Critical Care - Pain, Death and Dying

Critical Care Concept: P a i n , D e a t h a n d D y i n g , A s s e s s m e n t T o o l s u s e d i n C r i t i c a l Ca r e , P a t i e n t H a n d o v e r , a n d M e d i c a l Ab b r e v i a t i o n s . 4. Obstructive Shock: Caused by physical obstruction TABLE OF CONTENTS I. Pain II. Shock and Types od Shock to blood flow. 1. Examples: Pulmonary embolism, cardiac tamponade. Management: III. SIRS, SEPSIS, and SEVERE SEPSIS IV. Dying and Death  V.  Assessment Tools Used in Critical Care VI. Patient Handover Identify and Treat Underlying Cause: Fluid resuscitation, medications, or surgical intervention. Supportive Care: Maintaining airway, breathing, and circulation (ABCs). III. SIRS, Sepsis, and Severe Sepsis VII. Medical Abbreviations commonly Used Systemic Inflammatory Response Syndrome (SIRS): VIII. Advnace Directive  I. Pain Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It serves as a crucial protective mechanism, signaling the body to avoid or respond to harm. A systemic inflammatory response to various insults, including infection, trauma, or pancreatitis. Criteria include fever, hypothermia, tachycardia, tachypnea, and leukocytosis or leukopenia. Sepsis:  A severe infection causing systemic inflammation Types of Pain: and potentially leading to organ dysfunction. It is 1. Acute Pain:· Short-term pain that arises suddenly and is usually characterized by SIRS criteria plus a confirmed or linked to a specific injury or condition, often resolving with suspected infection. treatment. 2. Chronic Pain: Persistent pain lasting beyond the expected Severe Sepsis: healing time, often due to conditions like arthritis or neuropathy. It may not always have a clear cause.  Sepsis with associated organ dysfunction or hypoperfusion. Symptoms may include altered Management: mental status, decreased urine output, and lactic acidosis.  Pharmacological: Use of analgesics, such as acetaminophen, NSAIDs, or opioids, depending on the Management: severity.  Non-Pharmacological: Techniques like physical therapy,  Early Recognition and Treatment: Administer cognitive-behavioral therapy, and acupuncture can antibiotics, fluids, and vasopressors as needed. complement pain relief strategies.  Supportive Care: Monitor vital signs, organ function, and provide supportive measures like oxygen and II. Shock and Types of Shock ventilation. Definition: Shock is a critical condition where the body's organs IV. Dying and Death and tissues are not receiving adequate blood flow, leading to insufficient oxygen and nutrient delivery. Concepts of Dying: Types of Shock:  1. Hypovolemic Shock: Caused by significant loss of blood Dying: The process of approaching death, often characterized by physical, emotional, and psychological changes. Death: The cessation of all biological functions sustaining life. or fluids, leading to decreased blood volume.  1. Examples: Hemorrhage, severe dehydration. 2. Cardiogenic Shock: Results from the heart's inability to pump blood effectively. Care Approaches: 1. Examples: Myocardial infarction, congestive heart failure. 3. Distributive Shock: Characterized vasodilation and impaired blood flow. by widespread 1. Examples: Septic shock, anaphylactic shock.   Palliative Care: Focuses on relieving symptoms and improving quality of life, rather than curative treatment. Hospice Care: Specialized care for individuals in the final stages of life, emphasizing comfort and support for both patients and families. Emotional and Ethical Considerations: Critical Care Concept: Pa t i e n t Sa f e ty  To assess organ dysfunction and failure in critically Emotional Support: Providing comfort and addressing ill patients, especially in sepsis. emotional needs of patients and families.  Advance Directives: Legal documents outlining a patient’s wishes regarding medical treatment if they Components: become unable to communicate.  Respiratory System: Assesses oxygenation and respiratory support. Understanding pain, shock, SIRS, sepsis, and the process of dying  Coagulation: Evaluates platelet count and is fundamental in providing comprehensive patient care. Effective coagulation abnormalities. management involves recognizing symptoms, diagnosing  Liver Function: Measures bilirubin levels. conditions, and delivering appropriate interventions to improve  Cardiovascular System: Assesses blood pressure patient outcomes and ensure dignity in end-of-life care. and need for vasopressors.  Renal Function: Measures serum creatinine and V. Assessment Tools Used in Critical Care urine output.  Neurological Status: Assesses Glasgow Coma Scale. 1. Glasgow Coma Scale (GCS)  Purpose:  To assess the level of consciousness and neurological function in patients with head injuries or altered mental status. Components:     Scores range from 0 to 24, with higher scores indicating more severe organ dysfunction. 4. MAP (Mean Arterial Pressure) Monitoring Eye Opening: Scores from 1 (no response) to 4 Purpose: (spontaneous opening). Verbal Response: Scores from 1 (no response) to 5  To assess overall blood flow and perfusion status. (oriented). Motor Response: Scores from 1 (no response) to 6 (obeys Calculation: commands). Total Score:  Score Interpretation: Ranges from 3 (deep coma) to 15 (fully alert). Lower scores indicate a more severe level of impaired consciousness. 