Professional Documents
Culture Documents
Approach to a critically ill patient (PATIENT IS CONSCIOUS but IN DISTRESS): Rapid assessment via
the ABCDE approach then go on with History, Examination, Investigations and Management
a. If patient is breathing but appears acutely sick you can calculate the News score (or it is
usually calculated by the nurse) to assess the severity of your observations and decide for
how frequently you will monitor vital signs.
b. NEWS score equal or higher than 7 indicates a critically ill patient.
c. Monitor vital signs early: Place pulse oximeter – ECG monitor – Non-invasive BP monitoring
(e.g. BP cuff) and insert IV cannula (to administer drugs and take blood for investigations)
d. Call for help early if you need it if you want to be safe.
e. Airways - In a critically ill patient airway obstruction can be caused by loss of muscle tone
secondary to depressed level of consciousness or from physical obstruction
f. Airways is usually assessed simply by talking to the patient: if patient responds and is able
to talk it means airway is clear, otherwise a number of noises can be a sign of obstruction
g. Listen to patient’s breath sound close from his face. Look for signs of airway obstruction
such as snoring (relaxed tone in nose/pharynx), gurgling (secretions in airways) inspiratory
stridor (laryngeal damage), expiratory wheezes (airway obstruction to air outflow) or
hoarseness (damage-obstruction at level of trachea).
i. In partial obustruction air flow is noisy e.g. gurgling / snoring / stridor / wheezes vs
in complete obstruction there are no breath sounds at the nose or mouth.
ii. Other signs of obstruction are similar to those of respiratory distress: breathing
with adbomen and paradoxical chest breathing with chest (see saw breathing), the
use of accessory muscles of breathing and central cyanosis (late sign)