Fluid

250mL for cardiac failure. 250mL minimum for other patients.

Case 1
75 year old female, 12 hours post left total hip replacement
Current situation hypotension, PCA in progress, IVT running 125 ml/hr
Vital signs BP fallen from 130/70 to 95/50 in last 3 hrs, HR 110, wound drain
300mL

If she has a temperature too early for an infection (usually takes days) possibly blood
sitting somewhere or an embolus(?)

Pulmonary embolism & myocardial infarct (causing ventricular arrhythmias) are common
causes of sudden death.

Respiratory rate of > 25 suggest metabolic acidosis?

Es for patients at risk:
Emergency patient
Elderly
Existing co-morbidities
Extreme illness
Emerging from anaesthesia
Exsanguinating
Exiting from critical care units

For conscious patient:
Airway
Breathing
Circulation
Disability (neurological assessment)
Exposure
Fluids
Glucose
Give Oxygen
Position your patient (sit up for heart & respiratory)
Call for help if you cant manage (MET or senior nurse etc.)
Establish IV if not present +/- fluids (to prevent further hypotension)
Never leave a deteriorating patient without a priority management and review plan

ISBAR
Introduction identify yourself, your role and location
Situation state the patients diagnosis or reason for admission and current
problem
Background what is the clinical background or context?
Assessment What are the patients clinical observations? What do you think the
problem is? (Have current vital signs at the ready)
Recommend What do you recommend?


Preparing to communicate:
How long do I have to prepare?
Do I have all the data I need (e.g. FIO2)
Is the data close to the phone?
Have I assessed the patient clinically?
Have I assessed the patient.
Urgency of response the time you want them to act

For all hospitals, know the Standard escalation pathway and Alternate escalation pathway
(for exceptional circumstances).

Must extend head and tilt back to clear airway for bagging & masking. Can use two hands to
thrust the jaw and have someone else bag. Also capacity of bag is 2L, dont compress fully
pneumothorax. Normally people breathe ~5mL/kg of body weight.