2. APACHE II (Acute Physiology and Chronic Health Evaluation)  MAP = (SBP + 2*DBP) / 3 o o SBP: Systolic Blood Pressure DBP: Diastolic Blood Pressure Target Range:  A MAP of 60-70 mmHg is generally aimed for to ensure adequate organ perfusion. Purpose:  To estimate the severity of illness and predict outcomes 5. Hourly Urine Output Monitoring in critically ill patients. Components: Purpose:  To evaluate kidney function and fluid balance. Physiological Measurements: Includes temperature, blood pressure, heart rate, respiratory rate, and more. Normal Range:  Chronic Health Conditions: Accounts for pre-existing conditions like chronic liver disease or diabetes.  0.5 to 1.5 mL/kg/hr is considered normal.  Age: Affects overall score and prognosis. Decreased output can indicate renal impairment or fluid imbalance. Score Interpretation:   Higher scores correlate with increased risk of mortality and severity of illness. Importance:  Helps in early detection of kidney failure and fluid status monitoring, crucial for adjusting fluid therapy. 3. SOFA (Sequential Organ Failure Assessment) Score Purpose: 6. Cardiac Output Monitoring Purpose: Critical Care Concept: Pa t i e n t Sa f e ty To measure the amount of blood the heart pumps per Understanding and utilizing these assessment tools is crucial for providing effective and timely care in critical care settings. minute, reflecting heart function and perfusion. Each tool provides specific insights into the patient's condition, guiding interventions and monitoring responses Techniques: to treatment.    Pulmonary Artery Catheter (PAC): Measures cardiac VI.Patient Handover output directly. Echocardiography: Non-invasive method to estimate Definition: cardiac output.  Importance:  Essential for managing patients with heart failure, shock, and other critical conditions. Patient handover is the process of transferring responsibility and information about a patient from one healthcare provider to another. It ensures continuity of care and safety. Importance:   7. Ventilator Settings and Monitoring Purpose:   To assess and adjust mechanical ventilation in patients with respiratory failure. Parameters:  o o Respiratory Rate (RR): Number of breaths per minute. PEEP (Positive End-Expiratory Pressure): Maintains alveoli open and improves oxygenation. FiO2 (Fraction of Inspired Oxygen): Oxygen concentration delivered. Monitoring:  Key Components of Effective Handover 1. Identification: =olume (VT): Volume of air delivered with each breath.   Safety: Prevents errors and omissions. Continuity: Ensures that all relevant information is communicated for ongoing care. Efficiency: Enhances team coordination and patient outcomes. 2. Clinical Status: o o o Regularly check arterial blood gases (ABGs) to guide adjustments in ventilator settings. o Purpose:  To assess respiratory and metabolic function, including oxygenation, ventilation, and acid-base balance. Components:     Importance:  Guides treatment decisions, adjustments and fluid therapy. Current Orders: Medications, treatments, and interventions. Pending Tests/Procedures: Upcoming diagnostic tests or planned procedures. 4. Recent Changes: o o pH: Measures acidity/alkalinity. PaO2 (Partial Pressure of Oxygen): Indicates oxygenation status. PaCO2 (Partial Pressure of Carbon Dioxide): Reflects ventilation efficiency. HCO3- (Bicarbonate): Assesses metabolic component of acid-base balance. Chief Complaint: Main reason for admission or current issue. Diagnosis: Confirmed or suspected medical conditions. Vital Signs: Recent measurements and any abnormalities. 3. Treatment Plan: o 8. ABG (Arterial Blood Gas) Analysis Patient Details: Name, age, and medical record number. Location: Current unit/bed. Significant Updates: Changes in condition or treatment. Responses to Treatment: How the patient is reacting to interventions. 5. Patient Needs: o o Immediate Concerns: Any urgent issues or needs. Long-Term Goals: Ongoing care objectives and discharge plans. 6. Safety Information: including ventilation o o Allergies: Known allergies and reactions. Special Precautions: Any additional safety measures or concerns. Critical Care Concept: Pa t i e n t Sa f e ty Best Practices for Handover 1. Structured Format: o Use standardized tools or frameworks (e.g., SBAR: Situation, Background, Assessment, Recommendation). 2. Clarity and Conciseness: o Provide clear, relevant information without unnecessary detail. 3. Verification: o Confirm understanding by summarizing key points and asking for questions. 4. Documentation: o Ensure all information is recorded accurately in the patient’s records. 5. Communication: o Use direct, respectful, and professional language. Be attentive and engaged during the handover process. Example Handover Situation: "Mr. John Smith, 65 years old, in Room 301." Background: "Admitted 2 days ago with community-acquired pneumonia. History of COPD and diabetes." Assessment: "Vital signs stable: BP 130/85, HR 85 bpm, RR 18, Temp 98.6°F. Improved from yesterday but still on IV antibiotics." Recommendation: "Continue current antibiotic regimen. Monitor for any changes in respiratory status. Plan for chest X-ray tomorrow morning. Keep an eye on blood glucose levels due to diabetes." Patient handover is a critical component of safe and effective healthcare delivery. Adhering to a structured approach ensures all essential information is communicated, fostering continuity and quality of patient care. VII.Medical Abbreviation Commonly Used.