Monitoring the Critically III Patient: Jevon/Monitoring the Critically III Patient

Monitoring the Critically Ill Patient is an essential, accessible guide to caring for critically ill patients on the general ward. Now fully updated and improved throughout, this well established and handy referenced text assumes no prior knowledge and equips students and newly-qualified staff with the clinical skills and knowledge they need to confidently monitor patients at risk, identify key priorities, and provide prompt and effective care. This new edition includes the following 5 brand new chapters: Monitoring the critically ill child Monitoring the critically ill pregnant patient Monitoring the patient with infection and related systemic inflammatory response Monitoring a patient receiving a blood transfusion Monitoring pain Content: Chapter 1 Recognition and Management of the Deteriorating Patient (pages 1–24): Philip Jevon, Beverley Ewens and Jagtar Singh Pooni Chapter 2 Assessment of the Critically III Patient (pages 25–38): Philip Jevon, Beverley Ewens and Jagtar Singh Pooni Chapter 3 Monitoring Respiratory Function (pages 39–90): Philip Jevon, Beverley Ewens and Jagtar Singh Pooni Chapter 4 Monitoring Cardiovascular Function 1: ECG Monitoring (pages 91–114): Philip Jevon, Beverley Ewens and Jagtar Singh Pooni Chapter 5 Monitoring Cardiovascular Function 2: Haemodynamic Monitoring (pages 115–153): Philip Jevon, Beverley Ewens and Jagtar Singh Pooni Chapter 6 Monitoring Neurological Function (pages 154–176): Philip Jevon, Beverley Ewens and Jagtar Singh Pooni Chapter 7 Monitoring Renal Function (pages 177–196): Philip Jevon, Beverley Ewens and Jagtar Singh Pooni Chapter 8 Monitoring Gastrointestinal Function (pages 197–208): Philip Jevon, Beverley Ewens and Jagtar Singh Pooni Chapter 9 Monitoring Hepatic Function (pages 209–217): Philip Jevon, Beverley Ewens and Jagtar Singh Pooni Chapter 10 Monitoring Endocrine Function (pages 218–230): Philip Jevon, Beverley Ewens and Jagtar Singh Pooni Chapter 11 Monitoring Nutritional Status (pages 231–243): Philip Jevon, Beverley Ewens and Jagtar Singh Pooni Chapter 12 Monitoring Temperature (pages 244–257): Philip Jevon, Beverley Ewens and Jagtar Singh Pooni Chapter 13 Monitoring Pain (pages 258–266): Philip Jevon, Beverley Ewens and Jagtar Singh Pooni Chapter 14 Monitoring a Patient Receiving a Blood Transfusion (pages 267–280): Philip Jevon, Beverley Ewens and Jagtar Singh Pooni Chapter 15 Monitoring the Patient with Infection and Related Systemic Inflammatory Response (pages 281–301): Philip Jevon, Beverley Ewens and Jagtar Singh Pooni Chapter 16 Monitoring the Critically III, Pregnant Patient (pages 302–319): Philip Jevon, Beverley Ewens and Jagtar Singh Pooni Chapter 17 Monitoring the Critically III Child (pages 320–335): Philip Jevon, Beverley Ewens and Jagtar Singh Pooni Chapter 18 Monitoring During Transport (pages 336–345): Philip Jevon, Beverley Ewens and Jagtar Singh Pooni Chapter 19 Record Keeping (pages 346–353): Philip Jevon, Beverley Ewens and Jagtar Singh Pooni Title Page ......Page 2 Copyright ......Page 3 Contents ......Page 4 Foreword......Page 6 Preface......Page 7 Contributors......Page 9 INTRODUCTION......Page 10 Survival to discharge from in hospital cardiopulmonary arrest......Page 11 Suboptimal critical care......Page 13 TRACK A ND TRIGGER SYSTEMS......Page 18 EARLY WARNING SCORING SYSTEMS......Page 19 Critical c are o utreach t eams......Page 22 Medical e mergency t eams......Page 24 CLINICAL HANDOVER......Page 25 Provision of critical care......Page 26 TRAINING