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Yr 3 - RRAPID > ABCDE Approach > Flashcards

ABCDE Approach Flashcards

1
Q

How can the ‘airway’ be assessed?

A

Get patient to confirm their name & DOB - a normal response confirms a patent airway (move on to B)

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2
Q

What is the most common cause of an airway obstruction in adults?

A

A reduced conscious level - tongue, soft palate & epiglottis can occlude the upper airway.

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3
Q

If the patient is not verbally responsive, how can you assess the airway?

A
  • Look for chest movements - ensure your head is on the horizontal plane of chest
  • Listen for breath sounds
  • Feel for air movement on your cheek
  • Check for foreign bodies or secretions
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4
Q

What signs may indicate a patient has an obstructed airway?

A
  • Not able to talk in full sentences
  • Visibly SOB
  • Use of accessory muscles
  • Cyanosis
  • Angioedema (tongue/lip swelling)
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5
Q

What should you feel for when assessing the airway?

A

Tracheal position

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6
Q

What would angioedema indicate?

A

Anaphylaxis

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7
Q

What would a ‘gurgling’ sound indicate?

A

secretions

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8
Q

What would ‘snoring’ sounds indicate?

A

soft palate or tongue partially obstructing pharynx

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9
Q

what would a stridor indicate?

A

foreign body

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10
Q

How would a fully obstructed airway sound?

A

Silent

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11
Q

What manoeuvres can be done if the patient is unconscious with an obstructed airway?

A
  1. Head tilt chin lift
  2. Jaw thrust
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12
Q

When would the jaw thrust be used over the head tilt chin lift?

A

If suspected C-spine injury

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13
Q

What airway adjuncts can be used in unconscious patients with an obstructed airway?

A
  1. Oropharyngeal
  2. Nasopharyngeal
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14
Q

Which airway adjunct would be preferred in a patient who was not deeply unconscious?

A

Nasopharyngeal (better tolerated)

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15
Q

Which airway adjunct would be preferred in a patient who had a suspected base of skull fracture?

A

Oropharyngeal

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16
Q

How can the correct size of oropharyngeal adjunct be measured?

A

Measure from angle of mouth to edge of mandible

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17
Q

If patient not breathing/hypoxic, ventilate using bag and mask (2 person technique). What rate should you squeeze the bag at?

A

10-12 per minute

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18
Q

What is paradoxical breathing a sign of?

A

Sign of respiratory distress that occurs with increasing partial airway obstruction.

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19
Q

Describe paradoxical breathing

A
  • Chest contracts during inspiration and expands during exhalation (opposite of normal)
    • Vertical rib cage movement
  • The abdomen moves outwards as the diaphragm moves downwards, but the negative pressure generated against the obstructed airway draws the chest inwards
    • Abdominal hollowing, no distension
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20
Q

Define ventilation

A

The amount of air the reaches the alveoli

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21
Q

Define perfusion

A

The amount of blood that reaches the alveoli

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22
Q

Define a V/Q mismatch

A

Mismatch between alveolar ventilation and alveolar blood flow

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23
Q

What PaO2 defines respiratory failure?

A

PaO2 < 8 kPa

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24
Q

What response should always be done in any patient presenting SOB?

A

Sit patient up

Give 15L oxygen on a non-rebreathe mask

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25
Q

What 2 observations should always be done during ‘breathing’?

A
  1. O2 saturations (put on probe)
  2. Respiratory rate
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26
Q

What observation should be done during ‘breathing’ if concerned about an asthma attack?

A

Peak flow (PEFR)

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27
Q

What response should be taken if the SpO2 is low?

A

15L oxygen via a non-rebreathe mask

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28
Q

Describe some potential steps for the ‘look’, ‘listen’ and ‘feel’ aspect of ‘breathing’

A

Look:

  • Symmetrical chest expansion & depth
  • Breathing effort

Listen:

  • Auscultation of lung lobes

Feel:

  • Percussion
  • Chest expansion
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29
Q

What condition would reduced breath sounds with coarse crepitations and bronchial breathing over a certain area indicate?

A

Pneumonia

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30
Q

Describe the percussion in pneumonia

A

Dull over the affected zone

31
Q

Describe the vocal resonance in pneumonia

A

Increased over the affected zone

32
Q

Give the percussion sounds in a pleural effusion

A

Stony, dull

33
Q

How can a pleural effusion affect trachea position?

A

Central or shifted away from the affected side if large

34
Q

Describe breath sounds in a pleural effusion

A

Reduced/absent

35
Q

What condition would fine inspiratory crepitations ranging from the lung bases to throughout the lungs indicate?

A

Pulmonary oedema

36
Q

What condition would a high pitched expiratory wheeze indicate?

A

Severe asthma exacerbation

37
Q

What condition would a bilateral expiratory wheeze and crepitations indicate?

A

COPD exacerbation

38
Q

What investigations would you do in ‘breathing’?

A
  • ABG
  • Portable chest XR
39
Q

What would you give in a suspected asthma exacerbation?

A
  1. Sit patient up and give oxygen
  2. Salbutamol 5mg nebulised
  3. Ipratropium bromide
  4. Hydrocortisone or prednisolone
40
Q

What would you give in a suspected COPD exacerbation?

