ABCDE Flashcards by E P

What does it stand for?

Airway
Breathing
Circulation
Disability
Exposure

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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)

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A: What do you do first?

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

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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

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

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

Perfusion
- PE
- Hypotension

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B: What might you hear on auscultation?

Stridor
Wheeze
Fine crackles (rhonchi)
Coarse crackles (rales)

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B: What can cause stridor?

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

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B: What can cause wheeze?

Asthma
COPD

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B: What can cause fine crackles?

COPD
Cystic fibrosis
Bronchiectasis
Pneumonia

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B: What can cause coarse crackles?

Chronic bronchitis
Bronchiectasis
Pneumonia
Severe pulmonary oedema

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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

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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

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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

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B: What further investigations may be indicated?

CXR

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C: What do you do first?

Pulse
CRT
Peripheral temp
BP

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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