The Acutely Unwell Patient 25/04/2012 Dr Alasdair Scott BSc (Hons) - PowerPoint PPT Presentation

The Acutely Unwell Patient 25/04/2012 Dr Alasdair Scott BSc (Hons) MBBS PhD Academic FY1, North West Thames as703@ic.ac.uk

The Plan • Physiology and Shock • Assessment of the Critically Ill Patient • Surviving sepsis – what you can do

The Circulation

A Few Equations • Cardiac Output – CO = SV x HR (β1 receptors) – SV ∝ pre-load – SV ∝ contractility – SV inversely proportional to afterload • Mean Arterial BP= Perfusion Pressure – MABP = CO x SVR (α1 receptors) – MABP = SV x HR x SVR

The Circulation Heart Rate Pre-load SVR Contractility After-load

Shock – CHOD Shock = failure of organ perfusion Type Examples Problem Solution Cardiogenic MI ↓ contractility β1 agonist Tamponade - e.g. dobutamine Hypovolaemic Trauma ↓ pre –load Fluids Obstructive Tension pneumothorax ↑ afterload Relieve Obstruction PE ↓ pre –load Distributive Sepsis ↓ SVR α1 agonist Anaphylaxis ↓ pre –load - noradrenaline Neurogenic Shock - adrenaline

Assessment of the Critically Ill Patient

Sepsis and SIRS

Managing Sepsis – The Sepsis 7 1. Oxygen 2. Fluid:500 – 1000ml 3. Blood Cultures 4. Antibiotics IV: e.g. tazocin 5. ABG: pH, lactate, Hb 6. Urinary catheter + monitor urine output 7. Inform ITU