A
  1. Salbutamol 5mg nebulised
  2. Ipratropium bromide nebulised
41
Q

What is ‘shock’?

A

Acute circulatory failure leading to inadequate perfusion causing cellular hypoxia which leads to cellular disorder and failure of multiple organs.

42
Q

What are the 4 types of shock?

A
  1. Hypovolaemic
  2. Cardiogenic
  3. Vasodilatory/distributive
  4. Obstructive
43
Q

What type of shock does sepsis cause?

A

Vasodilatory/distributive

44
Q

What type of shock does anaphylaxis cause?

A

Vasodilatory/distributive

45
Q

What type of shock does a tension pneumothorax cause?

A

Obstructive

46
Q

What 4 observations should be done in ‘circulation’?

A
  • Pulse (rate, rhythm and character) → attach vital signs machine
  • Blood pressure → attach blood pressure cuff
  • Capillary refill time
  • Temperature
47
Q

What response in ‘circulation’ should almost always be done in an acutely unwell patient?

A

Insert 2x large bore cannulae (14G or 16G)

48
Q

Why is it important to measure the patient’s urine output?

A

One of the most sensitive organs to reduced perfusion is the kidney → risk of AKI (especially in sepsis)

49
Q

How can the urine output be measured?

A

Catheterise the patient (ideally in ‘circulation’)

50
Q

Describe some potential steps for the ‘look’, ‘listen’ and ‘feel’ aspect of ‘circulation’

A

Look:

  • JVP - raised?
  • Mucous membranes - dry?
  • Urine output

Listen:

  • Auscultation of heart valves
  • Auscultation of lungs

Feel:

  • Peripheries - cool and clammy? Warm?
51
Q

In hypotensive patients (i.e. low BP), what intervention should be given?

A

Fluid bolus - 500ml 0.9% saline over 15 minutes

52
Q

What can be done at the same time as inserting the cannula?

A

Take blood tests & cultures

53
Q

What blood tests might be useful to take?

A
  • VBG → for lactate
  • FBC
  • U&Es
  • Clotting
  • CRP
  • LFTs
  • Troponin (if cardiac concern)
  • Blood cultures (if infection/sepsis concern)
54
Q

If red flags for sepsis are identified, what treatment should be done?

A

SEPSIS 6 → BUFALO

Blood cultures

Urine output

Fluids (IV)

Antibiotics - broad spectrum IV

Lactate (VBG)

Oxygen

55
Q

If the patient presents with tachycardia, what investigation should be ordered?

A

12-lead ECG

56
Q

What 3 main aspect should you assess in ‘disability’?

A
  1. Conscious level
  2. Pupils
  3. Blood glucose
57
Q

How can you quickly assess the patients consciousness level?

58
Q

What aspects of the pupils are you assessing in ‘disability’?

A

Size, symmetry, direct & consensual pupillary responses

59
Q

What would pin point pupils indicate?

A

Opioid overdose

60
Q

How can the blood glucose be checked in ‘disability’?

A

Rapid finger prink test → capillary blood glucose

61
Q

If blood glucose levels are raised, what other test should you do? Why?

A

Blood ketones → DKA

62
Q

What investigation would you order if there were concerns about head trauma?

63
Q

What would a single fixed dilated pupil indicate?

A

Herniation of the temporal through the temporal hiatus (coning) as a result of 3rd cranial nerve compression

64
Q

What would miosis indicate?

A

Horner’s syndrome

65
Q

What would bilateral fixed dilated pupils indicate?

A

Brain death but can also occur in deep unconsciousness e.g. drugs/hypothermia

66
Q

Give some causes of hypoglycaemia

A
  • Excessive administration of insulin
  • Oral hypoglycaemics e.g. gliclazide
  • Alcohol
  • Liver failure
67
Q

If the patients was presenting with severe hypoglycaemia, what would your response be?

A

IV dextrose

Glucagon

68
Q

What would you be inspecting for in the ‘exposure’ aspect?

A

This may require exposing the patient - ensure to remain dignity & warmth.

Inspection for:

  • Trauma
  • Bleeding
  • Rashes
  • Jaundice
  • Abdominal distension
  • Melaena
  • Cannula site infection
  • Catheter site infection

INSPECT FRONT AND BACK

69
Q

What other aspects may be involved in the ‘exposure’ aspect?

A
  • Abdominal examination → signs of urinary retention?
  • Drug chart
  • Bedside: medication, vomit bowls etc
  • Patient history
  • Fluid levels
  • Escalate → SBARR
70
Q

Before giving an antibiotics (or any medication), what should always be done?

A

ALLERGIES - red penicillin wristband?

71
Q

What does the SBARR tool stand for?

A

Situation

Background

Assessment

Recommendation

Read back/review

72
Q

What is NEWS2?

A

A scoring system used to aid the recognition of acutely ill patients or patients who are deteriorating. An increasing score triggers a call for assessment.

73
Q

What 7 aspects does NEWS2 involve?

A
  1. Blood pressure
  2. Respiratory rate
  3. Respiratory support
  4. O2 sats
  5. Heart rate
  6. Conscious level (ACVPU)
  7. Temperature
74
Q

What is a high risk NEWS2?

Yr 3 - RRAPID (4 decks)

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