A-E Station Flashcards
What should you do to assess airway?
talk to the patient
if the patient cannot talk to you:
look in the mouth for obstruction / visible secretions
suction any visible secretions - don’t suction what you can’t see!
perform a head-tilt chin lift
insert a nasopharyngeal airway / oropharyngeal airway (ask about basal skulls fractures before)
What should you do to assess breathing?
Assess oxygen sats
Resp rate (normal is 12-20)
Tracheal deviation and chest expansion
Percussion and ausculation
What should you do to assess circulation?
assess temperature of extremities
assess capillary refill (less than 2 seconds is normal)
assess pulse
assess blood pressure
look for JVP
attach an ECG monitor
listen to heart sounds
What should you do to assess disability?
verbally assess their AVPU
Assess temperature
Assess pupillary reactions using a pen torch
Take capillary blood glucose
Consider urine dip and monitoring urine output
What should you do in exposure?
Assess the patient from head to toe
move their hair to the side if needed
expose genitalia
assess any lines
What interventions can you do in ‘breathing’?
15L oxygen via a non rebreathe if hypoxic
PEFR and asthma medications if indicated
ABG if hypoxic
Consider CXR
What interventions can you do in ‘circulation’?
get IV access (14 G cannula), take bloods and blood cultures if indicated
if hypotensive - give 500ml 0.9% NaCl stat
monitor urine output
Define altered conciousness
New onset confusion, decrease in GCS of > 2 points or repeated or prolonged seizures
How should you approach an A-E of a patient with altered conciousness?
Verbally assess AVPU
Check Airway:
If evidence of obstruction - call anaesthetics/ICU and apply airway manouevres
If airway unprotected turn patient to lateral position
Check Breathing
If breathing inadequate - call anaesthetics/ICU
Low sats = apply 15L of oxygen via non-rebreathe
If saturations do not improve on oxygen call for bag-valve-mask
If respiratory rate < 8 and recent opioid use - NALOXONE PEN
Take ABG
Check Circulation and give fluids if hypotensive
Check Disability using either ACVPU –or– GCS
Check pupils for size, equality, and reaction to light
Check blood glucose
Check Exposure
How should you react to change in glucose?
If hypoglycaemia - give dextrose (50ml 10% dextrose IV up to a total of 250ml)
If hyperglycaemia - check ketones and start fixed-rate insulin
infusion
Define anaphylaxis
Anaphylaxis is a life-threatening hypersensitivity reaction featuring rapidly developing hypotension and tachycardia, and potentially life-threating airway obstruction or bronchospasm
How should you approach an A-E for a patient with anaphylaxis?
Check airway
If airway involvement: call anaesthetics/ICU
Give oxygen
If respiratory distress: sit the patient upright
If hypotension: lie the patient flat –and– elevate the legs
Treat anaphylaxis:
500 micrograms IM adrenlaline, repeat at 5 minute intervals if no improvement
Give a rapid bolus of IV crystalloid
Check for and remove any suspected causative agent(s)
How should you approach an asthma A-E?
In breathing consider doing PEFR and ABG
Give 15L oxygen
If severe or life-threatening features - call anaesthetics/ICU urgently
Start nebulised bronchodilators:
* Give nebulised salbutamol once (continuously if severe or life-threatening)
* Give nebulised ipratropium once
Start steroid therapy - oral prednisolone or IV hydrocortisone
Consider cardiac monitoring and IV magneisum sulphate
Define choking
Foreign body airway obstruction, with an ineffective cough in a patient who is conscious
How would you approach an A-E for a patient who is choking?
check for visible obstruction that you can easily remove
position the patient upright
give 5 back blows, stop to check if airway has cleared, then 5 abdominal thrusts
If patient conscious but no improvement - call anaesthetics and ENT, may need to remove obstruction in theatre
Define hyperkalaemia
Serum potassium greater than 6.5 mmol, with or without ECG changes.
ECG changes may include:
flattened/absent P-waves
tall T- waves
broad QRS complexes
ST-segment changes
How should you manage hyperkalaemia if you pick it up during an A-E?
apply continuous cardiac monitoring
if ECG changes - bloods to check their serum potassium
give 30 mL IV 10% calcium gluconate over 2-5mins
give nebulised salbutamol
check bms, then start insulin / dextrose infusion
repeat blood glucose and serum potassium afterwards
How would you manage major haemorrhage if you pick it up during an A-E?
call for help and say that you would like to activate major haemorrhage protocol
call 2222
get IV access and insert 2 large bore cannulae
Take blood for FBC, clotting, fibrinogen, and cross-matching
give up to 2L warmed crystalloid bolus (pressure bag)
Give tranexamic acid and reverse any anticoagulants
Give blood
if visible bleeding - elevate site and apply pressure
