Introduction to Acute Illness Management

Airway Problems

• Allergic reaction

• CNS depression

• Foreign body, secretions 

• Infection

• Laryngospasm 

• Trauma 

Airway Management

• Ensure the airway is patent and maintained

• Simple airway maneuvers

• Positioning

• Airway adjunct ± suction

• Oxygen therapy

Airway Look

• Obstructions

• Swelling

• Secretions

• See sawing

• Colour

Airway Listen

• Can the patient speak in full sentence

• Added noises?

• Snoring (pharyngeal obstruction)

• Crowing (laryngeal spasm)

• Gurgling (fluids in the upper airways)

• Stridor

Airway Feel

For airflow or breaths at the mouth and nose 

Breathing

Increasing respiratory rate is sensitive indicator of acute deterioration

The frequency of vital signs will be increased in the acutely unwell patients to monitor clinical improvement or deterioration

Breathing Problems 

Exacerbations of existing respiratory disease

Infection

Muscle weakness

Pain

CNS depression

Trauma

Bronchospasm

Breathing Management

Position patient

High concentration oxygen

Oxygen saturation monitoring

Bag valve mask

Consider physiotherapy

Consider nebulisers (oxygen driven)

Breathing Look

Respiratory rate and pattern

Depth of respiration 

Symmetrical chest movement

Use of accessory muscles 

Colour 

O2 saturation 

Breathing Listen

Speaking in full sentences

Orientated or confused 

Added sounds: crackles, wheeze, bronchial breathing 

Breathing Feel

Check chest expansion

Symmetrical movement

Percussion

Tracheal deviation

Surgical emphysema

Blood Pressure

Hypotension is a LATE sign of cardiovascular compromise - it occurs as the body’s compensatory mechanisms begin to fail

It is preceded by an increase RR and HR

Blood Pressure 

Pressure = Flow x Resistance BP = Stroke Volume (SV) x Heart Rate (HR) 

• Cardiac Output (CO) = flow of blood pumped out from the left ventricle in a single contraction

• Stroke volume (SV) is the amount of blood pumped out from the left ventricle in a single contraction 

• Systemic vascular resistance (SVR)= resistance offered by the vessels against which the heart pumps

CO or SVR

ANYTHING affecting CO or SVR will impact BP

• The mean arterial pressure (MAP) is the average pressure exerted during the cardiac cycle and is directly related to vital organ perfusion

• MAP = diastolic + (systolic - diastolic) / 3

Circulation Problems

Sepsis

Dehydration

Blood loss

Drugs

Electrolyte abnormalities

Ischaemia

Myocardial infarction

Circulation Management

Ensure patent IV access

Take appropriate bloods

Consider blood cultures

IV bolus of fluids

Circulation Look

Colour

Haemorrhage

Urine output/fluid balance

Any evidence of infection?

Insensible loss?

Patient IV access?

Circulation Listen

Manual blood pressure

Circulation Feel

Pulse character, rate

Pulse- central vs peripheral

Temperature - central vs peripheral

Capillary refill time (CRT)

Circulation Blood Pressure

Patients who require continuous fluid resuscitation to manage hypotension are NOT STABLE

Escalate for further investigations

Disability Problems

1yr- brain injury, epilepsy, infection, compressive lesions,

2yr- hypoxia, cardiovascular, metabolic or intoxication

Disability Management

Protect and manage the airway = consider recovery position

Correct blood glucose

Control seizures

Manage pain appropriately

Consider using the GCS

Conscious level using AVPU/GCS

Drowsiness or lethargy

New confusion & or agitation

• Check Blood glucose

• Check Pupil size and reaction

• Check for signs/history of recent seizures

• Assess pain & sedation score using an objective tool

Disability – AVPU scale to assess consciousness level

Assesses brain prefusion and function 

• A- Alert (and awake) 

• V- Responds to voice stimulus 

• P- Responds to pain stimulus 

• U- Unresponsive 

The most common cause of airway compromise in the critically ill is a reduced conscious level

The airway MUST be protected in an unconsciousness patient 

Exposure

Perform a head-to-toe exam (front and back)

CHECK FOR:

• rashes

• surgical wounds

• drains/stoma output

• abdominal distension

• evidence of haemorrhage

• evidence of infection

• calf swelling and/or redness