Care of the critically ill surgical patient

Deranged vital signs which can become life threatening, and vital signs which need constant
monitoring, are both indications of the need to transfer to I.T.U.

The earlier you pick up a critically ill pt, the better the chance of survival.

ABCDE

With regards to A – beware patients post ENT- maxillofacial surgery because of airway

Cause of airway obstruction – oedema ex. after burns/ inhaling smoke, decreased consciousness can
cause tongue to fall back. Signs – inspiratory stridor etc

If cause of airway obstruction is ex. blood /foreign body- need suction

First- call senior and call anaesthetist

While they are coming, as an HO, try simple measures ex head tilt chin lift, oropharyngeal airway,
guedel airway

Tutorial case was pancreatitis – severe epigastric pain radiating to the back

NB in severe pancreatitis, patients often get a reactive pleural effusion

See PANCREAS mnemonic pertaining to the level of severity of pancreatitis NB LDH is not measured
in malta, but the score still has to be more than 3 for it to be severe pancreatitis

3 levels of care: 0 -routine ward care

1- Patients monitored more frequently, at risk of deteriorating (but still in the

ward)
2- HDU – 1 to 1 nursing, more detailed monitoring
3- Intensive care ex. in multiorgan failure, intubated etc

Patients in ITU require IV omeprazole as prophylaxis against stress ulceration, or H2 antagonist, and
sc heparin, unless CI, for DVT prophylaxis

Why do patients go to ITU?

Organ failure which cannot be managed on the ward

sepsis