assesment of critically ill patients in ICU

1. CENTER FOR PHYSIOTHERAPY AND REHABILITATION
SCIENCE
JAMIA MILLIA ISLAMIA
SUBMITTED TO: DR. JAMAL ALI MOIZ
SUBMITTED BY: FARZANA KHATOON
MPT 3RD SEM

2. ASSESSMENT OF CRITICALLY ILL PATIENTS IN ICU

3. who are critically ill
• Critical illness is any disease process which cause physiological instability leading
to disability or death within minutes or hours.
• A critically ill patients is one at imminent risk of death
• The severity of illness must be recognized early and appropriate measures taken
promptly to assess, diagnos and manage the illness.

5. AIRWAY
• The aim of the airway assessment is to establish the patency of the
airway and assess the risk of deterioration in the patient’s ability to
protect their airways.
The patient’s airway can be clear (if the patient is talking)
Partially obstructed (if air entry is diminished and often noisy) or
Completely obstructed (if there are no breath sounds at the mouth or
nose) (Resuscitation Council (UK) 2020).

6. Causes of Airway Obstruction(Mallet 2013; Thim et al. 2012)
• inhaling or swallowing a foreign object.
• small object lodged in the nose or mouth.
• allergic reaction.
• trauma to the airway from an accident.
• vocal cord problems.

7. Assessing the Airway-
• Observe patient for signs of airway obstruction: such as paradoxical
chest and abdominal movements.(Resuscitation Council (UK) 2020)
Treatment of airway obstruction
• According to Resuscitation Council (UK) (2020), airway obstruction is
a medical emergency. untreated airway obstruction can rapidly lead
to cardiac arrest, hypoxia, damage to the brain, heart, kidneys and
even death.
• Once airway obstruction has been identified, treat appropriately. For
example: suction if required, administration of oxygen and moving
the patient into a lateral position (Jevon 2012).

8. Breathing (B)
• Breathing function should only be assessed and managed after the airway
management.
Assessing Breathing
• Look for the general signs of respiratory distress such as sweating, the
effort needed to breathe, abdominal breathing and central cyanosis.
• Count patient’s respiratory rate: the normal respiratory rate in adults is
between 12 – 20 breaths/minute (Prytherch et al. 2010).
• The respiratory rate should be measured by counting the number of
breaths that a patient takes over one minute through observing the rise
and fall of the chest. A high respiratory rate is a marker of illness
(Resuscitation Council (UK) 2020).

9. • Measure patient’s peripheral oxygen saturation
• Blood gas analysis
• Assess air entry using a stethoscope

10. Circulation (C) - Assessment of circulation should be undertaken only
once the airway and breathing have been assessed and appropriately
treated.
• The aim of assessing the circulatory system is to determine the
effectiveness of the cardiac output. Cardiac output is the volume of
blood ejected from the heart each minute (Mallet 2013).
Assessing Circulation
• Blood pressure (BP): is an indication of the effectiveness of the
cardiac output.
• Assess the patient’s heart rate
• Patient’s temperature: normal temperatures range from 36.8Oc to
37.9Oc

11. Disability (D)
• This assessment involves reviewing the patient’s neurological status,
and its assessment should only be undertaken once A, B and C factors
have been optimised.
Assessing Neurological Function
Level of consciousness: It is rapid assessment of the patient’s level of
consciousness using the AVPU system (Smith 2003).

12. AVPU stands for
A = Awake-
• Observe if the patient can open his/her eyes, takes interest and responds
normally to his/her environment. This would be assessed as ‘awake’.
V = voice
• if the patient has his/her eyes closed and only opens them when spoken to,
this would be assessed as ‘voice’
P = pain
• The patient who doesn’t respond to voice should be shaken gently to try to
elicit a response. If there is still no response, then painful stimuli should be
applied. If the patient responds to painful stimuli, then the level of
consciousness is assessed as ‘responds to pain
U = Unresponsive
• Patient not responding to pain is ‘unresponsive

13. Exposure (E)
• By the time the assessment reaches this stage (exposure), there
should be a good understanding of the patient’s problems (Mallet
2013)

14. References
• Centre for Clinical Practice 2019, Acutely Ill Patients in Hospital,
National Institute for Health and Clinical Excellence (NICE), London,
viewed 20 March 2020.
• Jevon, P & Ewens, B 2012, Monitoring The Critically Ill Patient, 3rd
Edn, Wiley-Blackwell, Oxford.
• Mallet, J, Albarran, J, Richardson, R 2013, Critical care Manual of
Clinical Procedures and competencies, Wiley-Blackwell, Oxford.
• Mangione, S 2008, Physical Diagnosis Secrets, 2nd edn.,
Mosby/Elsevier, US

15. • O’Driscoll, BR, Howard, LS, Earis, J, Mak, V & British Thoracic Society
2017, ‘BTS Guideline for Oxygen Use in Adults in Healthcare and
Emergency Settings’, Thorax, vol. 72, no. 1, viewed 20 March 2020.
• Prytherch, DR, Smith, GB, Schmidt, P & Featherstone, PI 2010, ‘ViEWS
– towards a national early warning score for detecting adult inpatient
deterioration’, Resuscitation, vol. 81, no. 8, pp. 932-7, viewed 29
March 2018.
• Resuscitation Council (UK) 2020, The ABCDE Approach, Resuscitation
Council (UK), viewed 20 March 2020
• Smith, G 2003, ALERT Acute Life-Threatening Events Recognition and
Treatment, 2nd Edn, University Of Portsmouth, Portsmouth