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Module 1- Care of the ICU patient

Learning Outcomes

At the end of Week 1: Assessment (basic A to E of an intubated patient) students should be able to
Demonstrate the use of a systematic A-E approach in the assessment of the critically unwell patient and communicate assessment findings with the MDT in a structured way.

Below are the intended learning outcomes for specific components of the week;

1) Respiratory Assessment, Monitoring & Observation
 To be able to observe and monitor a patient requiring respiratory care including;
– Normal parameters for respiratory observations of Rate/Depth respiration
– Pulse rate
– Skin colour, peripheral and central cyanosis
– Use of accessory muscles
– Indications for and limitations of pulse oximetry
– Sputum assessment
– Basic ABG assessment
– Normal values
– Respiratory/Metabolic acidosis/ alkalosis
– Common causes of airway obstruction

2) Renal Assessment, Monitoring & Observation
To be able to understand different methods of measuring and recording;
– Urine output
– Fluid loss from drains
– GI loss (including vomit, nasogastric drainage, faeces)
– Problems recording loss during operative procedures
– Insensible loss (different routes and specific patients at risk)
– Bleeding (external and internal)

3) GI Assessment and Management 
– Assessment of bowel sounds
– Surgical procedures including;
o Hartmann’s procedure
o Oesophagectomy
o Colectomy

4) Neuro Assessment, Monitoring & Observation
Purpose of neurological assessment tools such as;
o AVPU tool
o GCS tool

Recommended frequency of GCS assessment and escalation of frequency

Scoring system for eye-opening;
o The correct method of assessment of eye-opening to voice and a painful stimulus
o The correct type of painful stimulus to assess for eye-opening
o The correct method for assessing pupil response to light including direct and
consensual light reflexes as an adjunct to Glasgow coma scale (GCS).

Scoring system for verbal/sound response;
o The correct method of assessing orientation and verbal/sound response
o Focal verbal de cit such as aphasia, receptive and expressive dysphasia

– Scoring system for motor response;
o Recording of the best limb response from arms
o How to identify the ability to obey commands
o Comparing left to right in order to identify focal deficit
o Differentiating between normal power, mild weakness and severe weakness
o Use of the correct method of painful stimulus when assessing limb response

– Students should also be able to understand;
o The correct use of  the trapezius pinch
o The contra-indications to orbital pressure and sternal rub
and further be able to correctly identify ;
o Flexion
o Abnormal Flexion
o Extension
o No response

Glasgow Coma Scale (GCS)
o Intracranial and extracranial reasons for deteriorating GCS
– Limitations of the GCS as an assessment tool;
o Assessment of vital signs to ensure there is a complete dataset
o AVPU score for assessing conscious level compared to GCS assessment
o Adjuncts to the GCS for detecting deterioration in clinical condition (NEWS/local track and trigger tool)

 

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