Editing CCrISP assessment (section)

== '''Full patient assessment''' ==

* Chart assessment
** Respiratory
*** RR
**** Most sensitive marker of the unwell patient, often the first thing to change
**** Low: opiate/sedative overdose, CNS depression (can be due to low cardiac output)
**** High: early sign of many kinds of shock; respiratory disease; cardiac failure; compensation for metabolic acidosis/hypoxia
*** FiO2
*** SaO2
** Circulation
*** HR, rhythm
**** Beware those on beta-blockers or mechanical pacing
**** Tachycardia: autonomic - pain, anxiety, pyrexia
**** Rhythm change in shock is generally a sign of physiological derangement, sepsis or MI
*** BP
**** Often late signs when present
**** Perfusion is more important than BP - consider the patient's usual BP, as relative hypotension can cause problems
*** CVP
**** Collapsed JVP with patient flat is always abnormal
**** Consider formal central monitoring if very difficult fluid management
**** High: temporary following a rapid fluid bolus; fluid overload; RV failure (MI or PE); cardiac failure; chronic respiratory disease; caused by pericardial effusion with tamponade
*** UO
**** Look for trends
**** Remember it gives a delayed picture of perfusion
**** Sudden complete anuria - blocked catheter
*** Fluid balance
**** Tally input vs output for past 24 hours
**** Look at overall FB
*** IV lines
*** Cardiac output measurements
** Surgical
*** Special requirements of this operation
*** Temperature
*** Drainages (nature and volume)
** Medication chart
* History
** Patient
** Junior staff
** Nurses
* Examination
** See above
* Review results
** Check blood tests - FBE, UEC as a minimum
** Order necessary additional tests
** CXR - very helpful to differentiate respiratory conditions from cardiovascular
** ECG