Daily Assessment 1

Hi, my name’s Jilly, and I’m an intensive care registrar working in South East Scotland. Today, we’re going to demonstrate a systematic A to E assessment of a critically ill patient. Daily assessments are performed on patients every day throughout their intensive care state, and today, we’ll demonstrate how to do it in a safe and effective way. Before you go and see a patient, I’d familiarise yourself with their presentation, any relevant past medical history, and any pertinent clinical details. As we show you, I’d strongly recommend using a systematic approach, such as the A to E one that we’ll demonstrate in a second. This will help you make sure that you cover everything, and you don’t miss any pertinent clinical information.

Now, you’re going to watch Shona who’s one of our advanced critical care practitioners, show Emma, who’s one of our new foundation doctors, how to perform daily A to E assessment on a patient. The patient’s called James Hill He’s a 24-year-old who is day three of his ICU admission Three days ago, he was an unrestrained passenger who was involved in a road traffic collision, and he was ejected from the vehicle. His major injuries include a left sided flail segment, a left hemopneumothorax, and an unstable pelvic fracture. He was intubated and ventilated in the A&E department and had a left sided surgical chest strait inserted. Yesterday, he went to theatre for surgical fixation of his pelvic injury.

So watch the A to E assessment, picking up on the pertinent clinical findings. I’d like you to think about what you– how you would approach this patient and the management plan that you might make for James. Yeah. Yeah? Don’t know what else. I might just say something about–

during a daily A to E assessment, it’s important to pay attention to some of the smaller things that can contribute to patient outcomes in ICU. That would include feeding, the use of analgesia and sedation, and as part of that, I’d do delirium assessment, thromboprophylaxis if appropriate, making sure the head of a bed is at 30 degrees, making sure the patient has stress ulcer prophylaxis prescribed, and making sure that the blood glucose is controlled as per NICE sugar recommendations.