ABCDE Approach for Critically Ill Patients

ABCDE admittance for Critically Ill PatientsThe topic I have chosen for my sketch is a forbearing with chest suffer. The Resuscitation Council (UK 2006) recommends that clinical staff should follow the ABCDE coming when assessing and treating critically ill patients. This will help to identify the deterioration of critically ill patients.With this in mind, it is important that patients presenting with cardiovascular conditions be promptly assessed and treated. hither I am following an ABCDE judicial decision on a patient with chest annoying. The 58-year-old (anonymous) male patient admitted with chest pain, 8hours after the onset of the symptoms. initially patient was thinking it is heartburn and been taken gaviscon and paracetamol.As I went to memorise the patient, I introduced myself and checked identity by asking the name.Patient is able to communicate.This incates that the air duct is patent. Patient is looking pale and in short of breath. Complaining of massiveness an d crushing pain around the chest radiating to left arm. sit patient upright position and checked breathing. Respiratory vagabond is 20bpm. (9-14bpm is convening resp rate-bts guidelines). The pattern of the breathing is normal, the movement of the chest wall is equal, and symmetrical.SaO2 checked is, 95% on room air. (Above 94%is normal or 88%-92% for those with resp bother (copd) BTS 2008).I administered 35% atomic number 8 via venturi mask. Supplemental oxygen therapy is important to maintain equal oxygen levels in the create from raw materials and organs when patients experiencing pain and shortness of breath. (Critical care legal opinion booklet)Patients peripheries are cold and clammy.this indicates poorly perfused tissues. Pressed on patients finger for 5 seconds to check the capillary refill time.(in health,initial blanching should disappear within 2seconds of releasing contract(Athern and Philpot 2002).CRT is 4 seconds. delayed CRT indicates poor perfusion(Lima and B akker 2005). checked radial pulse is tachycardic 114bpm.rate is regular. A manual pulse should always checked, as machines that measure heart rate tend to appoint an averaged value and therefore do not getaway irregularities or arterial insufficiency (Torrance and Elley, 1997).HR is above systolic neckcloth pressure indicating that patient having cardiac problem. Blood pressure is 101/54 mmhg, temporary worker 36 deg. Patient was very restless due to pain. Obtained ECG and present small eyeshade in the ST segment in standard leads.ST elevation is the first sign of infarction. This happens when myocardium injured. ECG is showing Acute Myocardial infarction. trouble oneself relief is the first priority, as uncontrolled pain increases sympathetic stimulation, which leads to change magnitude myocardial oxygen consumption. This can further aggravate the ischemia (T Moore P Woodrow). Informed doctor about patients condition. Inserted cannula and taken bloods for troponin t and routi ne investigating fbc, ues, coagulation profile. Doctor arrived and examined the patient, advised to give GTN spray and Diamorphine injection (GTN generates azotic oxide that is Vasoprotective.Nitrovasodilators act primarily to dilate veins and therefore has a major rig on reducing the filling pressures of the heart. This helps to reduce myocardial contraction, wall stress, oxygen demands .It is short acting, and its effects last up to 30 minutes. The sublingual driveway is preferred as this avoids metabolism by the liver which reduces the drug soaking up (H Chummun,KGopaul,A. Lutchman 2009) Diamorphine injection 5mg intravenously given .This is both potent analgesic and has positivistic hemodynamic effects particularly,vasodialatation which reduces the myocardial oxygen demand. Metochlorpromide 10mg intravenously (Antiemetic) given along with opiates to besmirch nausea, a side effect of opiates therapy. Aspirin and Clopidogrel 300mg given .These are anti blood platelet drugs , decrease the platelet aggregation and inhibit thrombus formation in the arterial circulation ,because in faster-flowing vessels,throbi are composed mainly of platelets with little fibrin. (BNF 2010)Patient is not thrombolysed with streptokinase injection, because the late manifestation and later administration is less effective outcome. Currently most protocols counseling a time window of 6hrs from the onset of pain during which it is appropriate to give thrombolytics.After this time it is usually considered that the risk of the drug outweigh the limited make headway gained(MrBassets and Mr Makins). Reassessed vital signs and pain. The pain is easing off slightly, scoring 2.respiratory rate 16bpm , HR 98bpm BP 112/68,CRT 2. Patients condition is improving. Pain assessment is a priority because continued pain is a symptom of ongoing MI, which places additional risk on myocardial tissue (Urden et al, 2002). repetition Diamorphine injection given as advised by doctor. Closely obser ved the patient, monitored breathing and oxygen saturation. Oxygen therapy continued, because it is important to dish the myocardial tissue to continue its pumping activity and to repair the damaged tissue around the site of the infarct (Sole et al, 2001).No shortness of breath at present. Repeat ECG taken in 15 minutes interval for assessment of dysrhythmias and it is noninvasive, well tolerated by patients and provides continuous information about the heart (Docherty and Douglas, 2003). Patients blood sugar checked and it is 6.7mmol.patient has no diabetic history.Patient is very unquiet and worried. dread can play a role in exquisite MI. It may affect the development of further heart disease, further morbidity or prognosis, health care use and rehabilitation. (Crow et al,1996, Januzzi et al 2000).I reassured patient. Anxiety management is assigned a high priority in the earlyish management of Acute MI. Doctor discussed with family about present condition and treatment. Fam ily fellow member who are anxious or upset about the patients condition may heighten patient anxiety, research suggest that family members should provide with information to abut their needs to reduce family anxiety (Quinn et al 1996).Doctor explained to the family about patients diagnosis and treatment. touchwood rate monitored continuously by attaching telemetry. This helps to identify cardiac arrhythmias. Vitals signs and pain score recorded regularly.Recognizing the signs of clinical deterioration and taking appropriate by the bye action can be a vital part of providing optimal patient care. The clinical signs of critical illness usually reflect compromised respiratory, cardiovascular and neurological function.The underlying aim of the initial interventions should be seen as a holding measure to keep the patient alive,and produces some clinical profit ,in order that definitive treatment may be initiated(Nolan et al,2005).