SLIDE 1
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 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) - - 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
SLIDE 2
SLIDE 3
The Circulation
SLIDE 4
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
SLIDE 5
The Circulation
Pre-load After-load Contractility Heart Rate SVR
SLIDE 6
Shock – CHOD
Type Examples Problem Solution Cardiogenic MI Tamponade ↓ contractility β1 agonist
- e.g. dobutamine
Hypovolaemic Trauma ↓ pre –load Fluids Obstructive Tension pneumothorax PE ↑ afterload ↓ pre –load Relieve Obstruction Distributive Sepsis Anaphylaxis Neurogenic Shock ↓ SVR ↓ pre –load α1 agonist
- noradrenaline
- adrenaline
Shock = failure of organ perfusion
SLIDE 7
Assessment of the Critically Ill Patient
SLIDE 8
Sepsis and SIRS
SLIDE 9
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