ABCDE management

Question 1

Airway - assessment

Answer 1

It’s patent if the pt can talk

It’s not patent if there are secretions / pt has aspirated / snoring / GCS <8

Look inside mouth - any obstructions?

Question 2

Airway - management

Answer 2

Consider suction, airway opening manoeuvres, oropharyngeal / nasopharyngeal airways, intubation (if GCS <8)

Tx any evident causes

Question 3

Breathing - assessment

Answer 3

Pulse oximetry
RR
Chest exam: cyanosis, tracheal deviation, chest inspection, expansion, percussion, auscultation
Calves

ABG, CXR

Question 4

Breathing - management

Answer 4

15L oxygen
Consider non-invasive or invasive ventilation if hypoxic or hypercapnic despite maximal therapy
If respiratory effort inadequate, must be supported

Tx any evident underlying causes

Question 5

Circulation - assessment

Answer 5

Cap refill (central)
Pulse
BP
Temperature
Auscultate heart, check JVP
Assess fluid balance 

Wide-bore IV cannula, apply 3-lead cardiac monitoring, ECG, catheter

Question 6

Circulation - management

Answer 6

Hypotension - lay supine and elevate legs, 500mL 0.9% saline STAT

Shock - 2 large bore IV cannulas, 1L normal saline STAT, replace blood with blood

If pt hypotensive and overloaded they need inotropes
If pt hypotensive despite adequate fluid resus they need vasopressors

Tx cause

Question 7

Disability - assessment

Answer 7

DON’T EVER FORGET GLUCOSE
GCS / AVPU
Pupils reactivity and symmetry
Pain assessment

CT brain - if intracerebral pathology needs to be excluded

Question 8

Disability - management

Answer 8

Correct glucose
Give analgesia if in pain

Look for and tx cause

Question 9

Everything else - assessment

Answer 9

Exposure - bleeds, rashes, injuries, drain / catheter output, lines
Examine abdomen
Focussed exam of relevant systems

Question 10

Investigations to find cause

Answer 10

Review notes

Bloods - ABG, venous bloods, capillary glucose, blood cultures
Orifice tests - urine dip, urine / sputum / faeces culture, urine BhCG
X-ray / imaging - portable CXR, CT brain
ECG
Special tests

Question 11

Request help as required

Answer 11

Inform senior

Med reg: medical problems
Endoscopist on call: upper GI bleeding
Surgical reg: surgical problems and bleeding
Cardiology registrar: MI / arrhythmia
Gynaecological registrar: ruptured ectopic
Intensive / high dependency care registrar: if likely to be required