lyell brougham nef operating room services royal adelaide hospital
TRANSCRIPT
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Lyell Brougham NEF
Operating Room Services
Royal Adelaide Hospital
Recognising the Deteriorating
Patient
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RECOGNISING the DETERIORATING PATIENT
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The primary purpose of the recovery
room is the critical evaluation of the
postoperative patient with the
emphasis on the anticipation and
prevention of complications.
Drain and Shipley 1987
POSTANAESTHETISIA RECOVERY UNIT
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RECOGNISING the DETERIORATING PATIENT
How we educate and how
we clinically practice,
effects competence!
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RECOGNISING the DETERIORATING PATIENT
50% of what we know is
probably wrong, our
problem is which 50%?
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RECOGNISING the DETERIORATING PATIENT
Standard 9:
Recognising and responding
to the Deteriorating Patient
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A = AIRWAY
B = BREATHING
C = CIRCULATION
D = DISABILITY
E = EXPOSURE
DETERIORATING PATIENT
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WHAT IS THE ESSENCE OF
INFECTION CONTROL?
QUESTION
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WHAT IS THE ESSENCE OF
INFECTION CONTROL?
A: Transmission
Prevention
QUESTION
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WHAT IS THE ESSENCE OF
DETERIORATING
PATIENT?
QUESTION?
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ASSESSMENT?
NURSING the DETERIORATING PATIENT
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ASSESSMENT?OR
ASSESSING?
NURSING the DETERIORATING PATIENT
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ASSESSMENT
PLANNING
IMPLEMENTATION
EVALUATION
THE NURSING PROCESS
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STRUCTURE
PROCESS
OUTCOME
MANAGEMENT MODEL
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STRUCTURE + PROCESS =
OUTCOME
MANAGEMENT MODEL
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STRUCTURE PROCESS
OUTCOME
EVALUATION MODEL
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1. ASSESSMENT
2. CURING
MEDICAL MODEL
2 Steps
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1. ASSESSING
2. CLINICAL
INTERVENTION
PARU NURSING MODEL
2 Steps
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RECOGNISING the DETERIORATING PATIENT
Standard 9:
Recognising and responding
to the Deteriorating Patient
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A = AIRWAY
B = BREATHING
C = CIRCULATION
D = DISABILITY
E = EXPOSURE
DETERIORATING PATIENT
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Check for loose dentures, teeth etc
Is the airway clear?
A = AIRWAY
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Respiratory rate
SpO2
Observation
CXR
ABG
Auscultation
B = BREATHING
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Heart Rate
Rhythm
BP
12 lead ECG
Capillary Return > 3 seconds
Bloods
IV Access
Fluids
Urinary Output
Fluid Balance Chart
C = CIRCULATION
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BSL
AVPU (Alert, Voice, Pain,
Unresponsive)
GCS
MEDICATION CHART
Anything else that doesn’t fit into
‘ABC’
D = DISABILITY
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Pull back the blankets and look!
E = EXPOSURE
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RECOGNISING the DETERIORATING PATIENT
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ASSESSMENTOR
ASSESSING?
NURSING the DETERIORATING PATIENT
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The primary purpose of the recovery
room is the critical evaluation of the
postoperative patient with the
emphasis on the anticipation and
prevention of complications.
Drain and Shipley 1987
POSTANAESTHETISIA RECOVERY UNIT
![Page 33: Lyell Brougham NEF Operating Room Services Royal Adelaide Hospital](https://reader038.vdocuments.mx/reader038/viewer/2022102900/551a2764550346a4248b51c2/html5/thumbnails/33.jpg)
You walk into a 6 bed bay.
There are 5 patients asleep and
one who has had a cardiac arrest!
HOW CAN YOU TELL WHICH PATIENT HAS
ARRESTED?
CLINICAL INTERVENTION
QUESTION
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Monitor the Patientnot
the machines!
ICU Mantra
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We need to learn to
read the patient like a
book.
WHAT WE NEED TO UNDERSTAND?
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We need to learn to
read the patient like a
book.
WHAT WE NEED TO UNDERSTAND?
EVERYTHING HAS MEANING?
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1. ASSESSING
2. CLINICAL
INTERVENTION
PARU NURSING MODEL
2 Steps
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What is the most valuable vital
sign of
a deteriorating patient?
QUESTION
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What is the most valuable vital
sign in a deteriorating patient?
A: STATE OF CONSCIOUSNESS
QUESTION
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State of Consciousness
Movement
Colour
Skin
Vital signs
OBSERVATIONS
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Problem:
No scales that accurately
reflect the SOC!
STATE OF CONSCIOUSNESS
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Awareness – Face,
eyes
Arms
Legs
Seizure / TIA
MOVEMENT
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Awareness – Face,
eyes
Arms
Legs
Seizure / TIA
MOVEMENT
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The trend is of more value
than the number!
COLOUR
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Movement
Colour
Temperature
Moisture (dry –
clammy)
SKIN
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Respiratory rate
SpO2
Observation
CXR
ABG
Auscultation
OBSERVATIONS
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83 yrs
#NOF
36 hrs from fall
Aramine throughout theatre
VIGNETTE
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83 yrs
#NOF
36 hrs from fall
Aramine throughout theatre
VIGNETTE
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The primary purpose of the recovery
room is the critical evaluation of the
postoperative patient with the
emphasis on the anticipation and
prevention of complications.
Drain and Shipley 1987
POSTANAESTHETISIA RECOVERY UNIT
![Page 50: Lyell Brougham NEF Operating Room Services Royal Adelaide Hospital](https://reader038.vdocuments.mx/reader038/viewer/2022102900/551a2764550346a4248b51c2/html5/thumbnails/50.jpg)
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The Australian Resuscitation Guidelines, December 2010• www.resus.org.au
• Thanks also to Kym Mart (NEF SDD)
References