SBAR Archives - Respiratory Learning

SBAR – quick report format – situation, background, assessment, recommendation

Posted on September 15, 2016September 19, 2016 by PulmaKu

In a nutshell :

SBAR – quick / rapid report handoff format adopted by hospitals.

why the submarine pic ? SBAR format was initially designed by submarine personnel.

The long winded version :

(in a submarine : deep, deep underwater with limited oxygen supply and tons of crushing pressure all around, there is not time for lengthy speeches – its more like “you have 2 seconds to tell me what’s wrong and how you would fix it”.

I was told a long time ago, by my supervisor back then, “don’t come to me with just a problem … have a suggested solution as well”. I have always liked that management style and give her credit for introducing me to that notion.

The third point, always know the history of anything and everything (in this case : SBAR came from the military).

We should treat a patient in crisis just like we were having a crisis in a submarine :

tell me the problem.

give me relevant background quickly.

tell me why you think the problem happened.

tell me how you would fix it.

2 min Evaluation – Urimeter – darker yellow – 10 seconds to reach a conclusion

Posted on September 14, 2016 by PulmaKu

2 min Evaluation – Urimeter = darker yellow – 10 seconds to reach a conclusion

The quick explanation :

Situation : urine = darker yellow.

Background : dehydrated / intravascularly depleted.

Action : cautious intravascular volume repletion.

Recommendation : Alveolar recruitment technique (ART).

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The “long winded” explanation :

S-B-A-R format reporting – quick reporting format for handoff from one healthcare professional to another.

A lot of this presentation is conjecture … but time and experience has proven correct 99 out of 100 times.

Darker yellow urine is a likely indicator that your patient is intravascularly depleted to some extent.

A “passive leg raise” maneuver (MORE TO FOLLOW AT A LATER DATE) will provide additional information as to the value of intravascular volume repletion.

If the patient’s systemic blood pressure / cardiac output improve significantly, a 500ml NSS repletion regimen is
likely going to improve outcomes.

Whenever fluid is repleted, alveolar should be protected via ART (alveolar recruitment technique) to avoid unintended
migration of NSS into the pulmonary interstitium and unintended alveolar compression (= compressive atelectasis).

2 min Evaluation – Urimeter = clear – 10 seconds to reach a conclusion

Posted on September 14, 2016September 14, 2016 by PulmaKu

The quick explanation :

Situation : urine = clear.

Background : fluid overloaded.

Action : forced diuresis.

Recommendation : Alveolar recruitment technique (ART).

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The “long winded” explanation :

S-B-A-R format reporting – quick reporting format for handoff from one healthcare professional to another.

A lot of this presentation is conjecture … but time and experience has proven correct 99 out of 100 times.

Clear – forced diuresis (Lasix) – fluid overloaded – increased CVP .

Fluid overloaded due to a transient hypotensive crisis.

The fluid is coursing its way thru the vasculature and some of that fluid is finding its way into the pulmonary parenchyma.

Use Alveolar Recruitment Technique (ART) to mitigate the effects of rogue intravascular fluid … finding its way to the extravascular space (pulmonary interstitium.

BiVent as a Quick Differentially Diagnosing Tool For Elucidating Pathologic Disease

Posted on May 22, 2016 by PulmaKu

Please enjoy this presentation on BiVent.

As with any discussion, please discuss enacting BiVent with your medical director, resp dept director, supervisors, managers, coordinators, resp peers, medical attending, medical resident, icu intensivist, physician’s assistant, nurse practioner, and nurse.

We present it as a differentially diagnosing tool to keep amidst our armamentarium of tools.

The beauty of this paradigm is that while awaiting any other tool required to diagnose or “rule-in” another diagnosis, the diagnosis of “run away atelectasis” can be ruled-in or ruled-out starting immediately.