Examination of the critically ill surgical patient

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Chapter 64 Examination of the critically ill surgical patient


Petrut Gogalniceanu, Julia Niewiarowski and Vijay M. Gadhvi



History




Age/sex



Background medical problems



Operation and postoperative day number



Cause of admission to ITU, and ITU day number



Current problems



Recent imaging



Events in last 24 hours



Examination



A Airway




Airway: maintaining own airway, respiratory adjuncts, intubated



FiO2



C-spine status



B Breathing




Respiratory rate (RR)



O2 saturation percentage (sats)



Ventilation method: self-ventilating/non-invasive ventilation (CPAP or BiPAP)/invasive ventilation



Trachea position



Surgical emphysema



Air entry in lungs



Abnormal breathing sounds



Chest wall: chest drains and rib/sternum fractures



ABG:




















pH HCO3 Hb
pCO2 Lactate Na+
pO2 Base excess K+



Chest x-ray (CXR)



C Cardiovascular


Pump:




Heart rate and rhythm (HR) and blood pressure (BP)



Mean arterial blood pressure (MAP) and central venous pressure (CVP)



Jugular venous pressure (JVP) and carotid pulse



Heart sounds: I + II + other



Inotropes



Peripheral oedema



ECG



Troponin and BNP36


Circuit:




Full examination of pulses:




neck: carotid



upper: supraclavicular, axillary, brachial, radial, ulnar



central: aorta



lower: femoral, popliteal, dorsalis pedis (anterior tibial artery), tibialis posterior (posterior tibial artery)



Peripheral perfusion: warmth and capillary refill time


Fluid:




Vascular access: central, peripheral, intraosseous



Evidence of external bleeding: urinary catheter, drains, stoma bags, rectal, vaginal or oral

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Feb 18, 2017 | Posted by in GENERAL SURGERY | Comments Off on Examination of the critically ill surgical patient

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