ABCDE ASSESSMENT

Question 1

If the patients condition changes always return to

Answer 1

Airway

Question 2

Airway initial observations

Answer 2

Strange if uncomfortable sensations in the mouth, chest or throat

• hoarseness
• itching
• burning
• swallowing difficulty
• chest tightness

Breathing difficulty
- airway and breathing systems are so closely linked that airway compromise is highly likely to impact on breathing

Question 3

Airway ; aural inspection

Answer 3

When airflow through the airways are unimpeded, breath sounds are quiet but audible.

In the absence of any breath sounds, use DRS ABC or the choking algorithm as necessary.

Noisy breathing may be a sign of airway compromise.

Question 4

Abnormal airway sounds: wheeze

Answer 4

Inflammation and narrowing of the airway can result in wheezing.

When wheeze is identified, a pause point from treatment with a bronchodilator (salbutamol) should be created within the ABCDE assessment

Conditions associated with bronchospasm - where the small airways of the lungs become narrowed - such as asthma, chronic obstructive pulmonary disease (COPD) and anaphylaxis, are all associated with wheezing.

Inflammation in larger airways can cause wheezing.

Common causes include infection, an allergic reaction or physical obstruction, such as a foreign body.

Question 5

Abnormal airway sounds: Stridor

Answer 5

Stridor is the sign of a blockage within the upper airways, should be treated as a life-threatening sign.

In a dental setting, identification of a stridor may be supported with a bronchodilator (salbutamol).

Anaphylaxis, choking, infection and injury are all associated with stridor.

Stridor can occur at any phase of respiration and may be uniphasic or biphasic, dependent on where the blockage is in the airway.

Question 6

Abnormal airway sounds: Cough

Answer 6

Associated with asthma, anaphylaxis, allergic reaction, infection and partial obstruction choking episodes

Question 7

Abnormal airway sounds: Snore

Answer 7

May indicate deterioration in pt conscious level indicating decreased ability to protect their own airway.

Use airway manoeuvres (head/chin tilt), airway adjuncts (oropharyngeal airways) and/or the recovery position should be considered.

Question 8

Abnormal airway sounds: Gurgle

Answer 8

Gurgling may be heard if liquids are present within the oropharyngeal airway, such as excessive saliva, vomit, blood or mucus.

Typically, liquids in the oropharynx are managed by swallowing to reduce liquid volumes or coughing to expel liquid from the airways.

When considered in the context of an actually unwell patient, a gurgle may suggest that deterioration in the patient’s conscious level has impacted on their ability to protect their own airway.

The use of suction and/or the recovery position should be considered.

Question 9

Airway: visual inspection

Answer 9

Lips mouth and tongue may look

• irritated
• swollen
• injured
• presence of foreign body

Question 10

Breathing

A problem with the airways will quickly cause a problem with breathing.

Answer 10

Pulse oximetry
- measures the oxygen level in the blood
- target range for oxygen saturation 94-98%
- if below 94%, pt is hypoxic
- in pt with a high risk of hypercapnia, a lower target range of 88-92% is accepted

Question 11

Hypercapnia

Answer 11

Used to describe elevated carbon dioxide levels in the blood

Question 12

Circulation - palpitations / chest pain

What do they indicate

Answer 12

Palpitations may suggest cardiac arrhythmia

Chest pain may suggest cardiac ischaemia / panic attacks

Question 13

Circulation: peripheral

Answer 13

Feeling of coldness and/or tingling in the limbs may be a sign of compensation in response to shock (low BP)

Question 14

Circulation: Central

Answer 14

Experiencing visual / auditory disturbance, dizziness and/or feeling faint may be a sign of shock

Question 15

Circulation: heart rate and rhythm

The body will accommodate for changes in blood flow and oxygen demand by increasing or decreasing heart rate as necessary

Answer 15

Low heart rate: sleep / high physical fitness

High heart rate: physical exertion (more oxygen consumed so body will respond by increasing heart rate / emotional stress (fight or flight response)

Question 16

How will the body respond to insufficiencies in oxygen: Airway

Answer 16

Airway compromise may reduce blood oxygen levels, requiring the heart to work harder to maintain oxygen delivery

Question 17

How will the body respond to insufficiencies in oxygen: Breathing

Answer 17

Airway compromise causes breathing difficulty
Breathing difficulty can both originate from or result in circulatory compromise

Question 18

How will the body respond to insufficiencies in oxygen: Disability

Answer 18

When the brain fails to receive adequate oxygenated blood, it fails as to function

This results in reduced consciousness which in turn may result in airway compromise - reducing the available oxygen for the heart to pump

Question 19

How will the body respond to insufficiencies in oxygen: Circulation

Answer 19

When circulation is compromised, the heart may not be able to deliver oxygenated blood around the body

In contrast airway and breathing compromise may cause circulatory compromise if the heart is not receiving adequate oxygenated blood

Question 20

Circulation: capillary refill times

Can be used to assess perfusion status in addition to blood pressure measurements or as an alternative if blood pressure monitors are not available

Answer 20

When body is adequately perfused both peripherally and centrally, oxygen is delivered to all areas of the body
In this state capillary refill times less than 2 seconds

When body unable to meet demand for blood flow and oxygen, it priorities core with aim to maintain perfusion to vital organs. It does this by reducing blood flow to the peripheries.
In this state, capillary refill times more than 2 seconds for periphery but normal range for centrally.

Compensatory mechanisms, such as reducing blood flow to the peripheries and/or increasing heart rate, will exhaust if circulatory compromise is prolonged. In this state, capillary refill times may be prolonged both peripherally and centrally. When the body is unable to meet perfusion requirements centrally, the vital organs will begin to shut down and the patients condition should be considered life-threatening.

Question 21

Circulation: Blood pressure

Answer 21

Blood pressure is a measure of circulatory status.
Systolic blood pressure measures the force as the heart contracts and diastolic when the heart relaxes and refills. Systolic blood pressure is used to assess perfusion status during acute illness.

The significance of values differs considerable when considering acute and chronic illness.
For example, a chronic systolic blood pressure of 160mmg increases the risk of other condition and may lead to a diagnosis of hypertension.

The same systolic pressure recorded during an acute illness is noteworthy but not treated as an emergency itself.

Question 22

Systolic blood pressure categories

Answer 22

<90 - critically low
(critical cardiovascular collapse, risk of organ failure)

91-100 - Very Low
(signs of cardiovascular collapse)

101-110 - Low
(early signs of cardiovascular collapse)

111-180 - Normal
(circulation sufficient to maintain normal central and peripheral perfusion)

181-219 - High
(potential risk of ACS, stroke, kidney damage, eye damage, seizure)

> 220 - Critical
(acute risk of ACS, stroke, kidney damage, eye damage, seizure)

Question 23

Disability: capillary blood glucose

Answer 23

Relevant to every acutely unwell pt
Particularly important if hypoglycaemia, seizure or syncope is suspected

Normal blood glucose - 4.0-8.0mmol/L

Question 24

Disability: AVPU

Answer 24

AVPU is a simple neurological assessment which aims to identify what level of stimulus is required for a patient to open their eyes and make an attempt to verbalise.

Verbalisation does not have to be intelligible, meaningful or appropriate.

New confusion in any patient should be viewed as clinically significant and used to help inform working impression.

Question 25

Disability: pain assessment

Answer 25

Question 26

Exposure: visual inspection

Answer 26

Finalise assessment

Useful when you have an unclear working diagnosis of asthma / hyperventilation / acute cardiac ischaemia (which all share symptoms of anaphylaxis), or in syncope / seizure (where the pt may have sustained an injury)