"improving intensive care in Scotland"

Assessment and treatment of the acutely ill adult

We may be confronted at any time with a sick patient. This may happen in the community, in the Emergency Room, in a ward or a clinic, in the intensive care unit. This module aims to give you the bones of an approach which can be applied whatever the situation, whatever the diagnosis.

Some advice

To paraphrase Captain Barbosa: "these are more rules than guidelines"

General rules

If you are responsible for a sick patient go and see him/her

Five seconds critically looking at a patient is worth twenty minutes talking about them on the phone

Oxygen is good for you and your patient: the vast majority of sick patients will benefit from high concentration oxygen so give them it! The correct amount is enough

In parallel with the patient being resuscitated and stabilised, someone should be getting a full history eg from relatives, paramedics, GP, ward staff. Delay in doing this can result in serious morbidity and occasionally mortality as delay in definitive treatment may result. Most likely in vascular events (ie thrombosis or bleeds)

Any IV access is better than none (for fluids and drugs)

If there is a cannula already in place, make sure it works

Avoid the ante-cubital fossa for iv access except as a last resort

Do a blood gas, Hb, K+, glucose and lactate on any sick patient. Base deficit may alert you to how sick they are

If you're not sure what is wrong with the patient could they have sepsis? Obtain cultures including blood cultures. Identifying sepsis early identifying sepsis early

If the patient isn't improving despite your treatment consider:

1. Calling for help

2. Is the diagnosis correct ?

3. Is this patient sick enough to require Intensive Care transfer? common reasons for ICU referral

4. Is there something else going on? ie a second diagnosis or a complication of the original diagnosis or its therapy.

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