Monitoring the Critically III Patient

Title Page
......Page 2
Copyright
......Page 3
Contents
......Page 4
Foreword......Page 6
Preface......Page 7
Contributors......Page 9
INTRODUCTION......Page 10
Survival to discharge from in hospital cardiopulmonary arrest......Page 11
Suboptimal critical care......Page 13
TRACK A ND TRIGGER SYSTEMS......Page 18
EARLY WARNING SCORING SYSTEMS......Page 19
Critical c are o utreach t eams......Page 22
Medical e mergency t eams......Page 24
CLINICAL HANDOVER......Page 25
Provision of critical care......Page 26
TRAINING HEALTHCARE STAFF......Page 27
ALERT c ourse......Page 28
Care of the Critically Ill Surgical Patient  CCrISP......Page 29
REFERENCES......Page 30
INTRODUCTION......Page 34
ABCDE APPROACH......Page 35
ASSESSMENT OF AIRWAY......Page 36
Causes of airway obstruction......Page 37
Look......Page 38
Listen......Page 39
Efficacy of breathing, work of breathing and a dequacy of ventilation......Page 40
Look......Page 41
Causes of circulatory compromise......Page 42
Causes of altered conscious level......Page 43
EXPOSURE......Page 44
REFERENCES......Page 46
INTRODUCTION......Page 48
Efficacy of breathing......Page 49
Respiratory rate......Page 50
Noisy respirations......Page 51
COMPREHENSIVE ASSESSMENT OF THE BREATHLESS PATIENT......Page 52
Shape of the chest......Page 53
Auscultation of the chest......Page 54
Patient ’ s age......Page 55
Cough......Page 56
Sputum......Page 57
Normal range for PEF measurement......Page 58
PULSE OXIMETRY......Page 59
The mechanics of pulse oximetry......Page 60
Advantages of pulse oximetry......Page 61
Procedure for pulse oximetry......Page 62
Causes of inaccuracy......Page 64
Complications......Page 65
Procedure for arterial blood sampling......Page 66
Indications for ABG analysis......Page 67
Principles of ABG analysis......Page 68
Parameters measured by a blood gas analyser......Page 70
Systematic analysis of ABG results......Page 72
Classifi cation of imbalance......Page 73
Respiratory acidosis......Page 74
Metabolic acidosis......Page 75
Respiratory alkalosis......Page 76
Metabolic alkalosis......Page 77
PRINCIPLES OF CAPNOGRAPHY......Page 78
MONITORING PRIORITIES OF A VENTILATED PATIENT......Page 80
Parameters to be monitored during mechanical ventilation......Page 83
Monitoring the endotracheal tube......Page 84
MONITORING THE PATIENT RECEIVING NON - INVASIVE VENTILATION......Page 86
PRINCIPLES OF MONITORING A PATIENT WITH A CHEST DRAIN......Page 87
Monitoring priorities of the patient with a temporary tracheostomy......Page 89
SCENARIOS......Page 92
REFERENCES......Page 96
INTRODUCTION......Page 100
COMMON FEATURES OF A CARDIAC MONITOR......Page 101
SETTING UP ECG MONITORING......Page 102
EASI 12 - lead ECG monitoring......Page 103
The ‘ flat - line ’ trace......Page 105
Small ECG complexes......Page 106
THE ECG AND ITS RELATIONSHIP TO CARDIAC CONTRACTION......Page 107
SYSTEMATIC APPROACH TO ECG INTERPRETATION......Page 108
QRS rhythm......Page 109
Sinus rhythm......Page 110
Site of origin......Page 111
Sinus tachycardia......Page 112
Atrial fibrillation......Page 114
Narrow complex tachycardia......Page 117
Ventricular fibrillation......Page 119
Pulseless electrical activity......Page 121
REFERENCES......Page 123
INTRODUCTION......Page 124
Stroke volume......Page 125
Peripheral resistance......Page 126
Cardiogenic shock......Page 129
Obstructive shock......Page 130
Assessment of pulse and ECG......Page 131
Assessment of urine output......Page 132
