Clinc2: ABCDE assessment

Question 1

How might you assess a patients airway?

Answer 1

Ability to speak
Listen for coughing, gasping, choking - indicate an obstruction
Look for obstructions, swelling, secretions, see-sawing and colour (Cyanosis)
Feel for airflow at the mouth and nose

Question 2

What are some different added breathings sounds?

Answer 2

Wheeze
Crackles
Pleural Rub
Stridor

Question 3

What causes snoring?

Answer 3

When the pharynx is partially occluded by the tongue or palate

Question 4

What causes stridor breathing sounds?

Answer 4

High pitched sound, squawking and continuous.
Causes by an upper airway obstruction
Causes by anrrowing of trachea/larynx, typically caused by croup, foreign body obstruction and epiglottitis.

Question 5

What is gurgling as an abnormal breathing sound?

Answer 5

Caused by liquid accumulation such as blood or vomit.
May also be described as course crackles
Typically in inspiration.

Question 6

What causes choking as a breath sound?

Answer 6

Due to a foreign body obstruction in the upper airway

Question 7

What are some abnormal breath sounds?

Answer 7

Diminished breath sounds
Bronchial breathing

Question 8

How should you respond to a patient with a compromised airway?

Answer 8

Crash call immediatly, urgent anaesthetic input to secure airway
Encourage to cough
Recovery position/ change position so more upright
Airway maneouvres (chin lift, head tilt, jaw thrust)
Remove visible secretion
Consider suction for secretions
Airway adjuncts

Question 9

What are some common causes of upper airway obstruction?

Answer 9

Anaphylaxis
Tumour
CNS depression
Foreign body inhalation
Secretions
Infection (epiglottitis or pharyngeal abscess)
Larynospasm
Trauma
Blocked tracheostomy

Question 10

What is the escalation of airway maneouvres?

Answer 10

Heal tilt/chin lift
Jaw thrust is noisy breathing persists or cervical injury suspected
Consider an airway adjunct
Is semi-conscious use a nasopharyngeal airway
If seriously unwell and no longer has a gag reflex consider and orophayngeal ariway

Question 11

How do you assess a patients breathing?

Answer 11

Oxygen saturation
Respiratory rate
Auscultate both the lungs
Check for even chest expansion
Percuss for resonance/dullness
Check for chest deformity and tracheal position
Look for respitaroty distress - sweating, central cyanosis and use of accessory muscles

Question 12

What is tachypnoea?

Answer 12

Increased RR
Response to hypoxia or hypercapnia

Question 13

What is bradypnoe?

Answer 13

Reduced RR
Due to impaired consciousness or drugs (such as opiods)

Question 14

What different percusion noises does a chest percussion indicate

Answer 14

Hyperresonance - Suggests a pneumothorax
Dull - fluid/infection/blood

Question 15

What does coarse crackles int he airway indicate?

Answer 15

Also called crepitations
Represents pus in the lung

Question 16

What can fine crackles in the lung indicate?

Answer 16

Fluid in the lungs
E.f from heart failure

Question 17

What does a pleural rub sound indicate on auscultation?

Answer 17

Creaking/snow crunchind sound
Heard at level of pleural effusion

Question 18

What does a lung wheeze of auscultation indicate?

Answer 18

Polyphonic - bronchoconstriction
Monophonic - distal airway obstruction

Question 19

What are some causes of respiratory failure?

Answer 19

Reduced consciousness (may be from CO2 narcosis)
Reduced respiratory effort (chest wall deformities, trauma, neuro-muscular disorders)

Question 20

What are some common respiratory pathologies?

Answer 20

Infection - pneuomina, empyema
Pulmonary embolus
Pneumothorax/ haemothorax
Tumour
Broncho/laryngospasm
Pulmonary odema

Question 21

What investigations may you perform if patient breathing is abnormal?

Answer 21

Arterial blood gases
Chest x-ray

Question 22

What interventions are commonly used if breathing is abnormal?

Answer 22

Oxygen through a non rebreath mask. (Aim for lower saturation in COPD patients using a venturi mask)
If unconscious use assisted ventilation through a bag-valve-mask aim for 12-15 bpm.

Question 23

How do you assess the circulation of a patient?

Answer 23

Look at the colour of hands and digits
Check for signs of bleeding
Listen - auscultate the heart
Feel - central and peripheral pulses - rate, rhythm, character and volume
Check blood pressure and capillary refill time

Question 24

What investigations may request if patient circulation is abnormal?

Answer 24

Request an ECG to check the patient rhythm
Take a blood sample to investigat possible causes of acute compromise

Question 25

What are some signs of circulatory failure?

Answer 25

Tachycardia/bradycardia
Weak or absent peripheral pulse
Irregular pulse
Hypo/hypertension
Heart murmurs
Delayed Capillary Refill time
Oliguria or anuria

Question 26

What blood tests are normally taken from a patient?

Answer 26

Troponin 1 or T: cardiac enzymes released from damaged cells, sign of MI.
Full blood count: infection, Hb and platelet levels
CRP: infection and inflammation
Urea and electrolytes: to assess renal function
Liver function tests
Clotting factor tests
Serum Glucose: to eliminate hypoglycema or diabetic ketoacidosis

Question 27

What is shown in the following ECG?

Answer 27

Normal sinus rhythm

Question 28

What is shown in the following ECG?

Answer 28

Ventricular tachycardia

Question 29

What is shown in the following ECG?

Answer 29

Ventricular fibrillation

Question 30

What are the common methods of intervention for circulatory problems?

Answer 30

Secure intravenous access - 2 large bore cannulas
If haemodynamically unstable - adminster IV fluids (Hartmanns solution or NaCl 0.95)

Question 31

How do you check for disability in the patient?

Answer 31

Check blood glucose levels
Asses pupils for size and equal expansion, reaction to light
Assess consciousness (GCS or AVPU)

Question 32

What is the cause of bilateral pinpoint pupils?

Answer 32

Opiates

Question 33

What can cause the dilation of pupils?

Answer 33

Secondary to brain injury
Overdose of prescription medication (antidepressants)
Recreational drug use (cocaine and amphetamines)

Question 34

What is the AVPU screening for patient consciousness?

Answer 34

A - awake
V - responds to voice
P - responds to pain
U - completely unresponsive

Question 35

What is normally measured in a GCS?

Answer 35

Eyes opening - spontaneous, speech, pain, not
Verbal response - oreintated, dissorietnated, inapproprate, incomprehensible, no
Best motor response - obeys commands, localised pain,abnormal

Question 36

What are the common causes of unconsciousness?

Answer 36

TIPPS V ‘vowels’
Trauma
Infection
Poison
Psychaitric
Shock
Alcohol
Epilepsy
Insulin
Opiods
Urine - metabolic problem with electrolytes

Question 37

How do you check a patients ‘exposure’ in the ABCDE assessment?

Answer 37

Inspection - expose and check for injury etc
Temperature
Urine output

Question 38

What is the framework for handing over a patient?

Answer 38

Identity
Situation
Background
Assessment and action
Response and rationale

Question 39

What does each section of ISBAR stand for?

Answer 39

Identity - your name, position and ward, patients name
Situation - primary concern, stats
Background - patient history, admitted with and when, lost obs
Assessment - think the patient has and have given, not sure what it is but is deteriorating/concerned
R - request for help/advice or action