 Hi guys, and welcome back to my latest video. Excuse my lame, um, videoing, um, attire, I guess, in pack drop. I'm just tired, honestly. I worked the past four days and I'm just tired. I'm going out of town tomorrow and I just don't want to get all ready and be super fancy. So, but today I want to talk about patient deterioration. This idea came from someone. Someone messaged me or commented on one of my Instagram posts about, like, can you talk about what it looks like when the patient's deteriorating? I was like, that's such a good idea. So, I want to talk about some of the basic things that you see and happen when a patient is deteriorating. Obviously, this is different for every patient in every situation. It's different and sometimes these things happen fast. Sometimes these things happen over time, but these are definitely trends and things that you'll see in your patients, um, if they are deteriorating. So, the biggest thing I want to start off with is, your body will compensate, compensate, compensate and compensate until it decompensates. So, some of these symptoms, some of these things that you're going to see are like your, the point between where your body is like, I'm done compensating and then it's done. You know, now you're decompensating. So, starting with when you look at your patient, one of the biggest things you'll see in a patient when they're deteriorating is skin color changes. They'll usually look pale, maybe gray, maybe they're turning blue because they're hypoxic and they're sweaty. Usually they're swammy, swammy, sweaty and clammy and their skin color changes. And then neurologically, most of the time, unless your patient is, um, intubated and sedated, most of the time you'll see a change in their level of consciousness. Now this could mean that they've gone from being calm to now they're being really restless and kind of out of their norm or they've gone from their norm to being like somnolent. And that's not a good sign. When someone is suddenly unresponsive or very difficult to stimulate, you have to be thinking about what can be causing this. Is it a stroke? Is their CO2 level super high? Are they hypoxic? Is their blood pressure super low? Why is someone all of a sudden altered? Whether it's super restless or more of a later stage of being somnolent. And I will say restless usually will come before somnolent, not all the time, but that's a little red flag. If one of your patients who is totally normal now is like super agitated, like what's going on? Is it, um, alcohol withdrawal, drug withdrawal, or is it something else that may be just as serious? Now getting into your vital signs, typically what you'll see when someone is deteriorating is an increase in their respiratory rate and then decreases. So maybe they're compensating for a while, they're breathing like 30, 40 times a minute, and all of a sudden they're got to be breathing, by got to be breathing, literally think of a fish out of water and that is not a good sign. By that point usually they are very gray and hypoxic and just not so good. Your heart rate, heart rate typically will climb before it drops. So and by the time it's dropped, that's not good. So usually you'll see your patient's heart rate is up like 120s, 130s, 140s, 180s. If they're on beta blockers, then maybe their heart rate increases only to like 80 or 90. And that is them compensating for something, whether it's temperature increase, sepsis, infection, lactic acid, anything really can make your heart rate go up. But then when you start to see that heart rate decline, that is usually, that's you're about to code someone, at least from my personal experience. Unless the heart rate's declining because you're treating what's causing the elevated heart rate. But for example, if you have a patient that is hypoxic, their O2 levels dropping and let's say they're sat in 70% and their heart rate is high because it's trying to perfuse, they're at 140. And then you keep seeing their stats drop and their heart rate's going up and then suddenly you see the heart rate starting to go down because the heart is stressed and overworked and not getting enough oxygen and so it starts to go down. Now you're at 100 and 100 normal heart rate, right? But in this scenario, not a good sign. 70 normal heart rate, right? But really, by the time they're at 70, they probably don't have a pulse. They're probably in PEA or they're very close to it. Kind of similar to the heart rate. The blood pressure usually will go up and then down as well. Not always. It kind of can vary. Sometimes the heart rate's elevated because the blood pressure is low and it's trying to compensate for that low blood pressure. But you will usually see kind of them follow one another. So when your blood pressure is going down, your heart rate's stressed and then when your heart rate gives out, because your blood pressure keeps going down and you just can't perfuse anymore. And the last final sign I want to talk about is your O2 sets. So O2 sets I feel like can almost be misleading. At times you don't want to pay attention to just your O2 sets. But a lot of times patients will be sat and 89, 88, you're like, okay, you know, it's fine. It's not, it's low, but it's not too low. And then suddenly, literally, they're at 50% and you're like, oh my God, like, wait, wait, wait, wait, wait, stop. So O2 sets I've noticed tend to kind of slowly decline. Like you're hanging out in your low 90s, high 80s. And then suddenly it's like now you're down to 40% and you're like, oh my gosh, that's not good. And also the same another thing with O2 sets is a lot of times your pulse ox is on your finger. If your blood pressure is low, like you're not going to, if your blood pressure is low, you're not going to get a good reading on your plethora. If someone is on four vasopressors and they're so clamped down their extremities, you're not going to get an accurate waveform. So even if your waveform says you're at 85 or if it says you're at 25, you just don't know if that's true or not true. So really correlate that waveform with how it looks and with the heart rate. And that will kind of help give you an idea if it's accurate and accurate reading. So those are some of the things that you'll see when a patient is deteriorating. Some patients have all these things. Some have less signs than this, but these are all great things to look out for and that you'll see a lot, especially if you're in the ICU and in the ER, and you'll still see it if you're on other floors, but probably not as often, but it's important to look out for these things because these things are happening. Get your critical mind hats on and think, why is their heart rate suddenly high? Why are they breathing so fast? Is it pain or is it something deeper? Do we need to check a blood gas? Do we need to check these labs? You get a chest x-ray, whatever it is, but be critically thinking and monitoring your patients for these things because you want to intervene quickly so that way they don't code and passively end their life. Thank you guys for watching and I will see you guys in my next video. Bye.