological problem needs to be corrected NOW to prevent further deterioration of the patients conditions?"
Life-threatening physiological abnormalities take priority over make an accurate diagnosis.
1.2 Initial Assessment of the Critically Ill Patient
A primary and secondary survey approach is recommended in the assessment of a seriously ill patient.
What is the goal of the primary survey? (Initial Contact - First minutes)Finding the main physiological problem
What is the goal of the secondary survey?Finding the underlying problem
What do you need to know from the history in the primary survey?Main features of circumstances and environment
- Witnesses, personnel, relatives
- Main symptoms: pain, dyspnea, altered mental status, weakness
- Trauma or no trauma
- Operative or nonoperative
- Medications and/or toxins
- What treatment has been given so far?
- Delay in treatment?
What do you need to know from the examination in the primary survey?Look, listen, feel -> ABCD (D: level of consciousness)
What do you need to know from monitoring in the primary survey?Essential physiology, vital signs
- Heart rate, rhythm
- Blood pressure
- Respiratory rate and pulse oximetryLevel of consciousness
What do you need to know from the investigations in the primary survey?
What are the first steps in treatment during the primary survey?
- Adequate airway and oxygen
- IV access (and fluids)
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Laatst toegevoegde flashcards
Priorities in adrenal insufficiency (3)
- IV cortico
- vasoactive med if needed
Priorities in anaphylactic shock (2-3)
- subcutaneous epi
very low BP: IV epi
Priorities in septic shock (5-6)
- volume (sec. vasopressor (nor > epi)
- control infection (catheter removal, surgery, drainage etc)
- cortico's (200 mg/24u)
in case of myocardial dysfunction: dobutamine
What is the effect of milrinone on HR & BP?
BP: +++ (beta 2) / beta2 = dilatation > don't kill hypovolemic patients
> CO > stroke volume
What is the effect of dobutamine on HR & BP?
HR: +++ / ++++++ (a.k.a. Tachycardia in hypovolemic)
BP: ++ (beta2) / --- in hypovolemic
Inotrope > increase CO/stroke volume
What is the effect of vasopressin on HR & BP?
BP: potent (V1 receptor)
Indication: refractory hypotensive shock
What is the dose range and eenheid of fenylepifrine?
What is the effect of fenylepifrine on HR & BP?
BP +++ (alfa)
pure alfa > arterial dilation without cardiac depression > e.g. Neurogenic shock or hypotension by epidural anesthetic
Side effects of epi? (2)
Increase myocardial oxygen consumption
Aerobic lactate producation (instead of hypoperfusion-induced)
What is the effect of epi on HR & BP?
BP: +++ (beta2) > vasoconstrictor at higher doses