Arterial blood pressure measurements......Page 133
Factors influencing blood pressure measurements......Page 134
GENERAL PRINCIPLES OF MONITORING WITH TRANSDUCERS......Page 135
Principles of arterial pressure monitoring......Page 136
Complications of a rterial line insertion......Page 137
Monitoring priorities of a patient with an arterial line......Page 139
PRINCIPLES OF CENTRAL VENOUS PRESSURE MONITORING......Page 141
Indications for central venous catheters......Page 142
Procedure for CVP measurement using a transducer......Page 143
Troubleshooting......Page 145
Management of a patient with a central venous catheter......Page 147
Pulmonary artery catheter......Page 149
Indications......Page 150
Pressures......Page 151
Precautions......Page 152
Thermodilution......Page 153
Procedure......Page 154
Mixed venous oxygen saturation......Page 155
Non - invasive methods of measuring cardiac output......Page 156
Transoesophageal echocardiography......Page 157
SCENARIOS......Page 158
REFERENCES......Page 160
INTRODUCTION......Page 163
AVPU ASSESSMENT......Page 164
THE GLASGOW COMA SCALE......Page 165
Eye o pening......Page 168
Verbal response......Page 169
Motor response......Page 170
PUPILLARY ASSESSMENT......Page 172
Principles of monitoring the patient with seizures......Page 173
PRINCIPLES OF INTRACRANIAL PRESSURE MONITORING......Page 174
Principles of intraventricular catheters......Page 175
Principles of jugular bulb oximetry monitoring......Page 176
Effects of over - and under - sedation......Page 177
Over - sedation......Page 178
Daily sedation interruption......Page 179
Relieving/ preventing pain......Page 180
Epidural analgesia......Page 181
CONCLUSION......Page 182
REFERENCES......Page 183
INTRODUCTION......Page 186
Appearance of urine......Page 187
Procedure for dipstick test of urine......Page 188
Significance of the results......Page 189
URINE OUTPUT MONITORING......Page 192
MONITORING FLUID BALANCE......Page 193
MANAGEMENT OF ACUTE RENAL FAILURE......Page 194
Clinical course......Page 197
Complications of ARF......Page 198
MONITORING DURING RENAL REPLACEMENT THERAPY......Page 200
Monitoring anticoagulation......Page 202
REFERENCES......Page 204
ASSESSMENT OF BOWEL FUNCTION......Page 206
Constipation......Page 207
Timing of vomiting......Page 208
Volume of vomit......Page 209
Fistulas......Page 210
ACUTE UPPER GASTROINTESTINAL TRACT BLEEDING......Page 211
PRINCIPLES OF MONITORING PANCREATIC FUNCTION......Page 213
REFERENCES......Page 216
INTRODUCTION......Page 218
CAUSES OF ACUTE LIVER FAILURE......Page 219
Clinical features of ALF......Page 220
Encephalopathy......Page 221
Cerebral oedema......Page 222
Sepsis......Page 223
Metabolic disturbances......Page 224
REFERENCES......Page 225
PRINCIPLES OF MONITORING PITUITARY GLAND FUNCTION......Page 227
PRINCIPLES OF MONITORING THE ENDOCRINE FUNCTION OF THE PANCREAS......Page 228
Procedure for bedside blood glucose measurements......Page 229
Hyperglycaemia and diabetic ketoacidosis......Page 232
Addisonian crisis......Page 234
Thyroid crisis......Page 235
Hypercalcaemia......Page 236
Hypocalcaemia......Page 237
REFERENCES......Page 238
INTRODUCTION......Page 240
Assessment......Page 241
PRINCIPLES OF MONITORING ENTERAL FEEDING......Page 242
Nasogastric feeding......Page 243
Nasoduodenal and nasojejunal feeding......Page 245
Complications of enteral feeding......Page 246
PRINCIPLES OF MONITORING TPN......Page 247
REFERENCES......Page 251
INTRODUCTION......Page 253