HEALTHCARE STAFF......Page 27 ALERT c ourse......Page 28 Care of the Critically Ill Surgical Patient CCrISP......Page 29 REFERENCES......Page 30 INTRODUCTION......Page 34 ABCDE APPROACH......Page 35 ASSESSMENT OF AIRWAY......Page 36 Causes of airway obstruction......Page 37 Look......Page 38 Listen......Page 39 Efficacy of breathing, work of breathing and a dequacy of ventilation......Page 40 Look......Page 41 Causes of circulatory compromise......Page 42 Causes of altered conscious level......Page 43 EXPOSURE......Page 44 REFERENCES......Page 46 INTRODUCTION......Page 48 Efficacy of breathing......Page 49 Respiratory rate......Page 50 Noisy respirations......Page 51 COMPREHENSIVE ASSESSMENT OF THE BREATHLESS PATIENT......Page 52 Shape of the chest......Page 53 Auscultation of the chest......Page 54 Patient ’ s age......Page 55 Cough......Page 56 Sputum......Page 57 Normal range for PEF measurement......Page 58 PULSE OXIMETRY......Page 59 The mechanics of pulse oximetry......Page 60 Advantages of pulse oximetry......Page 61 Procedure for pulse oximetry......Page 62 Causes of inaccuracy......Page 64 Complications......Page 65 Procedure for arterial blood sampling......Page 66 Indications for ABG analysis......Page 67 Principles of ABG analysis......Page 68 Parameters measured by a blood gas analyser......Page 70 Systematic analysis of ABG results......Page 72 Classifi cation of imbalance......Page 73 Respiratory acidosis......Page 74 Metabolic acidosis......Page 75 Respiratory alkalosis......Page 76 Metabolic alkalosis......Page 77 PRINCIPLES OF CAPNOGRAPHY......Page 78 MONITORING PRIORITIES OF A VENTILATED PATIENT......Page 80 Parameters to be monitored during mechanical ventilation......Page 83 Monitoring the endotracheal tube......Page 84 MONITORING THE PATIENT RECEIVING NON - INVASIVE VENTILATION......Page 86 PRINCIPLES OF MONITORING A PATIENT WITH A CHEST DRAIN......Page 87 Monitoring priorities of the patient with a temporary tracheostomy......Page 89 SCENARIOS......Page 92 REFERENCES......Page 96 INTRODUCTION......Page 100 COMMON FEATURES OF A CARDIAC MONITOR......Page 101 SETTING UP ECG MONITORING......Page 102 EASI 12 - lead ECG monitoring......Page 103 The ‘ flat - line ’ trace......Page 105 Small ECG complexes......Page 106 THE ECG AND ITS RELATIONSHIP TO CARDIAC CONTRACTION......Page 107 SYSTEMATIC APPROACH TO ECG INTERPRETATION......Page 108 QRS rhythm......Page 109 Sinus rhythm......Page 110 Site of origin......Page 111 Sinus tachycardia......Page 112 Atrial fibrillation......Page 114 Narrow complex tachycardia......Page 117 Ventricular fibrillation......Page 119 Pulseless electrical activity......Page 121 REFERENCES......Page 123 INTRODUCTION......Page 124 Stroke volume......Page 125 Peripheral resistance......Page 126 Cardiogenic shock......Page 129 Obstructive shock......Page 130 Assessment of pulse and ECG......Page 131 Assessment of urine output......Page 132 Arterial blood pressure measurements......Page 133 Factors influencing blood pressure measurements......Page 134 GENERAL PRINCIPLES OF MONITORING WITH TRANSDUCERS......Page 135 Principles of arterial pressure monitoring......Page 136 Complications of a rterial line insertion......Page 137 Monitoring priorities of a patient with an arterial line......Page 139 PRINCIPLES OF CENTRAL VENOUS PRESSURE MONITORING......Page 141 Indications for central venous catheters......Page 142 Procedure for CVP measurement using a transducer......Page 143 Troubleshooting......Page 145 Management of a patient with a central venous catheter......Page 147 Pulmonary artery