A-E assessment and SBAR Flashcards
What are main principles of A-E approach?
- Complete a full initial assessment.
- Treat life-threatening problems as you identify them
- Continually reassess the patient for any response to treatment and/or interventions you have made
- Call for help early
- Remember to use the SBARD communication tool to handover
What is SBAR?
situation, backgorund, assessment, recommendation
What do you look for in A of A-E
What interventions can you put in place?
Is airway patent?
Is patint talking, conscious?
look for unusual chest and abdo mov
listen and feel for breath at mouth and nose
ID noises that could mean obstruction
Interventions:
* emergency - manage airway and 2222
* Head tilt and chin lift - jaw thrust if C spine trauma
* Airway adjuncts - oropharyngeal and nasopharyngeal
* Suction - for fluids using ‘yankauer’ suction catheter –> put in towards cheek and sweep across, occluding hole to cause suction for 5-10seconds. If suction not available = recovery position.
What 3 criteria are present in anaphylaxis illness script?
- sudden onset and rapid progression of symptoms
- life threatening A, B or C problems
- skin and or mucosal changes = flushing, urticaria, angiodema
Management for anaphylaxis in emergency?
In cardiac arrest drug trolley
IM adrenaline
1:1000
What do you look for in B of A-E
What interventions can you put in place?
Look at pt - do they have increased work of breathing?
* accessory muscle use
* tripod position
* chest movement - equal expansion? rise and fall equal?
Assess RR for 1 minute
Chest sounds - auscultate, percuss
Cyanosis?
Interventions:
* pulse ox –> give oxygen if needed - high flow 15L non rebreathe. (There may be portable oxygen cyclinder if not on wall)
* ABG
* if wheeze/asthma –> bronchodilators, nebs, steriods
* CXR
What do you look for in C of A-E
What interventions can you put in place?
Look for:
* is patient clammy, sweaty.
* cyanosis
* catheter - is it draining, what colour is urine?
* moist mucous membranes
* fluid balance chart
Examining pt:
* CRT for 5s –> if back in 2s+ on hand, do on sternum
* Pulse for 1 min - rate, rhythm, character
* BP
* ECG
* JVP
* mucous mem
* Heart sounds - 1 and 2, is apex displaced?
* odema on ankles?
Interventions:
* IV access - 2 wide bore 14-16G cannulas (or IO access)
* Blood sampling - FBC, CRP, U+Es, coag, glucose, LFTs, VBG
* CM (if need to give blood), G+S (store blood type if needed)
* fluid resus - 500ml bolus 0.9% sodium chlorid
* blood cutlures for sepsis
* D dimer if suspect PE
* troponins
* mast cell tryptase - for anaphylaxis
* toxicology screen - if think overdose?
Common causes of reduced conc?
- Hypoxia
- hypercapnia
- recent sedatives or analgesia
- trauma/head injuries
- seizures
- drugs
- hypoglycaemia
What do you look for in D of A-E
What interventions can you put in place?
Look for:
ACVPU
Blood glucose and ketones
Pupillary response
* constricted = opiod drugs, heroin
* dilated = trauma to brain, ICP, cocaine, weed, amphetamines
Temperature
Drug chart review and allergies
Interventions:
* CT head
* Give glucose if hypogly
* DKA = IV fluids (0.9% sodium chloride) and insulin - fixed rate insulin infusion - 0.1unit/kg.hour. When gluc < 14mmol/L, start 10% dextrose at 125mls/hr
* Seizure - IV lorazepam 4mg. X2 then IV phenytoin.
* Temp - broad spec abx based on local guidelines.
* Naloxone for opioid overdose
What do you look for in E of A-E
What interventions can you put in place?
Head to toe, front and back.
Any trauma, brusing, bone deformity?
Bleeding? Wounds or drains?
Rashes, bites, mucosal changes?
Swellings?
Breath odour - ketones, alcohol.
Interventions:
Bleeding -urgent senior input, major haemorrhage protocol, tranexamic acid. - hopefully would have already been done sooner
Wound infection - broad spec abx.
DVT - guidelines for DVT.
what to say when you want to give oxygen?
High flow 15L non-rebreathe mask
THEN titrate down
What to say when giving fluids
I would monitor there fluid status - by listening to heart sounds, lung bases and monitoring urine output
