ACUTELY ILL PATIENT

An Analysis of Care of an Acutely Ill Patient



An Analysis of Care of an Acutely Ill Patient

Introduction

In order to analyze the methods of caring of an acutely ill patient, I am selecting the below mentioned scenario, as recommended by the Department of health, NICE (National Institute for Clinical Excellence) and NPSA (National Patient Safety Agency):

My Patient is a 60 year old man who had hypovolemic shock in recovery (post anaesthetic care unit). Patient was awake on arrival to recovery. Airway was fine. Respiration rate of 26, Heart rate of 110, Blood pressure of 83/44, Saturation level of 90% on 4 litres of oxygen, delayed capillary refill time (say how many seconds). He had urinary catheter.

Condition of Patient

Hypovolemia (also hypovolemia) is a state of decreased blood volume; more specifically, decrease in volume of blood plasma. It is thus the intravascular component of volume contraction (or loss of blood volume due to things such as hemorrhaging or dehydration), but, as it also is the most essential one, hypovolemia and volume contraction are sometimes used synonymously.

Common causes of hypovolemia can be dehydration, bleeding, vomiting, severe burns and drugs such as diuretics or vasodilators typically used to treat hypertensive individuals. Rarely, it may occur as a result of a blood donation, sweating, and alcohol consumption. It is also common during surgery due to the use of anaesthetics, nil-by-mouth, and in-operation bleeding.

The first response to hypovolemia is an inversed baroreflex, where a lack of activation of baroreceptors results in elevation of total peripheral resistance and cardiac output via increased contractility of the heart, heart rate, and arterial vasoconstriction, which tends to increase blood pressure (Silva et al., 1991).

There is also autoreperfusion, in which decreased blood pressure results in decreased filtration of fluid out of capillaries, in effect causing a volume shift from interstitial fluid to blood plasma.

A vascular pathogenesis of pancreatitis has been postulated in diabetics, the aged, Ortner's Syndrome, and various low-flow states. This report studies canine pancreatic secretion in a preparation of hypovolemic shock produced by controlled hemorrhage maintained for varying durations.

Pancreatic secretion was collected by cannulation of the main pancreatic duct in anesthetized dogs. Secretion was administered by continuous intravenous (i.v.) infusion of 4 U/kg/h. Four 15-min samples of pancreatic juice were collected. Then the dogs were bled by arterial line withdrawing 25-30% of total blood volume or until the mean blood pressure dropped to about 60 mmHg. Blood was collected in heparinized containers for reinfusion. Blood samples for amylase and 15-min samples of pancreatic juice for volume, bicarbonate, and enzymes were obtained during hypovolemia as well as during and following restoration of the blood volume (Silva et al., 1991).

Hypovolemia induced significant decreases in pancreatic flow, bicarbonate and amylase secretion, parameters which increased after reinfusion but never returned to pre-shock levels. Increasing the period of hypovolemia increased the inhibition of pancreatic flow, increased blood amylase elevation, and resulted in visible pancreatic edema.

We conclude that pancreatic secretion is diminished by hypovolemia, that this is initially reversible when hypovolemia is brief, but ...