chapter  2
Patient assessment
ByBernard Riley
Pages 10

Critically ill patients may be encountered in all areas of the

hospital, from the Accident and Emergency department to

medical or surgical wards, operating theatres, recovery wards

or critical care units. Patients may be referred by other doc-

tors, ward nurses, physiotherapists or critical care outreach

teams. Some may be acutely unwell to the point of requiring

immediate resuscitation, whereas others may be relatively

stable and require assessment and the formulation of a man-

agement plan to ensure continued progress towards full

recovery. In either case the aim is to use a systematic approach

to assessment to ensure that all immediately life-threatening

problems are recognized and the correct treatment is started

immediately. Critically ill patients often have multiple prob-

lems, and the use of a systematic approach reduces the risk of

missed diagnoses and provides a framework for treatment

when working under stressful conditions. You are interested

in all the patient’s problems and their responses to the treat-

ments instigated. Documentation is vital, as shift working and

frequent handovers provide ample opportunity for failures in

communication. Each entry in the notes should be dated and

timed, and the person making the entry should sign it legibly.

Several systems have been recommended for use with particu-

lar types of patient, such as the Advanced Trauma Life