Appraoach To Acutely Unwell Flashcards
What does ABCDE stand for?
Airway, breathing, circulation, disability & exposure
What are 3 signs of airway issues?
See-saw breathing (abdominal breathing)
Using accessory muscles
Central cyanosis
What are signs of Breathing problems? (6)
- sweating
- redness
- chest expansion shortens
- cyanosis
- accessory muscle use
- record spO2/auscultation/percussion/tracheal positioning
What signs are for circulatory concern?
- Colour of skin (redness)
- temperature
- swelling?
- veins?
- pulse, cap. Refill, auscultation, BP
- look for blood loss
What signs suggest disability problems?
- skewed ABG
- check for drug toxicity
- BGM
- AVPU/GCS
What signs suggest exposure issue?
Rashes
External wound
Abdo exam?
Treatment for airway problem?
- Simple airway manoeuvres
- Airway suction
- Insert adjunct (oropharyngeal/nasopharyngeal)
- Tracheal intubation
- Oxygen/ tracheostomy
Treatment for breathing problems?
Oxygen if below 94%
Oxygen for COPD aim for 88-92%
What mask would you use for normal patient to get sats above 94%?
Usually 15L non-rebreathe
What mask would you use for COPD patient to get sats between 88-92%?
Venturi mask 28% for 4L or Venture 24% 4L.
What treatment would you do for cardiovascular problems? (6/7 steps)
Insert 1 or more cannula (usually 20g pink or 14/16 orange/grey for more or bigger bolus)
- take blood from cannula
FLUID 500ml Hartmanns OR 0.9% sodium chloride over 15 mins, 250 for those with pre-existing heart problems
Reasses HR and BP every 5 mins.
Repeat fluid challenge if not improved.
ECG recorded
(Aspirin 300mg asap for suspected ACS)
What tx would you give for low glucose?
50ml of 10% glucose/dextrose if below 4mmol
what would you give for drug toxicity?
Naloxone
What is the goal CRT?
<2secs
What can a bounding pulse indicate?
Sepsis
What can hypotension suggest?
Vasodilation = anaphylaxis, sepsis
SHOCK UNTIL PROVEN OTHERWISE
What does hyper-resonance indicate on percussion?
Pneumothorax or fluid
What type hypersensitivity reaction is an allergic reaction
Type 1
What is sepsis??
Where the body launches a large immune response to an infection, causing systemic inflammation and organ dysfunction.
What causes sepsis
Release of chemicals = endothelial lining of blood vessels = more permeable = oedema = reduced intravascular volume
= decreased oxygen supply = more anaerobic respiration = lactic acid waste product = metabolic acidosis
What is septic shock
Hypovolemia and therefore hypoperfusion to organs causing organ failure
How do we treat spesis?
Sepsis six
What do you give and take in sepsis six
Give: oxygen, antibiotics and fluid
Take: blood culture, urine output and blood gas for lactate
What other medication is given alongside iv fluid for sepsis??
Vasopressors (noradrenaline)