catheter......Page 149 Indications......Page 150 Pressures......Page 151 Precautions......Page 152 Thermodilution......Page 153 Procedure......Page 154 Mixed venous oxygen saturation......Page 155 Non - invasive methods of measuring cardiac output......Page 156 Transoesophageal echocardiography......Page 157 SCENARIOS......Page 158 REFERENCES......Page 160 INTRODUCTION......Page 163 AVPU ASSESSMENT......Page 164 THE GLASGOW COMA SCALE......Page 165 Eye o pening......Page 168 Verbal response......Page 169 Motor response......Page 170 PUPILLARY ASSESSMENT......Page 172 Principles of monitoring the patient with seizures......Page 173 PRINCIPLES OF INTRACRANIAL PRESSURE MONITORING......Page 174 Principles of intraventricular catheters......Page 175 Principles of jugular bulb oximetry monitoring......Page 176 Effects of over - and under - sedation......Page 177 Over - sedation......Page 178 Daily sedation interruption......Page 179 Relieving/ preventing pain......Page 180 Epidural analgesia......Page 181 CONCLUSION......Page 182 REFERENCES......Page 183 INTRODUCTION......Page 186 Appearance of urine......Page 187 Procedure for dipstick test of urine......Page 188 Significance of the results......Page 189 URINE OUTPUT MONITORING......Page 192 MONITORING FLUID BALANCE......Page 193 MANAGEMENT OF ACUTE RENAL FAILURE......Page 194 Clinical course......Page 197 Complications of ARF......Page 198 MONITORING DURING RENAL REPLACEMENT THERAPY......Page 200 Monitoring anticoagulation......Page 202 REFERENCES......Page 204 ASSESSMENT OF BOWEL FUNCTION......Page 206 Constipation......Page 207 Timing of vomiting......Page 208 Volume of vomit......Page 209 Fistulas......Page 210 ACUTE UPPER GASTROINTESTINAL TRACT BLEEDING......Page 211 PRINCIPLES OF MONITORING PANCREATIC FUNCTION......Page 213 REFERENCES......Page 216 INTRODUCTION......Page 218 CAUSES OF ACUTE LIVER FAILURE......Page 219 Clinical features of ALF......Page 220 Encephalopathy......Page 221 Cerebral oedema......Page 222 Sepsis......Page 223 Metabolic disturbances......Page 224 REFERENCES......Page 225 PRINCIPLES OF MONITORING PITUITARY GLAND FUNCTION......Page 227 PRINCIPLES OF MONITORING THE ENDOCRINE FUNCTION OF THE PANCREAS......Page 228 Procedure for bedside blood glucose measurements......Page 229 Hyperglycaemia and diabetic ketoacidosis......Page 232 Addisonian crisis......Page 234 Thyroid crisis......Page 235 Hypercalcaemia......Page 236 Hypocalcaemia......Page 237 REFERENCES......Page 238 INTRODUCTION......Page 240 Assessment......Page 241 PRINCIPLES OF MONITORING ENTERAL FEEDING......Page 242 Nasogastric feeding......Page 243 Nasoduodenal and nasojejunal feeding......Page 245 Complications of enteral feeding......Page 246 PRINCIPLES OF MONITORING TPN......Page 247 REFERENCES......Page 251 INTRODUCTION......Page 253 FACTORS INFLUENCING BODY TEMPERATURE......Page 254 Chemical dot thermometers......Page 255 Bladder probe......Page 257 PHYSIOLOGICAL EFFECTS OF HYPOTHERMIA......Page 258 Cardiovascular system......Page 259 Endocrine system......Page 261 PHYSIOLOGICAL EFFECTS OF HYPERTHERMIA......Page 262 MONITORING PRIORITIES OF A PATIENT WITHHYPERTHERMIA......Page 264 REFERENCES......Page 265 INTRODUCTION......Page 267 FACTORS INFLUENCING PAIN......Page 268 Adverse effects of untreated pain......Page 269 Patient ’s self - report......Page 270 Pain intervention......Page 271 Monitoring the patient with an epidural......Page 272 Monitoring the patient with patient - controlled analgesia......Page 273 REFERENCES......Page 274 BLOOD COMPONENTS AND THEIR USES......Page 276 Red