"improving intensive care in Scotland"

Assessment and treatment of the acutely ill adult

C for Circulation 2/2

If there is good flow from your iv cannula take blood for immediate investigations. If flow is sluggish don't compromise the cannula by trying to get blood samples, do a venepuncture. In any patient where volume resuscitation is a priority (hypovolaemia, haemorrhage, sepsis) send blood for cross matching.

Rapid infusion can be facilitated by the use of pressure infusors and in major fluid resuscitation the early application of a fluid warmer reduces coagulopathy and the development of hypothermia.

As you infuse fluids the haemoglobin will fall due to haemodilution (even if the patient is not bleeding). The optimisation of tissue oxygen delivery is pivotal to management (this will be explained further under the heading "equations of life").

Immediate investigations

Arterial blood gases: O2, CO2, acid-base

Potassium

Glucose

Haemoglobin

Lactate*

12 lead ECG

CXR

Blood cultures, if sepsis is suspected

Specific targeted tests

Abnormalities in the investigations in bold destabilise the patient and are all amenable to direct intervention. *Elevated lactate and base deficit worse than -4 correlates with severe illness

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