2. ABCDE approach Flashcards
What does ABCDE stand for
Airway Breathing Circulation Disability Exposure
Before you start the ABCDE what kind of things are you thinking
What are your initial impressions of the patient
Can you take a quick focuses history
Ask for a set of vital signs and monitoring if available
Airway
When assessing the airway what kind of things are you asking yourself
is the patient talking
is the patient responsive
are there an added sounds to breathing (snoring, gurgling, stridor)
Airway
when assessing the airway what thing would make you move on to breathing
if the patient is talking
Airway
what potential interventions could you give
open airway (only responding to pain or unresponsive) Suction (gurgling) nebulised adrenaline (stridor) simple airway adjunct- oral nasal (if having to do airway manoeuvres)
Airway
Under what circumstances would you open their airway
if the are only responding to pain or if they are unresponsive
Breathing
what are you thinking when assessing breathing (think PIPPA)
Inspection • Respiratory rate? • Respiratory effort? • O2 saturations? Palpation • Trachea central? • Expansion equal? Percussion • Areas of dullness or hyper-resonance? Auscultation • Breath sounds? • Added sounds? • Inequality to the sides?
Breathing
what investigations would you want to consider in regards to breathing
ABG
CXR
Breathing
What potential interventions could you do
- Sitting up (struggling to breath)
- Oxygen (SpO2 less than their expected normal)
- Ventilation (drowsy patient, resp rate <8, open airway)
- Specific treatment (see below)
Circulation
when assessing circulation what questions are you asking yourself
- what is the heart rate, rhythm and character of the pulse
- are the peripheries warm and what is cap refill
- what is the blood pressure
- is there any signs of haemorrhage
- what is the temperature
- Are there any heart sounds or murmurs
- what does the ECG show
Circulation
what are the potential interventions when assessing circulation
IV access
Bloods (VBG, FBC, U&Es, X-match, LFTs clotting)
fluid challenge - 250ml 0.9% NaCl stat (tachycardia, cap refill time > 2 secs +/- hypotension)
specific treatment (see below)
Disability
What kind of things would you be assessing in this section
Assess responsivenss (AVPU) ie are they alert +/- confusion is there any reduction in alertness or new onset confusion (ie check blood glucose, check pulls and posturing and check drug chart)
Disability
if there is any reduction in alertness or new onset of confusion what things would you want to be checking
blood glucose
pupils and posturing
drug char
Disability
What potential interventions would you consider when assessing disability
optimise airway, breathing and circulation to ensure the brain is well oxygenated
give glucose if they are hypoglycaemic
Acute brain injury (unequal, unresponsive pupils, abnormal posturing) - CT scan and expert help
Drugs/medication overdose (recreational or iatrogenic) - support ABCDE, reversal agent where possible
Exposure and everything else
What would you want to do in this section
examine the patient more closely if appropriate (rashes, swelling and bleeds)
take a more detailed history if possible
review notes, blood results, ECGs, X rays
If there is a global wheeze then what could the potential diagnosis be and therefore what would be the most appropriate treatment
Asthma
Peak flow to asses severity
nebulised salbutamol
Nebulised ipratropium
oral or IV cortiocosteriods
If there are bibasal crackles with peripheral odema and bat wings on CXR what would be the potential diagnosis and most appropriate treatment
Pulmonary oedema
Furosemide
nitrates
if very severe CPAP
If the patient has a temperature, localised crackles, bronchial breathing and opacity on CXR what would be the potential diagnosis and most appropriate treatment
Pneumonia
Is the patient septic ?
IV antibiotics
if the patient examination shown;
quietness to the lung bases
dull to percuss
loss of costophrenic & cardiophrenic angles on CXR
what would be the potential diagnosis and most appropriate treatment
pleural effusion
important to treat the cause and consider draining
If the patient examination shows globally quiet breath sounds global wheeze acidosis retaining CO2
what would be the potential diagnosis and most appropriate treatment
exacerbation of COPD
O2 guided by SpO2
treat the exacerbating cause
nebulised salbutamol & ipratropium
if the patient examination shows
in extreme hyperresonant
decreased breath sounds
mediastinnal shift
what would be the potential diagnosis and most appropriate treatment
Tension pneumothorax
needle decompression
chest drain
If the patient is in shock what main things will you notice about the circulation
increased HR
increased Capillary refill time (CRT)
decreased BP
Name some main types of shock
Hypovolemic shock (too little blood volume)
cariogenic shock (due to heart problems)
septic or anaphylactic shock (due to some kind of distribution weather that be an infection or allergen)
neurogenic shock (caused by damage to the nervous system)
