A-E ASSESSMENT Flashcards
AIRWAY
what are the steps?
can the patient talk?
- if yes, then move onto breathing
- if no, look for signs of compromise
- open mouth
- listen for abnormal breathing noises
AIRWAY
what are the possible causes of airway compromise?
- inhaled foreign body
- blood in airway
- vomit/secretions in airway
- soft tissue swelling (anaphylaxis, infection)
- local mass effect (tumours)
- laryngospasm (asthma, GORD, intubation)
- depressed level of consciousness
AIRWAY
what are the interventions?
SEEK IMMEDIATE SUPPORT (CRASH CALL)
- head tilt/jaw thrust
- oropharyngeal/nasopharyngeal airway
- anaphylaxis (IM adrenaline)
- blood, vomit or secretions (suction)
- stridor (sit upright, urgent anaesthetic input)
AIRWAYS
how would you manage stridor?
sit upright
urgent anaesthetist input
BREATHING
what are the steps for assessing breathing?
- respiratory rate
- oxygen saturation
- general inspection
- tracheal position
- chest expansion
- percussion
- auscultation
BREATHING
what does dullness on percussion mean?
- increased tissue density
- cardiac dullness
- consolidation
- tumour
- lobar collapse
BREATHING
what causes stony dullness on percussion?
pleural effusion
BREATHING
what causes hyper-resonance on percussion?
decreased tissue density
- pneumothorax
BREATHING
what are the investigations?
- ABG (if indicated)
- portable CXR = if suspected pneumonia, pneumothorax or pulmonary oedema
BREATHING
what are the interventions?
- sit patient upright
- oxygen = 15L non-rebreather mask
- if COPD = 4L on 24% or 28% venturi mask
- antibiotics if pneumonia
BREATHING
what are the specific interventions for asthma?
- nebulised salbutamol
- nebulised ipratropium bromide
- corticosteroids
- magnesium sulfate
- aminophylline
BREATHING
what are the specific interventions for exacerbation of COPD?
- bronchodilators (salbutamol and ipratropium bromide)
- corticosteroids
- antibiotics (if evidence of infection)
CIRCULATION
what are the steps?
- heart rate
- blood pressure
- fluid balance
- general inspection
- feel peripheral temperature
- measure CRT
- radial pulse
- brachial pulse
- inspect JVP
- auscultation
- inspect sacrum for oedema
- inspect ankles for oedema
CIRCULATION
what are the investigations/procedures?
- wide bore cannula (14G or 16G)
- FBC, U&Es, LFTs
- 12 lead ECG (if chest pain, arrhythmia, murmur or electrolyte imbalance)
- bladder scan (if suspected retention/obstruction)
- urine pregnancy test
- cultures/swabs
- fluid output/catheterisation
CIRCULATION
what are the bloods required for sepsis?
FBC
U&Es
LFT
CRP
Lactate
Blood cultures
CIRCULATION
what are the blood required for haemorrhage or surgical emergency?
(FBC, U&Es, LFTs)
coagulation
cross-match
CIRCULATION
what are the bloods required for ACS?
(FBC, U&Es, LFTs)
troponin
CRP
serum glucose
coagulation screen
CIRCULATION
what are the bloods required for arrhythmias?
(FBC, U&Es, LFTs)
calcium
magnesium
phosphate
TFTs
coagulation
CIRCULATION
what are the bloods required for a PE?
(FBC, U&Es, LFTs)
D-dimer (if appropriate based on Well’s score)
CIRCULATION
what bloods are required for overdose?
(FBC, U&Es, LFTs)
toxicology screen (e.g. paracetamol levels)
CRP
lactate
coagulation screen
CIRCULATION
what bloods are required for anaphylaxis?
(FBC, U&Es, LFTs)
mast cell tryptase
CIRCULATION
what are the interventions if hypovolaemic?
- hypovolaemic = 500ml 0.9% sodium chloride over less than 15 mins (250ml if fluid overloaded)
- significant haemorrhage = activate massive transfusion protocol (red cells, platelets + FFP)
CIRCULATION
what are the interventions if ACS?
- morphine
- nitrates
- aspirin
- clopidogrel
- oxygen (if required)
CIRCULATION
what are the interventions for sepsis?
- alert senior clinician
BUFFALO
- oxygen (if required)
- blood cultures
- lactate
- measure urine output
- IV antibiotics
- IV fluids
CIRCULATION
what are the interventions for fluid overload?
- diuretics (IV furosemide)
- close fluid balance monitoring
CIRCULATION
what are the interventions for AF?
- treat underlying trigger
- consider rate vs rhythm control
DISABILITY
what are the steps for assessing disability?
- assess consciousness using ACVPU
- assess pupil size
- assess direct + consensual pupil response
- neuro exam (move limbs)
- review drug chart
- test blood glucose
- if glucose raised, test ketones
DISABILITY
what are the investigations?
CT head
DISABILITY
what are the interventions?
- maintain airway ( GCS <8 or P or U on ACVPU) + get urgent help from anaesthetist
- correct hypoglycaemia
DISABILITY
what are the interventions for opioid overdose?
- ventilation
- naloxone
DISABILITY
what is the management of DKA?
- IV fluids
- insulin (fixed rate 0.1U/kg/hr)
DISABILITY
what is the management of seizures?
- maintain airway
- IV lorazepam
DISABILITY
what are the components of ACVPU?
- Alert = patient is fully alert
- Confusion = new onset or worsened confusion
- Verbal = making some kind of voice when spoken to
- Pain = responds to painful stimulus
- Unresponsive
EXPOSURE
what are the steps for assessing exposure?
