ABCDE approach in emergency presentations Flashcards
What is the ABCDE approach?
The approach to all deteriorating or critically ill patients
What is the aim of the ABCDE approach?
The aim of the initial treatment is to keep the patient alive and achieve some clinical improvement.
This will buy time for further treatment and making a diagnosis.
What is the first step when assessing a collapsed patient?
If the patient is awake, ask “How are you?”.
If the patient appears unconscious or has collapsed, shake him and ask “Are you alright?”
If he responds normally he has a patent airway, is breathing and has brain perfusion.
If he speaks only in short sentences, he may have breathing problems. Failure of the patient to respond is a clear marker of critical illness.
What is ‘A’ in ABCDE?
Airway obstruction is an emergency.
Untreated, airway obstruction causes hypoxia and risks damage to the brain, kidneys and heart, cardiac arrest, and death.
How do you assess for signs of airway obstruction?
Paradoxical chest and abdominal movements (‘see-saw’ respirations)
The use of the accessory muscles of respiration.
Central cyanosis is a late sign of airway obstruction.
In complete airway obstruction, there are no breath sounds at the mouth or nose.
In partial obstruction, air entry is diminished and often noisy.
In the critically ill patient, depressed consciousness often leads to airway obstruction.
How do you treat airway obstruction?
In most cases, only simple methods of airway clearance are required (e.g. airway opening manoeuvres, airways suction, insertion of an oropharyngeal or nasopharyngeal airway).
Tracheal intubation may be required when these fail.
Do you use oxygen to treat airway obstruction?
Provide high-concentration oxygen using a mask with oxygen reservoir.
Ensure that the oxygen flow is sufficient (usually 15 L min-1) to prevent collapse of the reservoir during inspiration.
If the patient’s trachea is intubated, give high concentration oxygen with a self-inflating bag.
In acute respiratory failure, aim to maintain an oxygen saturation of 94–98%. In patients at risk of hypercapnic respiratory failure (see below) aim for an oxygen saturation of 88–92%.
What is ‘B’ in ABCDE?
Breathing (B)
During the immediate assessment of breathing, it is vital to diagnose and treat immediately life-threatening conditions (e.g. acute severe asthma, pulmonary oedema, tension pneumothorax, and massive haemothorax).
Look for signs of respiratory distress
What are the signs of respiratory distress?
Look, listen and feel for the general signs of respiratory distress: sweating, central cyanosis, use of the accessory muscles of respiration, and abdominal breathing.
How do you assess breathing?
Check for signs of respiratory rate.
Count Respiratory rate- A high (> 25 min-1) or increasing respiratory rate is a marker of illness.
Assess the depth of breath, the rhythm of respiration, chest expansion bilaterally.
Check for the presence of any chest deformity or raised JVP.
Note inspired oxygen conc. and Spo2.
IPPA.
Treatment of breathing problems
The specific treatment of respiratory disorders depends upon the cause.
Nevertheless, all critically ill patients should be given oxygen.
How do you treat breathing problems in COPD patients?
In a subgroup of patients with COPD, high concentrations of oxygen may depress breathing (i.e. they are at risk of hypercapnic respiratory failure - often referred to as type 2 respiratory failure).
Nevertheless, these patients will also sustain end-organ damage or cardiac arrest if their blood oxygen tensions are allowed to decrease.
In this group, aim for a lower than normal PaO2 and oxygen saturation.
Give oxygen via a Venturi 28% mask (4 L min-1) or a 24% Venturi mask (4 L min-1) initially and reassess.
Aim for target SpO2 range of 88–92% in most COPD patients
What should you do if the patient’s rate or depth of breathing is inadequate?
Use bag-mask or pocket mask ventilation to improve oxygenation and ventilation, whilst calling immediately for expert help.
In cooperative patients who do not have airway obstruction consider the use of non-invasive ventilation (NIV).
In patients with an acute exacerbation of COPD, the use of NIV is often helpful and prevents the need for tracheal intubation and invasive ventilation.
