A-E Critically unwell patient

Question 1

How is A assessed in A-E?

What are the common causes of it not being patent?

Answer 1

If the patient is speaking it is patent

Commonly obstructed by secretions, the patient has aspirated or the soft palate when GCS > 8

Question 2

What is the management for an airway problem?

Answer 2

• Simple airway manouvres
• Suction
• Adjuncts e.g. guedel, supraglottic airway, ET tube

Question 3

How is B assessed in A-E?

Answer 3

• Sats
• Resp Rate
• Chest examination e.g. cyanosis, trachea, chest expansion, percussion, auscultation
• Calves

Question 4

How should a breathing problem be managed?

Answer 4

• 15L/min through non rebreathe mask - (85%-90%)
• Sit up if SOB
• Treat obvious causes e.g. tension pneumothorax, asthma, anaphylaxis
• If not imporving consider NIV or invasive ventilation

Question 5

How is C assessed in A-E?

Answer 5

• BP
• HR
• Central cap refill
• Auscultate Heart - JVP, look for signs of fluid overload
• Fluid balance - e.g. IN fluids, intake, OUT e.g. catheter, drains, vomit
• Place wide bore IV cannula to take bloods (inc VBG)

Question 6

How should a circulation problem be managed?

Answer 6

• Hypotension - 500ml crystalloid STAT, monitor BP, HR and UO - 250ml initailly in heart failure
• Shock - 2 large bore cannulae - take bloods including G&S and crossmatch
• -Fluid challenge 1L stat
• -replace blood with blood (O neg)
• -In massive blood loss call 2222 and activate major haemorrhage protocol

Question 7

What is the typical maintenance fluid volume?

Answer 7

20-30mls/kg

Question 8

If a patient is not responding to fluids what are the two possible states they are in?

Answer 8

Overloaded (don't require more fluids)
Very underfilled (needs lots of fluid)

Question 9

What circulation state requires inotropes?

Answer 9

Overloaded and hypotensive

Question 10

What circulation state requires vasopressors?

Answer 10

Still hypotensive despite adequate fluid resusciation

Question 11

How is D assessed in the A-E?

Answer 11

• DEFG - Don’t ever forget glucose
• GCS
• Temperature
• Pupils - reactivity and symmetry
• Pain

Question 12

How much morphine should be given for pain?

Answer 12

10mg in 10mls of saline titrated slowly according to pain IV

Question 13

How is E assessed in the A-E?

Answer 13

• Exposure - look for bleeds, rashes, sores etc.

- Focussed exam of relevant systems