cells......Page 277 Fresh frozen plasma and cryoprecipitate......Page 278 IMPORTANCE OF PATIENT IDENTIFICATION......Page 279 Administration......Page 280 Administration set......Page 281 MONITORING PRIORITIES IN A PATIENT RECEIVING A BLOOD TRANSFUSION......Page 282 During transfusion......Page 283 Post - transfusion......Page 284 Acute haemolytic transfusion reactions......Page 285 Transfusion - related lung injury......Page 286 Allergic reactions or anaphylaxis......Page 287 CONCLUSION......Page 288 REFERENCES......Page 289 INTRODUCTION......Page 290 HOW INFECTION OCCURS AND THE RELATIONSHIP BETWEEN THE INFECTIOUS AGENT AND HOST......Page 291 Physical and chemical barriers to infection innate defence......Page 292 Cell - mediated immunity......Page 293 Patient presentation......Page 295 The pathophysiology of SIRS / sepsis......Page 297 Airway......Page 298 Breathing......Page 299 Circulation......Page 300 Disability......Page 301 Exposure......Page 302 Respiratory system......Page 303 Cardiovascular monitoring......Page 304 Microbiological monitoring/ investigations......Page 305 Other investigations......Page 306 SCENARIOS......Page 307 REFERENCES......Page 308 INTRODUCTION......Page 311 Changes associated with breathing......Page 312 Placental blood flow and caval compression......Page 313 ACUTE ILLNESSES AND DEATHS ASSOCIATEDWITH PREGNANCY......Page 314 Thrombosis/ thromboembolism......Page 315 Haemorrhage......Page 316 Miscarriage......Page 317 Assessing and monitoring the acutely unwell pregnant patient......Page 318 Breathing......Page 319 Circulation......Page 320 Exposure......Page 322 Cardiac arrest during pregnancy......Page 323 SCENARIOS......Page 324 CONCLUSION......Page 326 REFERENCES......Page 327 INTRODUCTION......Page 329 IMPORTANCE OF TREATING CHILDREN DIFFERENTLY......Page 330 Weight......Page 331 Physiological......Page 332 ABCDE APPROACH......Page 333 Assessment of airway......Page 334 Look......Page 336 Feel......Page 338 Assessment of circulation......Page 339 Feel......Page 340 Management of circulatory compromise......Page 341 Management of altered conscious level......Page 342 CONCLUSION......Page 343 REFERENCES......Page 344 INTRODUCTION......Page 345 POTENTIAL PROBLEMS AND HAZARDS ASSOCIATED WITH TRANSPORT......Page 346 Hazards associated with air transport......Page 349 PATIENT MONITORING EQUIPMENT REQUIRED FOR TRANSPORT......Page 350 MONITORING DURING TRANSFER......Page 351 CONCLUSION......Page 352 ACKNOWLEDGEMENT......Page 353 REFERENCES......Page 354 IMPORTANCE OF GOOD RECORD KEEPING......Page 355 PRINCIPLES OF GOOD RECORD KEEPING......Page 357 LEGAL ISSUES ASSOCIATED WITH RECORD KEEPING......Page 360 REFERENCES......Page 362 Index......Page 363 __Monitoring the Critically Ill Patient__ is an essential, accessible guide to caring for critically ill patients on the general ward. Now fully updated and improved throughout, this well established and handy referenced text assumes no prior knowledge and equips students and newly-qualified staff with the clinical skills and knowledge they need to confidently monitor patients at risk, identify key priorities, and provide prompt and effective care. This new edition includes the following 5 brand new chapters: * Monitoring the critically ill child * Monitoring the critically ill pregnant patient * Monitoring the patient with infection and related systemic inflammatory response * Monitoring a patient receiving a blood transfusion * Monitoring pain Content: Chapter 1 Recognition and Management of the Deteriorating Patient (pages 1–24): Philip