Essay on Medicine: Managing Acutely Ill Patient

Following the bedside assessment, the best evidence-based approach to use is ABCDE assessment to reach a diagnosis and administer definitive treatment. The ABCDE evidence-based approach and diagnostic synthesis are simultaneous and complementary processes that must be carried out in stepwise fashion (Thim, Krarup, Grove, Rohde, and Lofgren, 2012).

Initial Assessment

The ABCDE assessment can be accomplished by first observing the patient. Offering a handshake should be part of the evaluation because it will provide the information on the level of consciousness, peripheral perfusion and airway patency of the patient (Soar et al. 2008). Focusing on the history of the patient, investigations, and examinations by the bedside nurse must be addressed before moving to the next step (Frost, 2014).

Airway Assessment

With a respiration of 20 bpm, there may be partial airway obstruction. This can be noticed by noisy breathing gurgling or intercostal recession. The reduced level of consciousness can cause a reduced level of consciousness. Therefore, the partially obstructed airway can be relieved by the use of simple techniques such as a chin lift or jaw thrust (National Institute for Health and Clinical Excellence, 2007). However, other airway adjuncts can be used such as nasopharyngeal and oropharyngeal (Frost, 2014).

Breathing Assessment

First, it is essential to count the breaths per minute (bpm). In case of increased respiratory work, then the patient has acute illness resulting from increased oxygen consumption and metabolic rate. In such a situation, clinical examination such as auscultation, percussion, and tracheal palpation may uncover the diagnosis (Frost & Wise, 2012). Secondly, high flow oxygen needs to be administered immediately using the oxygen mask with a reserve bag with an oxygen concentration of 60-85% (Frost & Wise, 2012).

Circulatory Assessment

First assess the radial pulse (bpm), character and rhythm. Determine the blood pressure. Use the jugular venous pulse to distinguish between cardiogenic shock or hypovolaemic states (National Institute for Health and Clinical Excellence, 2007). Vasodilatation and bounding pulse indicate circulatory features of septic shock (Frost, 2014). In case the patient is shocked, administering intravenous fluid is the best management.

Disability Assessment

This refers to the patients neurological status. Best clinical examination included analyzing the patients level of consciousness, pupillary reflexes, localizing neurological signs and signs of meningism (Soar et al. 2008). However, the AVPU method may also be necessary for testing the level of consciousness of the patient.

Exposure Assessment

This assessment requires the body to be examined as a whole. Paying attention to the knee or the wound after the surgery and other body injuries is essential. Besides, regulating the environment temperature is important.

After the diagnosis and the causes of deterioration are understood, treatment should start immediately. Thus, the patient can either be transferred to intensive care unit, endoscopy suite, interventional cardiology laboratory or operating theatre (National Institute for Health and Clinical Excellence, 2007).

Bibliography

Frost, P., 2014. Recognition and Early Management of Acutely Ill Patients. [Online] Available at: https://learningcentral.cf.ac.uk/bbcswebdav/institution/Medic/Undergraduate/Acutely%20Ill%20Patient/Acutely%20Ill%20Patient%20(Revised%202014).pdf[Accessed 28 November 2017].

Frost, P. & Wise, M., 2012. Early management of acutely ill ward patients. [Online] Available at: http://www.bmj.com/bmj/section-pdf/187636?path=/bmj/345/7874/Practice.full.pdf[Accessed 28 November 2017].

Thim, T., Krarup, N.H.V., Grove, E.L., Rohde, C.V. and Lofgren, B., 2012. Initial assessment and treatment of the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. International journal of general medicine, 5, p.117.

Soar, J., Pumphrey, R., Cant, A., Clarke, S., Corbett, A., Dawson, P., Ewan, P., Foex, B., Gabbott, D., Griffiths, M. and Hall, J., 2008. Emergency treatment of anaphylactic reactionsguidelines for healthcare providers. Resuscitation, 77(2), pp.157-169.

National Institute for Health and Clinical Excellence, 2007. Acutely ill patients in hospital: Recognition of and response to acute illness in adults in hospital. [Online] Available at: https://www.nice.org.uk/guidance/cg50/resources/cg50-acutely-ill-patients-in-hospital-full-guideline3[Accessed 28 November 2017].