nursing profession & the coming wave of healthcare disruption
TRANSCRIPT
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21st June 2019
Nursing Department KCMH
Nursing Profession &
The Coming Wave of
Healthcare Disruption
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Hypovolemic shock: Assessment,
Treatment & Consequences
Ong-orn JaichaiyaphumCNE,MNS, RN
Nursing Professional Development CenterNursing Department KCMH
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Role of ICU nurses to assess
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Signs & Symptomps of Shock
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Signs and symptoms of hemorrhage by class
Parameter Class I Class II (mild) Class III (moderate) Class IV (severe)
Approximate blood loss (ml) < 15% (< 750) 15-30% (750-1,500) 31-40% (1,500-2,000) > 40% (>2,000)
Heart rate
Blood pressure
Pulse pressure
Respiratory rate
Urine output
Glasgow Coma Scale
Base deficite 0 to -2 mEq/L -2 to -6 mEq/L -6 to -10 mEq/L -10 mEq/L or Less
Need for blood products Monitor Possible Yes MTP
LOC slightly
anxious
mildly
anxious
anxious
confused
confused
lethargic
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Hypovolemic
shock assessment
Clinical
parameter
LOC
Urine output
BP
HR
Skin
Hemodynamic
parameter
CO/CI
SVR
SV/SVV
EDV
Perfusion
parameter
SvO2
ScvO2
Base deficit
Lactate
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Assessment vs Resuscitation Endpoints
Init
ial A
ss
es
sm
en
t
Resu
scit
ati
on
E
nd
po
ints
Traditional vs. New
Acute vs. Ongoing
Static vs. Dynamic
Global vs. End Organ
• Mentation
• Skin Perfusion
• Pulse
• Blood Pressure
• Pulse Pressure
• Shock Index
• Urine Output
• pH• Serum Lactate• Base Deficit• Arterial Wave Analysis• ScvO2
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Arterial Waveform
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Static & Dynamic
Measurement
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Passive leg raising test
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Importance of Occult Hypovolemia
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Nursing assessment
Nurses commonly experience
scenarios where hemodynamic
monitoring is focused on
hypovolemia (see case study)
in clinical practice.
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Limitation of conventional assessment
Classic sign & symptom of shock
• Changing mentation
• Tachycardia
• Cool, clammy, skin
• Prolonged capillary refill
• Narrowed pulse pressure
• Decreased urine output
• Hypotension
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Pulse Contour Analysis
Pulse
Contour
Analysis
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Performance of Nursing Care
Assessment
- ABCD Approach
- Clinical Approach
EGDPT
- Minimization of
crystalloid
- 1:1:1 Product
ratio
- Permissive
hypotension
- Avoid
hypothermia
- Effective
collaboration
Hemodynamic
Monitoring
- Conventional
- Advanced
End Point of
Resuscitation
- Monitor organ
perfusion
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The SVO Algorithm: Putting It All Together
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Nursing care delivery
ABCD Approach
Clinical
assessment
Early hemorrhage
control
Keep warm nursing
Hemodynamic
monitoring
Balance
resuscitation
Effective
Collaboration
End organ perfusion
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Thank you for your attention