GENERAL APPROACH Unilateral or bilateral weakness Upper vs Lower motor neuron lesion Brain Spinal cord Peripheral nerves NMJ Muscles INTRODUCTION CUBICLE wheelchair walking aids hand weights INFUSIONS IVIG (GB, MG, vasculitis) VENTILATOR high level of pressure support (global weakness) PEEP…
GENERAL APPROACH Phase of injury— Acute: ileus, cardiovascular, ventilation— Sub-acute: recurrent atelectasis and segmental collapse— Chronic: pain, psychological issues, infection (uro, resp, pressure areas), autonomic dysreflexia, spasm. Stability of spine Tracheostomy Other injuries INTRODUCTION CUBICLE Edgerton spinal bed until spine…
GENERAL APPROACH Type of renal failure Acute (usually multi-factorial) Chronic (e.g. dialysis dependent) or Acute on Chronic (e.g. post-renal transplant) Causes Pre-renal – hypovolemia, any cause of shock, sepsis, renovascular disease Intra-renal – nephrotoxins, urine for casts + protein, sepsis,…
GENERAL APPROACH Illness requiring ICU admission Pregnancy + Baby Delivery – when or already done INTRODUCTION CUBICLE CTG presence of midwives INFUSIONS PET: MgSO4, phenytoin, hydralazine, GTN pre-term labour: tocolytics, steroids thromboembolism: heparin bleeding: blood products, fluid boluses, TXA cardiogenic…
GENERAL APPROACH Infectious community acquired nosocomial (surgical site, lines, chest, urine, sinusitis) Non-infectious head injury DVT -> PE drug/toxin SIRS (post surgery, trauma, aspiration, pancreatitis) Hypermetabolic syndromes -> thyroid storm-> NMS-> MH-> heat stroke-> phaeo-> liver failure-> burns-> cocaine toxicity->…
GENERAL APPROACH Cause Treatment (source control) — complete or ongoing? Nutrition — NBM? route? nutritional status? Complications – ACS, fungal sepsis? How to move forward? Important causes intra-abdominal sepsis pancreatitis abdominal trauma perforation (e.g. ulcer, appendicitis, diverticulitis, tumor, obstruction, anastomotic…
GENERAL APPROACH Introduction Cubicle Infusions Ventilator Monitor Equipment Question specific examination GENERAL QUESTIONS Why does this patient have severe respiratory failure? Brain Cough Nerves NMJ Respiratory Muscles Pleura Airways (large and small) Parenchymal Chest wall Ventilator asynchrony Cardiac failure Abdominal…