Assessment of Icu Patient
Assessment of Icu Patient
Assessment of Icu Patient
Dr Nikhilesh Jain
CHL Hospitals,Indore
Objectives
Observation.
Communication.
Monitoring.
Diagnosis
What do we assess?
Tachypnoea
Altered level of Consciousness
Derangement of heart rate
Derangement of blood pressure
Derangement of arterial oxygen saturation
Derangement of urine output
Early warning systems?
Heart rate.
Blood pressure.
Respiratory rate.
Oxygen saturation.
Respiratory Support / Oxygen Therapy.
Urinary output.
Conscious level.
LEEDS TEACHING HOSPITALS NHS TRUST CRITICAL CARE OUTREACH
Score 3 2 1 0 1 2 3
Blood Pressure <70 71-80 81-100 101-179 180-199 200-220 > 220
- BP ( systolic)
Each measurement is given a score from the table above. If the patient’s total score is 3 or more, the call out algorithm is
triggered and you must call for help. Please follow as directed. May 2001 Adapted from the Great Yarmouth Scoring System by Richard Morgan.
MEWS is/becomes 3 MEWS is/becomes 5
Local action
Contact consultant +/-
(guidelines)
refer to appropriate
No specialty
Continue monitoring/
follow-up Patient improved when
reviewed after 2 hours
Yes No
Ian Goulden 14
Primary Survey
Level of Consciousness
Airway
Breathing
Circulation
Disability
Expose and Examine
Primary Survey - Level of Consciousness
Cervical Spine
Airway obstruction? Paradoxical movement?
Respiratory insufficiency?
Secure airway manually / adjuncts
Cricothyroid puncture?
Airway Obstruction
Primary Survey - Breathing
Effectiveness of Breathing
Work of Breathing
Primary Survey - Breathing
Cyanosis, hypoxia?
Rate, depth, symmetry of chest movement? Use
of accessory muscles?
Palpate chest wall for structural integrity
Chest injury / flail / pneumothoraces
O2 therapy / Assisted ventilation
Manage injury / pnuemothoraces
Primary Survey - Circulation
A = Alert.
V = Responds to Vocal Stimuli Only
P = Responds to Painful Stimuli Only
U = Unconscious
Primary Survey - Expose and Examine
CVS
Pulse (s) / BP / ECG / Palpation /
Auscultation / Jugular veins / Oedema.
Respiratory
Rate / Rhythm / Palpation - Trachea and
Thorax / Auscultation / Peakflow?
Pulse oximetry / CXR / ABG analysis?
Secondary Survey.
Thorough full system assessment
Renal
Urine output - 1ml/kg/hour ? 30mls/hr?
Categories of Urine Output
Secondary Survey.
Thorough full system assessment
Abdomen.
Inspect / Palpate / Auscultate
Musculoskeletal.
Inspect / Palpate / Range of Movement /
Motor and Sensory function.
Metabolic