INSPECTION
- inspect skin for rashes, bruising + infection
- review IV lines for signs of infection
- expose + inspect abdomen
- inspect calves for erythema/swelling
- review surgical wounds
- review output of catheter + any drains
PALPATION
- palpate abdomen
- palpate calves for tenderness
TEMPERATURE
EXPOSURE
what are the investigations?
- cultures/swabs if signs of infection
EXPOSURE
what are the interventions?
CONTROL BLEEDING
- pressure if external bleeding
WARM PATIENT
- blankets
- seek senior advice for warmed fluids + bair hugger
TREAT INFECTION
- if infection is suspected, reassess for sepsis
- antibiotics
UPPER GI BLEED
what specific steps should be included in A-E of upper GI bleed?
CIRCULATION
- insert 2 wide bore cannulas
- FBC, U&Es, LFTs, group + crossmatch, coagulation screen
- strict fluid balance
- reverse anticoagulation (discuss with senior)
- terlipressin (consultant led)
- prophylactic antibiotic
- endoscopy (discussed with on-call endoscopist)
EXPOSURE
- rectal exam (for evidence of melaena)
ACUTE ASTHMA
what specific steps are in A-E assessment of acute asthma?
BREATHING
- ABG
- Peak expiratory flow rate (PEFR)
- nebulised salbutamol
- nebulised ipratropium bromide
- IV hydrocortisone
- IV magnesium sulphate
- IV aminophylline
ANAPHYLAXIS
what are the specific steps for A-E assessment of anaphylaxis?
AIRWAY
- listen for signs of airway compromise
- open mouth to check for obstruction
- IM adrenaline
BREATHING
- oxygen 15L via non-rebreather mask
CIRCULATION
- insert 2 wide bore cannulas
- blood tests = FBC, U&Es, LFTs + mast cell tryptase
EXPOSURE
- remove causative agent (e.g. medication)
- start non-sedating oral antihistamine (e.g. cetirizine)
STROKE
what are the specific steps for A-E assessment for stroke?
CIRCULATION
- wide bore cannula
- bloods (FBC, U&Es, LFTs, coagulation, HbA1c, cholesterol)
- 12-lead ECG (to check for AF)
DISABILITY
- calculate GCS score
- National institute of health stroke scale (NIHSS)
- blood glucose
- immediate CT head
- ischaemic = thrombolysis (within 4.5hrs) or thrombectomy or aspirin 300mg + clopidogrel 75mg
- haemorrhagic = anticoagulant reversal, labetalol (to lower BP), refer to neurosurgery
BENZODIAZEPINE OVERDOSE
what are the specific steps for A-E assessment for benzodiazepine overdose?
CIRCULATION
- bloods (FBC, U&Es, LFTs, CRP, CK, Lactate, Coagulation, Toxicology)
- 12-lead ECG
- 3 lead continuous ECG monitoring
DISABILITY
- flumazenil (only if requiring ventilation + confident no other substances taken)
PULMONARY EMBOLISM
what are the specific steps for A-E assessment of PE?
BREATHING
- ABG (low PaO2, metabolic acidosis)
- CXR (normal)
- Well’s score
- CTPA or V/Q scan if indicated by Well’s score
- D-dimer if indicated by well’s score
- oxygen 15L via non-rebreather mask
- commence treatment (DOAC e.g. apixaban) if there will be delay in scanning
CIRCULATION
- bloods (FBC, U&Es, LFTs, coagulation, CRP, troponin, d-dimer)
- ECG (sinus tachycardia)
EXPOSURE
- inspect calves for signs of DVT
PULMONARY EMBOLISM
what are the components of Well’s score?
- clinical signs of DVT (leg swelling + pain on palpation of deep veins) = 3
- alternative diagnosis less likely = 3
- heart rate >100 = 1.5
- immobilisation for >3 days or surgery in last 4 weeks = 1.5
- previous DVT/PE = 1.5
- haemoptysis = 1
- malignancy (treatment in last 6m or palliative) = 1
score >4 = PE likely, CTPA or V/Q scan
score <4 PE unlikely, do d-dimer
DKA
what are the specific steps for A-E assessment of DKA?
BREATHING
- VBG (only do ABG if hypoxaemia)
- oxygen 15L non-rebreather
CIRCULATION
- wide bore cannula
- bloods (FBC, U&Es, LFTs, CRP, blood cultures, serum glucose)
- VBG
- 12 lead ECG
- urine pregnancy test
- if hypotensive = 500ml 0.9% sodium chloride over less than 15 mins
- if not hypotensive = 1000ml 0.9% sodium chloride over 1 hour
DISABILITY
- blood glucose (4 - 5.8 mmol/L)
- capillary ketones
- fixed rate insulin infusion (0.1U/kg/hr)
EXPOSURE
- IV antibiotics if infection is suspected
AF
what are the specific steps for A-E assessment for AF?
CIRCULATION
- bloods (FBC, U&Es, LFTs, CRP, troponin, coagulation, TFTs)
- ECG (irregular, absence of P waves)
- cardioversion (if unstable or <48hrs)
- rate control (metoprolol, diltiazem/verapamil)
- anticoagulation (CHA2DS2-VASc + ORBIT)
- diuretics (furosemide if overloaded)
COPD
what are the specific steps for A-E assessment of COPD?
BREATHING
- ABG
- CXR
- sputum culture
- oxygen via venturi mask
- sit upright
- nebulised salbutamol
- nebulised ipratropium bromide
- oral steroids
- consider NIV
CIRCULATION
- bloods (FBC, U&Es, LFTs, CRP, blood cultures)
- ECG
- antibiotics
PULMONARY OEDEMA
BREATHING
- ABG if low sats
- CXR (blunting costophrenic angles, fluids in fissures)
- oxygen 15L non-rebreather
CIRCULATION
- bloods (FBC, U&Es, LFTs, CRP, troponin, plasma BNP)
- ECG
- diuretics (IV furosemide)