Jevon, Beverley Ewens and Jagtar Singh PooniChapter 2 Assessment of the Critically III Patient (pages 25–38): Philip Jevon, Beverley Ewens and Jagtar Singh PooniChapter 3 Monitoring Respiratory Function (pages 39–90): Philip Jevon, Beverley Ewens and Jagtar Singh PooniChapter 4 Monitoring Cardiovascular Function 1: ECG Monitoring (pages 91–114): Philip Jevon, Beverley Ewens and Jagtar Singh PooniChapter 5 Monitoring Cardiovascular Function 2: Haemodynamic Monitoring (pages 115–153): Philip Jevon, Beverley Ewens and Jagtar Singh PooniChapter 6 Monitoring Neurological Function (pages 154–176): Philip Jevon, Beverley Ewens and Jagtar Singh PooniChapter 7 Monitoring Renal Function (pages 177–196): Philip Jevon, Beverley Ewens and Jagtar Singh PooniChapter 8 Monitoring Gastrointestinal Function (pages 197–208): Philip Jevon, Beverley Ewens and Jagtar Singh PooniChapter 9 Monitoring Hepatic Function (pages 209–217): Philip Jevon, Beverley Ewens and Jagtar Singh PooniChapter 10 Monitoring Endocrine Function (pages 218–230): Philip Jevon, Beverley Ewens and Jagtar Singh PooniChapter 11 Monitoring Nutritional Status (pages 231–243): Philip Jevon, Beverley Ewens and Jagtar Singh PooniChapter 12 Monitoring Temperature (pages 244–257): Philip Jevon, Beverley Ewens and Jagtar Singh PooniChapter 13 Monitoring Pain (pages 258–266): Philip Jevon, Beverley Ewens and Jagtar Singh PooniChapter 14 Monitoring a Patient Receiving a Blood Transfusion (pages 267–280): Philip Jevon, Beverley Ewens and Jagtar Singh PooniChapter 15 Monitoring the Patient with Infection and Related Systemic Inflammatory Response (pages 281–301): Philip Jevon, Beverley Ewens and Jagtar Singh PooniChapter 16 Monitoring the Critically III, Pregnant Patient (pages 302–319): Philip Jevon, Beverley Ewens and Jagtar Singh PooniChapter 17 Monitoring the Critically III Child (pages 320–335): Philip Jevon, Beverley Ewens and Jagtar Singh PooniChapter 18 Monitoring During Transport (pages 336–345): Philip Jevon, Beverley Ewens and Jagtar Singh PooniChapter 19 Record Keeping (pages 346–353): Philip Jevon, Beverley Ewens and Jagtar Singh Pooni Monitoring the Critically Ill Patient is an invaluable, accessible guide to caring for critically ill patients on the general ward. Now fully updated and improved throughout, this well-established and handy reference guide text assumes no prior knowledge and equips students and newly-qualified staff with the clinical skills and knowledge they need to confidently monitor patients at risk, identify key priorities, and provide prompt and effective care. This new edition includes the following five new chapters: Monitoring the critically ill child Monitoring the critically ill pregnant patient Monitoring the patient with infection and related systemic inflammatory response Monitoring a patient receiving a blood transfusion Monitoring pain Recognition & management of the deteriorating patient Assessment of the critically ill patient Monitoring respiratory function Monitoring cardiovascular function 1 : ECG monitoring Monitoring cardiovascular function 2 haemodynamic monitoring Monitoring neurological function Monitoring renal function Monitoring gastrointestinal function Monitoring hepatic function Monitoring endocrine function Monitoring nutritional status Monitoring temperature Monitoring pain Monitoring a patient receiving a blood transfusion Monitoring the patient with infection and related systemic inflammatory response Monitoring the critically ill, pregnant patient Monitoring the critically ill child Monitoring during transport Record keeping.