The document discusses following the ABCDE approach for assessing and treating a critically ill patient presenting with chest pain. It summarizes assessing the patient's airway, breathing, circulation, disability, and exposure. The patient was found to have signs of poor circulation including cold skin, delayed capillary refill time, and tachycardia. An ECG showed ST elevation consistent with acute myocardial infarction. Treatment including oxygen, pain medications, antiplatelet drugs, and monitoring were provided to improve the patient's condition while in care.

1. Approach for Critically Ill Patients Essay.
Approach for Critically Ill Patients Essay.The topic I have chosen for my vignette is a patient
with chest pain. The Resuscitation Council (UK 2006) recommends that clinical staff should
follow the ABCDE approach when assessing and treating critically ill patients. This will help
to identify the deterioration of critically ill patients.With this in mind, it is important that
patients presenting with cardiovascular conditions are promptly assessed and treated.
Approach for Critically Ill Patients Essay.Here I am following an ABCDE assessment on a
patient with chest pain. The 58-year-old (anonymous) male patient admitted with chest
pain, 8hours after the onset of the symptoms. Initially patient was thinking it is heartburn
and been taken gaviscon and paracetamol.As I went to see the patient, I introduced myself
and checked identity by asking the name.Patient is able to communicate.This incates that
the airway is patent. Patient is looking pale and in short of breath. Complaining of heaviness
and crushing pain around the chest radiating to left arm. Sat patient upright position and
checked breathing. Respiratory rate is 20bpm. (9-14bpm is normal resp rate-bts
guidelines).ORDER A PLAGIARISM-FREE PAPER HEREThe pattern of the breathing is
normal, the movement of the chest wall is equal, and symmetrical.SaO2 checked is, 95% on
room air. (Above 94%is normal or 88%-92% for those with resp problem (copd) BTS
2008).I administered 35% oxygen via venturi mask. Supplemental oxygen therapy is
important to maintain adequate oxygen levels in the tissues and organs when patients
experiencing pain and shortness of breath. (Critical care assessment booklet)Patient's
peripheries are cold and clammy.this indicates poorly perfused tissues. Pressed on patients
finger for 5 seconds to check the capillary refill time.(in health,initial blanching should
disappear within 2seconds of releasing pressure(Athern and Philpot 2002).CRT is 4
seconds. delayed CRT indicates poor perfusion(Lima and Bakker 2005). checked radial
pulse is tachycardic 114bpm.rate is regular. A manual pulse should always checked, as
machines that measure heart rate tend to give an averaged value and therefore do not
pickup irregularities or arterial insufficiency . Approach for Critically Ill Patients Essay.HR is
above systolic blood pressure indicating that patient having cardiac problem. Blood
pressure is 101/54 mmhg, Temp 36 deg. Patient was very restless due to pain. Obtained
ECG and showing small elevation in the ST segment in standard leads.ST elevation is the
first sign of infarction. This happens when myocardium injured. ECG is showing Acute
Myocardial infarction.Pain relief is the first priority, as uncontrolled pain increases
sympathetic stimulation, which leads to increased myocardial oxygen consumption. This
can further aggravate the ischemia (T Moore & P Woodrow). Informed doctor about

2. patient's condition. Inserted cannula and taken bloods for troponin t and routine
investigation fbc, u&e's, coagulation profile.Approach for Critically Ill Patients Essay. Doctor
arrived and examined the patient, advised to give GTN spray and Diamorphine injection
(GTN generates nitric oxide that is Vasoprotective.Nitrovasodilators act primarily to dilate
veins and therefore has a major effect on reducing the filling pressures of the heart. This
helps to reduce myocardial contraction, wall stress, oxygen demands .It is short acting, and
its effects last up to 30 minutes. The sublingual route is preferred as this avoids metabolism
by the liver which reduces the drug concentration (H Chummun,KGopaul,A. Lutchman
2009) Diamorphine injection 5mg intravenously given .This is both potent analgesic and
has positive hemodynamic effects particularly,vasodialatation which reduces the
myocardial oxygen demand. Metochlorpromide 10mg intravenously (Antiemetic) given
along with opiates to minimize nausea, a side effect of opiates therapy. Aspirin and
Clopidogrel 300mg given .These are antiplatelet drugs ,decrease the platelet aggregation
and inhibit thrombus formation in the arterial circulation ,because in faster-flowing
vessels,throbi are composed mainly of platelets with little fibrin.Patient is not thrombolysed
with streptokinase injection, because the late presentation and later administration is less
effective outcome. Currently most protocols advocate a time window of 6hrs from the onset
of pain during which it is appropriate to give thrombolytics.After this time it is usually
considered that the risk of the drug outweigh the limited benefit gained(MrBasset's and Mr
Makin's). Reassessed vital signs and pain. The pain is easing off slightly, scoring
2.respiratory rate 16bpm , HR 98bpm BP 112/68,CRT 2. Patient's condition is improving.
Pain assessment is a priority because continued pain is a symptom of ongoing MI, which
places additional risk on myocardial tissue (Urden et al, 2002). Repeat Diamorphine
injection given as advised by doctor. Closely observed the patient, monitored breathing and
oxygen saturation. Oxygen therapy continued, because it is important to assist the
myocardial tissue to continue its pumping activity and to repair the damaged tissue around
the site of the infarct (Sole et al, 2001).Approach for Critically Ill Patients Essay.No
shortness of breath at present. Repeat ECG taken in 15 minutes interval for assessment of
dysrhythmias and it is noninvasive, well tolerated by patients and provides continuous
information about the heart . Patient's blood sugar checked and it is 6.7mmol.patient has no
diabetic history.Patient is very anxious and worried. Anxiety can play a role in acute MI. It
may affect the development of further heart disease, further morbidity or prognosis, health
care use and rehabilitation. (Crow et al,1996, Januzzi et al 2000).I reassured patient.
Anxiety management is assigned a high priority in the early management of Acute MI.
Doctor discussed with family about present condition and treatment. Family member who
are anxious or upset about the patient's condition may heighten patient anxiety, research
suggest that family members should provide with information to meet their needs to reduce
family anxiety (Quinn et al 1996). Doctor explained to the family about patient's diagnosis
and treatment. Heart rate monitored continuously by attaching telemetry. This helps to
identify cardiac arrhythmias. Vitals signs and pain score recorded regularly.Recognizing the
signs of clinical deterioration and taking appropriate timely action can be a vital part of
providing optimal patient care. The clinical signs of critical illness usually reflect
compromised respiratory, cardiovascular and neurological function.The underlying aim of

3. the initial interventions should be seen as a 'holding measure' to keep the patient alive,and
produces some clinical improvement ,in order that definitive treatment may be
initiated.Approach for Critically Ill Patients Essay.