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Initial assessment

[Ajirway

? Clear

[Bjreathing

Distress

Ratę

fcjirculation Pulse: Ratę

Rhythm

Volume

Blood pressure: Direct arterial

[D]isability Conscious level:

Glasgow Coma Scalę Pupil responses Localising signs

Circulation: Venous access Fluids

Vasoactive drugs

Chest movement Auscultation

pressure

Peripheral perfusion Peripheral pulses Temperaturę Cdour

Capillary refill

Immediate managemcnt

Airway:

Support, ? Intubate Breathing:

Oxygen

Continuous positive airway pressure (CPAP), non-invasive ventilation (NIV)

Intubate and ventilate

Monitoring

Heart ratę; ECG Respiratory ratę; Sp0₂ BP—arterial linę Temperaturę GCS; pupil size, reaction Urine output

Central venous pressure

Initial invostigations

Fuli blood count Urea and electrolytes Creatinine Glucose

Arterial blood gas lactate Coagulation

Cultures: blood. urine. sputum

Chest X-ray

ECG

Recognising the critically ill patient

Cardiovascular signs

•    Cardiac arrest

•    Pulse ratę <40 or > 140 bpm

•    Systolic blood pressure (BP) <100 mmHg

•    Tissue hypoxia

Poor peripheral perfusion Metabolic acidosis Hyperlactataemia

•    Poor response to volume resuscitation

•    Oliguria: <0.5 ml/kg/hr (check urea. creatinine. K⁺)

Respiratory signs

•    Threatened or obstructed airway

•    Stridor. intercostal recession

•    Respiratory arrest

•    Respiratory ratę < 8 or > 35/min

•    Respiratory ‘distress’: use of accessory muscles; unable to speak in complete sentences

•    Sp0₂ < 90% on high-flow 0₂

•    Rising PaC0₂ > 8 kPa (> 60 mmHg), or > 2 kPa (> 15 mmHg) above 'normal' with acidosis

Neurological signs

•    Threatened or obstructed airway

•    Absent gag or cough reflex

•    Failure to maintain normal Pa0₂ and PaC0₂

•    Failure to obey commands

•    Glasgow Coma Scalę (GCS) <10

•    Sudden fali in level of consciousness (GCS fali > 2 points)

•    Repeated or prolonged seizures

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