1 / 29

Monitoring the unconscious patient

Monitoring the unconscious patient. Lam Sai Chu Sindy N.O. AHNH. Unconscious patient. Patient makes no appropriate response to stimuli either external (pain) or internal (thirst). Stage of unconsciousness. Somnolence - state of unconsciousness from which patient can be fully awakened

tassos
Download Presentation

Monitoring the unconscious patient

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Monitoring the unconscious patient Lam Sai Chu Sindy N.O. AHNH

  2. Unconscious patient • Patient makes no appropriate response to stimuli either external (pain) or internal (thirst)

  3. Stage of unconsciousness • Somnolence - state of unconsciousness from which patient can be fully awakened • Stupor - state of unconsciousness from which patient can be awakened to produce inadequate responses to verbal & physical stimuli

  4. Stage of unconsciousness • Coma - state of unconsciousness from which patient who appears to be asleep, cannot be aroused by verbal and physical stimuli to produce any meaningful response

  5. Cause of unconsciousness • Poisons & drug • Vascular causes • Infection • Seizures • Others

  6. Objectives in monitoring • Assess adequacy of vital organ function • Follow course of acute illness • Assess patient discomfort and effect of measures • Track the effects of therapeutic interventions • Detect complications and other adverse event

  7. Objectives in monitoring • Determine the need for interventions • Assess the performance of monitors and support devices • Detect readiness for and predict success of therapeutic interventions • Evaluate patient’s nutritional / metabolic state

  8. Adverse effects of monitoring • To patient • pain • uncomfortable position • discomfort restricting movement • Inconvenience and distress for family

  9. Adverse effects of monitoring • Diversion of caregivers’ attention away from patient • Noise pollution for both patient and staff

  10. Physiological Function • Oxygenation • Circulation • Neurological function • Nutrition • Fluids & electrolytes • Elimination

  11. Physiological Function • Physical activity & rest • Senses • Skin Integrity • Endocrine function • Psychosocial state

  12. Scenario 1 • A 45 year old woman was taken to hospital after falling 40 feet from the second floor. • On arrival at hospital, RR 18 / minute, PR 100 / minutes, BP 145/90 mmHg, T 35.5 C, GCS - 6, pupils - equal and reacted sluggish to light, compound Rt. tibial fracture. • After CT scan, she was admitted to ICU after wound debridement, insertion of subdural ICP monitor

  13. Oxygenation - Airway • Patency • Position of ETT • Monitor taping of ETT - too tight or not • +/- suction

  14. Breathing • Breath sounds • Coping with ventilation • Presence of spontaneous breathing • Amount of sputum • Present of gap / cough reflex

  15. Circulation and Cerebral Perfusion • ECG ( rate, rhythm and presence of ectopic beat) • Blood pressure • Pulses (peripheral) & capillary refill • Presence of bleeding • Level of consciousness, responsiveness

  16. Neurological function • Level of consciousness • Pupil size • ICP monitor • Glasgow Coma Scale • Sedation level

  17. Best Ocular Response Open spontaneously 4 Open to verbal command 3 Open to pain 2 No response 1 Glasgow Coma Scale

  18. Best motor response Obeys verbal command 6 Localizes pain 5 Flexion withdrawal 4 Abnormal flexion 3 Abnormal extension 2 No response 1 Glasgow Coma Scale

  19. Best verbal response Oriented and converses 5 Disoriented and converses 4 Inappropriate words 3 Incomprehensible sounds 2 No response 1 Glasgow Coma Scale

  20. Ramsay Sedation Score Awake levels 1. anxious and agitated or restless 2. co-operative, oriented and tranquil 3. responds to command only

  21. Ramsay Sedation Score Asleep level (response to glabellar tap or loud auditory) 4. brisk response 5. sluggish response 6. no response

  22. Fluids and Electrolytes • IV fluids, IV line patency, • Urine output • Drain - NG tube • Serum albumin level

  23. Skin Integrity • Sign of edema • Sign of dehydration • Wound condition • Sign of infection • Personal hygiene • Skin protection

  24. Sensory-perceptual function • Pain score • Hearing sensation • Discomfort • Thirst

  25. Psychosocial State • Anxiety / worry • Depression • Agitation / restlessness

  26. “ICU Patient’s lament” Don’t monitor me - my wedge pressure’s fine My QRS complex is not a straight line I don’t have a pneumo or sepsis or gout; At least if I do, I don’t want to find out. Your fancy new gizmos and beepers and light. Are vaulting my bill up to unforeseen heights. They poke me and probe me and add to my stress.

  27. “ICU Patient’s lament” But whether they help me is anyone’s guess. They haven’t been tested to see if they work, But using them you’ve gone completely berserk No one asks me how it feels here in bed ---- you spend all your time with my data instead. I want to be cared for, and comforted too. But that doesn’t happen with all that you do

  28. “ICU Patient’s lament” So go somewhere else with your new expertise ---- Don’t monitor me, just leave me in peace! Hudson LD. Monitoring of critically ill patients : conference summary. 1985

  29. Thank You

More Related