FACTORS INFLUENCING BODY TEMPERATURE......Page 254
Chemical dot thermometers......Page 255
Bladder probe......Page 257
PHYSIOLOGICAL EFFECTS OF HYPOTHERMIA......Page 258
Cardiovascular system......Page 259
Endocrine system......Page 261
PHYSIOLOGICAL EFFECTS OF HYPERTHERMIA......Page 262
MONITORING PRIORITIES OF A PATIENT WITHHYPERTHERMIA......Page 264
REFERENCES......Page 265
INTRODUCTION......Page 267
FACTORS INFLUENCING PAIN......Page 268
Adverse effects of untreated pain......Page 269
Patient ’s self - report......Page 270
Pain intervention......Page 271
Monitoring the patient with an epidural......Page 272
Monitoring the patient with patient - controlled analgesia......Page 273
REFERENCES......Page 274
BLOOD COMPONENTS AND THEIR USES......Page 276
Red cells......Page 277
Fresh frozen plasma and cryoprecipitate......Page 278
IMPORTANCE OF PATIENT IDENTIFICATION......Page 279
Administration......Page 280
Administration set......Page 281
MONITORING PRIORITIES IN A PATIENT RECEIVING A BLOOD TRANSFUSION......Page 282
During transfusion......Page 283
Post - transfusion......Page 284
Acute haemolytic transfusion reactions......Page 285
Transfusion - related lung injury......Page 286
Allergic reactions or anaphylaxis......Page 287
CONCLUSION......Page 288
REFERENCES......Page 289
INTRODUCTION......Page 290
HOW INFECTION OCCURS AND THE RELATIONSHIP BETWEEN THE INFECTIOUS AGENT AND HOST......Page 291
Physical and chemical barriers to infection  innate defence......Page 292
Cell - mediated immunity......Page 293
Patient presentation......Page 295
The pathophysiology of SIRS / sepsis......Page 297
Airway......Page 298
Breathing......Page 299
Circulation......Page 300
Disability......Page 301
Exposure......Page 302
Respiratory system......Page 303
Cardiovascular monitoring......Page 304
Microbiological monitoring/ investigations......Page 305
Other investigations......Page 306
SCENARIOS......Page 307
REFERENCES......Page 308
INTRODUCTION......Page 311
Changes associated with breathing......Page 312
Placental blood flow and caval compression......Page 313
ACUTE ILLNESSES AND DEATHS ASSOCIATEDWITH PREGNANCY......Page 314
Thrombosis/ thromboembolism......Page 315
Haemorrhage......Page 316
Miscarriage......Page 317
Assessing and monitoring the acutely unwell pregnant patient......Page 318
Breathing......Page 319
Circulation......Page 320
Exposure......Page 322
Cardiac arrest during pregnancy......Page 323
SCENARIOS......Page 324
CONCLUSION......Page 326
REFERENCES......Page 327
INTRODUCTION......Page 329
IMPORTANCE OF TREATING CHILDREN DIFFERENTLY......Page 330
Weight......Page 331
Physiological......Page 332
ABCDE APPROACH......Page 333
Assessment of airway......Page 334
Look......Page 336
Feel......Page 338
Assessment of circulation......Page 339
Feel......Page 340
Management of circulatory compromise......Page 341
Management of altered conscious level......Page 342
CONCLUSION......Page 343
REFERENCES......Page 344
INTRODUCTION......Page 345
POTENTIAL PROBLEMS AND HAZARDS ASSOCIATED WITH TRANSPORT......Page 346
Hazards associated with air transport......Page 349
PATIENT MONITORING EQUIPMENT REQUIRED FOR TRANSPORT......Page 350
MONITORING DURING TRANSFER......Page 351
CONCLUSION......Page 352
ACKNOWLEDGEMENT......Page 353
REFERENCES......Page 354
IMPORTANCE OF GOOD RECORD KEEPING......Page 355
PRINCIPLES OF GOOD RECORD KEEPING......Page 357
LEGAL ISSUES ASSOCIATED WITH RECORD KEEPING......Page 360
REFERENCES......Page 362
Index......Page 363