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Recognition and management of the seriously ill patient The aim of assessment of seriously ill patient 1) Identify the physiological abnormalities. 2) Identify the most appropriate way to correct those abnormalities. 3) Diagnose the underlying problem. T...

Recognition and management of the seriously ill patient The aim of assessment of seriously ill patient 1) Identify the physiological abnormalities. 2) Identify the most appropriate way to correct those abnormalities. 3) Diagnose the underlying problem. The process involves taking a full history and thoroughly examining and investigating the patient occurs is different manner in the seriously ill patient. The difference is due to the urgency with which treatment needs to be started. There is rarely time to take a full history or carry out a very detailed examination before initiating treatment. Tasks that are typically carried out sequentially often have to be carried out in parallel with history taking, examination and initial resuscitation often occurring simultaneously. Often it is necessary to restrict oneself to only the information required to guide the next treatment decision and to fill in missing components of history, examination and investigation after treatment has been Initiated on a "best guess" basis. The working diagnosis needs to be repeatedly reassessed as more information becomes available and on the basis of response to treatment. 1 1) Initial assessment The first step in assessing a seriously ill patient is to estimate how ill the patient is and how much time is available for assessment and investigation before initiating treatment. Warning signs of a severely ill patient Parameter Values Blood pressure Systolic 4 units of PRBCs in 1 h when on-going need is probable Replacement of 50% of total blood volume (TBV) within 3 h. Complications of massive blood transfusion Coagulopathy Hypothermia Citrate Toxicity Acid–Base Balance: High Serum Potassium Concentration 13 MCQ TEST 1- Effects of storge on whole blood (all true except one) a) blood becomes more acidic b) Rise in plasma potassium concentration c) Loss of all platelet function d) Reduction in Factor VIII e) Rise in plasma calcium concentration 2- Acute hemolytic reaction (all true except one) a) Occur within hours after transfusion b) More severe than delay type. c) Due to ABO incompatibility d) Need supportive treatment only e) Acute intravascular hemolysis 3- Definition of massive blood transfusion (all true except one) a) Replacement of one entire blood volume within 24 h b) Transfusion of >10 units of packed red blood cells (PRBCs) in 24 h c) Transfusion of >20 units of PRBCs in 24 h d) Transfusion of >4 units of PRBCs in 1 h when on-going need is probable e) Replacement of 50% of total blood volume (TBV) within 12 h. 4- Transfusion related acute lung injury (all true except one) a) (TRALI) presents as acute hypoxia and noncardiac pulmonary edema b) occurring within 6 h of blood product transfusion. c) It may occur with transfusion of any blood component. d) Treatment is similar to that for acute respiratory distress syndrome 14  e) TRALI may resolve within a few days with supportive therapy. 5- Management of hemolytic reaction (all true except one) a) the transfusion should be stopped immediately and the blood bank should be notified. b) Blood should be drawn to identify hemoglobin in plasma, to repeat compatibility testing, c) A urinary catheter should be inserted d) the urine should be checked for albumin. e) Osmotic diuresis should be initiated with mannitol and intravenous fluids 6- Indications of plasma transfusion (all true except one) a) International normalized ratio (INR) >1.5 with: b) Anticipated invasive procedure or surgery. c) Massive hemorrhage (over one blood volume) d) Emergent reversal of muscle relaxant drug. e) Treatment of isolated factor deficiencies. 7- RED BLOOD CELL transfusion guidelines (all true except one) a) Hemodynamic instability: Ongoing bleeding with unresponsive b) Hemodynamically Stable: ICU Patients: Hemoglobin