A-I assessments Flashcards
What are you assessing during Airway assessment?
Look for:
Facial swelling/tongue swelling
Trauma
Symmetrical rise in chest
Listen for:
Stridor/wheeze
Silence
Use your hands to:
Head tilt, chin lift
What is the difference between stridor and wheeze?
Stridor - more inpsiratory, monophonic as it is in the upper airway
Wheeze - more expiratory, polphonic in lower airway
When would you not do head tilt chin lift, and what would you do instead?
C-spine injuries, arthritis of the neck e.g. ankylosing spondylitis or rheumatoid arthritis are contraindications for the head tilt chin lift
so do jaw thrust instead
What do you call it when the abdomen rises at a different time to the chest during inspiration?
Respiratory alternans
What do you assess during breathing?
Resp rate SATS + how much oxygen are they on \+ what is the trend? Resp exam Investigations: ABG CXR CTPA V/Q ventilation perfusion scan
What do you look for during circulation?
HR BLOOD PRESSURE listen to chest temperature of peripheries CAPILLARY REFILL Investigations - echo, ecg etc
What drugs are given to increase blood pressure?
MetaRAMinol
Norad
Drugs to decrease BP
Hydrasalazine
Labetalol
Assessing D
GCS
Blood glucose
Neuro exam - you can probs try all except sensation for the GCS examination
Pupil dilation
If the pupil is fixed and dilated, what does it mean?
increased ICP or stroke
Why does the pupil become fixed and dilated in increased ICP?
Pressure on optic nerve means that it doesn’t conduct sensory info to the brain, so the brain can’t respond using parasympathetic occulomotor drive, so sympathetic takes over - aka unopposed sympathetic dilation of pupils in end stage raised ICP
What is the triad that signifies raised ICP
Cushing’s reflex
What is Cushing’s reflex? How does it arise?
Hypertension
Bradycardia
Decreased RR
Raised ICP -> Pressure on brain arteries therefore reduced blood flow -> baroreceptor reflex by increasing vagal tone, hence hypertension.
Carotid artery receptors then sense that the mean arterial blood pressure is too high, so activate the parasympathetic nervous system to slow down the heart to the point of bradycardia.
How does the Cushing’s reflex compare to shock?
In shock (e.g. sepsis):
you have fluid leakage therefore HYPOTENSION
Your body tries to compensate by TACHYCARDIA and increased resp rate
Whereas in cushing’s reflex,
the brain’s first response to reduced blood flow to the brain is: HYPERTENSION
and then in response to this it activates BRADYCARDIA and a reduced resp rate.
What do you look for in E?
Rashes
Blood loss
Skin changes - temperature - hypothermia
Swelling in legs - DVT
What does F stand for?
Fluids and renal
- how much are they taking in
- how much are they peeing out
- any renal replacement therapy?
What do you check for in G?
Gastro
#- when did they last open bowels, bowel sounds, how are they feeding,
Glucose
Liver function
What do you check in H?
Haematology
Bloods
What do you find in malaria blood films?
Multiple RBC inclusions with parasites
What is I and what do you look for?
Infection
- temperature
- microbiology lab results
- how long have cannulas been there?
- any current antibiotics?
- any ABx resistance?
What would gram positive coccus bacteria in chains suggest?
Pneumococcus
What would Gram positive coccus clusters suggest?
Staph aureus
What is the most common cause of ventilation induced pneumonia?
Staph aureus
