ABCDE Flashcards
What does it stand for?
- Airway
- Breathing
- Circulation
- Disability
- Exposure
A: what can cause airway obstruction?
- Reduced consciousness
- Foreign objects - teeth, food, vomit, blood, thick sputum, pen tops
- Bronchospasm
- Infection causing swelling
- Allergic reaction (anaphylaxis)
A: What do you do first?
Look for…
- Condensation in the mask
- Anything in mouth causing obstruction
A: What sounds are worrying? What are possible causes? What is the management?
- Snoring
- Tongue obstructing
- Head tilt chin lift
- OPA/NPA - Gurgling
- Fluid
- Take deep breaths to stimulate coughing
- Suction - Stridor
- Upper airway obstruction
- Infection -> swelling
- Anaphylaxis
- Thick sputum
- Oxygen - Wheeze
- Narrowing of bronchi
- Bronchospasm
- Bronchodilator nebulisers - Silence
- Complete obstruction
- Sign of respiratory arrest
Always apply 100% oxygen
B: What are examples of ventilation problems vs perfusion problems?
Ventilation
- COPD
- Asthma
- Chest infection
- Rib fractures
- Spinal injury
Perfusion
- PE
- Hypotension
B: What might you hear on auscultation?
- Stridor
- Wheeze
- Fine crackles (rhonchi)
- Coarse crackles (rales)
B: What can cause stridor?
- Croup
- Epiglottis
- Upper airway obstruction
- Tumours
- Peritonsillar abscess
- Airway oedema - allergic reaction
- Foreign body aspiration
B: What can cause wheeze?
- Asthma
- COPD
B: What can cause fine crackles?
- COPD
- Cystic fibrosis
- Bronchiectasis
- Pneumonia
B: What can cause coarse crackles?
- Chronic bronchitis
- Bronchiectasis
- Pneumonia
- Severe pulmonary oedema
How do you differential fine from coarse crackles?
- Coarse sound like bubbling/popping
- Coarse are louder and longer in duration
- Fine are heard loudest at lung bases
- Coarse are heard anywhere
B: What is the initial treatment of B?
- High flow oxygen
- If breathing shallow or low resp rate -> additional breaths with the bag valve mask connected to high flow O2
- If giving nebulisers - give with O2
- Do not remove O2 at anytime
B: How much oxygen do you give a COPD pt in an acute setting when their CO2 status is unknown?
- Give 100% O2 and aim for stats >96%
- Obtain an ABG and establish if they are a CO2 retainer asap
- At this point can titrate O2 to maintain stats 88-92% if needed
- Hypoxia kills faster than hypercapnia
B: What further investigations may be indicated?
CXR
C: What do you do first?
- Pulse
- CRT
- Peripheral temp
- BP
C: What interventions may be important at this point?
- IV access and bloods
- Catheter
C: What bloods should you consider?
- FBC
- U+Es
- CRP
- Culture
- Glucose
- VBG - lactate
- Clotting
- Group and save
C: How do you work out someones minimum hourly UO?
- > 0.5ml/kg/hr
- Therefore half of their wt
- If weigh 80 kg, UO should be 40ml/hr
C: How do you monitor someones UO?
Fluid balance chart
C: How do you managed decreased UO?
- If perfusion adequate? - BP
- Are they on nephrotoxic drugs - temporarily hold
- If anuric - is there outflow obstruction?
C: How do you manage a dehydrated pt?
- Bolus 250-500ml/15 mins
- Recheck BP
- Can give boluses up to 2L before asking for senior help
C: What do you see when someone positively responds to a fluid challenge?
- BP increased
- CRT shortens
- UO increases
- Pt becomes more responsive (if cerebral perfusion affected)
C: What is shock?
Any physiological state where there is inadequate delivery of oxygen to the tissues and organs
C: What are different types of shock?
- Hypovolaemic
- Cardiogenic
- Septic
- Neurogenic
- Anaphylactic
C: What are signs/symptoms of hypovolaemic shock?
- Increased RR
- Increased HR
- Peripheral shutdown - increased CRT, pale, cool, clay
- Altered consciousness
C: What are signs/symptoms of cariogenic shock?
- Increased RR
- Increased HR
- Peripheral shutdown - increased CRT, pale, cool, clay
- Altered consciousness
C: What are signs/symptoms of septic, neurogenic, anaphylactic shock?
- Increased RR
- Increased HR
- Peripheral vasodilation - decreased CRT, flushed
- Altered level of consciousness
C: Does BP always drop in a shocked pt?
- No!
- Shock can still occur with a pt displaying a normal BP - the body will initially compensate to maintain it
- Pts who are bleeding do not drop their BP until they have lost a Hird of the blood volume
- Pts with septic shock my have normal BP but high lactate
C: What further investigations may be indicated?
ECG
D: What do you need to check as part of D?
- Conscious level A(C)PVU
- Pupils
- Glucose
D: How can you classify potential causes of reduced consciousness?
- Primary causes - events within the skull and brain
- Secondary causes - events within the body which impacts badly upon the brain
D: What are primary causes of reduced consciousness?
- Brain injury (trauma, CVA, haemorrhage)
- Infection (meningitis, encephalitis)
- Epilepsy seizures
- Hydrocephalus
D: What are secondary causes of reduced consciousness?
- Hypoxia
- Hypercapnia
- Hypotension
- Hypo/hyperglycaemia
- Hyponatraemia
- Alcohol
- Drugs
D: What AVPU indicates a major threat to airway and breathing?
If the patient only responds to pain or is unresponsive
D: What BG would indicate hypoglycaemia? What is the management?
- <3mmols/L
- Bolus 25-50ml glucose 50%
D: What further investigations may be indicated?
CT head
E: What do you check for?
- Rashes
- Bleeding
- Wounds
- Drains
