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4 > ABCDE > Flashcards

ABCDE Flashcards

1
Q

What does it stand for?

A
  • Airway
  • Breathing
  • Circulation
  • Disability
  • Exposure
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2
Q

A: what can cause airway obstruction?

A
  • Reduced consciousness
  • Foreign objects - teeth, food, vomit, blood, thick sputum, pen tops
  • Bronchospasm
  • Infection causing swelling
  • Allergic reaction (anaphylaxis)
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3
Q

A: What do you do first?

A

Look for…
- Condensation in the mask
- Anything in mouth causing obstruction

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4
Q

A: What sounds are worrying? What are possible causes? What is the management?

A
  1. Snoring
    - Tongue obstructing
    - Head tilt chin lift
    - OPA/NPA
  2. Gurgling
    - Fluid
    - Take deep breaths to stimulate coughing
    - Suction
  3. Stridor
    - Upper airway obstruction
    - Infection -> swelling
    - Anaphylaxis
    - Thick sputum
    - Oxygen
  4. Wheeze
    - Narrowing of bronchi
    - Bronchospasm
    - Bronchodilator nebulisers
  5. Silence
    - Complete obstruction
    - Sign of respiratory arrest

Always apply 100% oxygen

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5
Q

B: What are examples of ventilation problems vs perfusion problems?

A

Ventilation
- COPD
- Asthma
- Chest infection
- Rib fractures
- Spinal injury

Perfusion
- PE
- Hypotension

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6
Q

B: What might you hear on auscultation?

A
  • Stridor
  • Wheeze
  • Fine crackles (rhonchi)
  • Coarse crackles (rales)
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7
Q

B: What can cause stridor?

A
  • Croup
  • Epiglottis
  • Upper airway obstruction
    • Tumours
    • Peritonsillar abscess
    • Airway oedema - allergic reaction
  • Foreign body aspiration
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8
Q

B: What can cause wheeze?

A
  • Asthma
  • COPD
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9
Q

B: What can cause fine crackles?

A
  • COPD
  • Cystic fibrosis
  • Bronchiectasis
  • Pneumonia
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10
Q

B: What can cause coarse crackles?

A
  • Chronic bronchitis
  • Bronchiectasis
  • Pneumonia
  • Severe pulmonary oedema
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11
Q

How do you differential fine from coarse crackles?

A
  • Coarse sound like bubbling/popping
  • Coarse are louder and longer in duration
  • Fine are heard loudest at lung bases
  • Coarse are heard anywhere
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12
Q

B: What is the initial treatment of B?

A
  • 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
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13
Q

B: How much oxygen do you give a COPD pt in an acute setting when their CO2 status is unknown?

A
  • 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
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14
Q

B: What further investigations may be indicated?

A

CXR

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15
Q

C: What do you do first?

A
  • Pulse
  • CRT
  • Peripheral temp
  • BP
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16
Q

C: What interventions may be important at this point?

A
  • IV access and bloods
  • Catheter
17
Q

C: What bloods should you consider?

A
  • FBC
  • U+Es
  • CRP
  • Culture
  • Glucose
  • VBG - lactate
  • Clotting
  • Group and save
18
Q

C: How do you work out someones minimum hourly UO?

A
  • > 0.5ml/kg/hr
  • Therefore half of their wt
  • If weigh 80 kg, UO should be 40ml/hr
19
Q

C: How do you monitor someones UO?

A

Fluid balance chart

20
Q

C: How do you managed decreased UO?

A
  • If perfusion adequate? - BP
  • Are they on nephrotoxic drugs - temporarily hold
  • If anuric - is there outflow obstruction?
21
Q

C: How do you manage a dehydrated pt?

A
  • Bolus 250-500ml/15 mins
  • Recheck BP
  • Can give boluses up to 2L before asking for senior help
22
Q

C: What do you see when someone positively responds to a fluid challenge?

A
  • BP increased
  • CRT shortens
  • UO increases
  • Pt becomes more responsive (if cerebral perfusion affected)
23
Q

C: What is shock?

A

Any physiological state where there is inadequate delivery of oxygen to the tissues and organs

24
Q

C: What are different types of shock?

A
  • Hypovolaemic
  • Cardiogenic
  • Septic
  • Neurogenic
  • Anaphylactic
25
Q

C: What are signs/symptoms of hypovolaemic shock?

A
  • Increased RR
  • Increased HR
  • Peripheral shutdown - increased CRT, pale, cool, clay
  • Altered consciousness
26
Q

C: What are signs/symptoms of cariogenic shock?

A
  • Increased RR
  • Increased HR
  • Peripheral shutdown - increased CRT, pale, cool, clay
  • Altered consciousness
27
Q

C: What are signs/symptoms of septic, neurogenic, anaphylactic shock?

A
  • Increased RR
  • Increased HR
  • Peripheral vasodilation - decreased CRT, flushed
  • Altered level of consciousness
28
Q

C: Does BP always drop in a shocked pt?

A
  • 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
29
Q

C: What further investigations may be indicated?

A

ECG

30
Q

D: What do you need to check as part of D?

A
  • Conscious level A(C)PVU
  • Pupils
  • Glucose
31
Q

D: How can you classify potential causes of reduced consciousness?

A
  • Primary causes - events within the skull and brain
  • Secondary causes - events within the body which impacts badly upon the brain
32
Q

D: What are primary causes of reduced consciousness?

A
  • Brain injury (trauma, CVA, haemorrhage)
  • Infection (meningitis, encephalitis)
  • Epilepsy seizures
  • Hydrocephalus
33
Q

D: What are secondary causes of reduced consciousness?

A
  • Hypoxia
  • Hypercapnia
  • Hypotension
  • Hypo/hyperglycaemia
  • Hyponatraemia
  • Alcohol
  • Drugs
34
Q

D: What AVPU indicates a major threat to airway and breathing?

A

If the patient only responds to pain or is unresponsive

35
Q

D: What BG would indicate hypoglycaemia? What is the management?

A
  • <3mmols/L
  • Bolus 25-50ml glucose 50%
36
Q

D: What further investigations may be indicated?

A

CT head

37
Q

E: What do you check for?

A
  • Rashes
  • Bleeding
  • Wounds
  • Drains

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