ApexMD

Assessment of the Critically Ill Patient

  • Pts. usually show signs of deteriorating organ function days before organ failure actually develops
  • If these signs are picked up and acted upon, the need for organ support may be prevented ==> reduced morbidity
  • The greater your physiological reserve, the later these signs develop, thus have a low threshold of suspicion in the young
  • Signs can form part of an early warning score to both alert and trigger action by the admitting / ITU outreach team

Signs include :

  • HR > 90, <50 bpm
  • SBP < 90 mmHg
  • RR < 8, > 20 per min.
  • Temp < 36, > 38 deg C
  • GCS < 15 or AVPU
  • (Awake, responds to Voice, Pain, Unresponsive)
  • UO < 0.5ml/kg/hr
  • O2 sats in air < 94%
  • Get increased score for each sign depending on degree of perturbation from normal

Respiratory Status

  • Assess for evidence of airway compromise
  • Stridor, tracheal tug
  • Resting respiratory rate > 25 is the most sensitive indicator of physiological compromise

Neurological

  • Confusion also early sign of significant physiological compromise

Scoring

  • CURB-65 score useful for pts with pneumonia / Sepsis :
  • Confusion
  • elevated Urea
  • Respiratory rate
  • low Blood pressure
  • age > 65 yrs