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from Section 4 - Walking the Walk (and Talking the Talk)
Published online by Cambridge University Press: 09 June 2025
Recognition and management of the sick patient outside of the operating theatre is often required by an anaesthetic trainee. There are a number of scoring systems in use, but the majority use the following parameters: respiration rate, oxygen saturation, systolic blood pressure, pulse rate, level of consciousness or new confusion and temperature. Values within the normal range score 0, and increase to 3 with progressively more abnormal (high or low) scores.
A number of clinical pictures may present with a sick patient but common scenarios encountered include haemorrhage and hypovolaemia, cardiac events (arrhythmias/myocardial infarction/failure), sepsis, pulmonary embolus and various iatrogenic problems ( e.g. pneumothorax, epidural problems, PCA overdose). Rapid diagnosis and management is essential. This will include blood tests, ABG, urinary catheter and often a urinary catheter. Patients may need imaging in the radiology department too, when stable.
Basic resuscitation involves ensuring delivering facemask oxygen, establishing reliable iv access and appropriate monitoring. This may include intravascular monitoring. Often iv fluids are required and should be guided by the monitoring available. Rapid treatment of sepsis is essential with appropriate antibiotics.
It is difficult to manage these patients on the ward and transfer to theatres/ICU is preferable.
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