Clinc2: ABCDE assessment Flashcards
How might you assess a patients airway?
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
What are some different added breathings sounds?
Wheeze
Crackles
Pleural Rub
Stridor
What causes snoring?
When the pharynx is partially occluded by the tongue or palate
What causes stridor breathing sounds?
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.
What is gurgling as an abnormal breathing sound?
Caused by liquid accumulation such as blood or vomit.
May also be described as course crackles
Typically in inspiration.
What causes choking as a breath sound?
Due to a foreign body obstruction in the upper airway
What are some abnormal breath sounds?
Diminished breath sounds
Bronchial breathing
How should you respond to a patient with a compromised airway?
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
What are some common causes of upper airway obstruction?
Anaphylaxis
Tumour
CNS depression
Foreign body inhalation
Secretions
Infection (epiglottitis or pharyngeal abscess)
Larynospasm
Trauma
Blocked tracheostomy
What is the escalation of airway maneouvres?
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
How do you assess a patients breathing?
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
What is tachypnoea?
Increased RR
Response to hypoxia or hypercapnia
What is bradypnoe?
Reduced RR
Due to impaired consciousness or drugs (such as opiods)
What different percusion noises does a chest percussion indicate
Hyperresonance - Suggests a pneumothorax
Dull - fluid/infection/blood
What does coarse crackles int he airway indicate?
Also called crepitations
Represents pus in the lung
What can fine crackles in the lung indicate?
Fluid in the lungs
E.f from heart failure
What does a pleural rub sound indicate on auscultation?
Creaking/snow crunchind sound
Heard at level of pleural effusion
What does a lung wheeze of auscultation indicate?
Polyphonic - bronchoconstriction
Monophonic - distal airway obstruction
What are some causes of respiratory failure?
Reduced consciousness (may be from CO2 narcosis)
Reduced respiratory effort (chest wall deformities, trauma, neuro-muscular disorders)
What are some common respiratory pathologies?
Infection - pneuomina, empyema
Pulmonary embolus
Pneumothorax/ haemothorax
Tumour
Broncho/laryngospasm
Pulmonary odema
What investigations may you perform if patient breathing is abnormal?
Arterial blood gases
Chest x-ray
What interventions are commonly used if breathing is abnormal?
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.
How do you assess the circulation of a patient?
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
What investigations may request if patient circulation is abnormal?
Request an ECG to check the patient rhythm
Take a blood sample to investigat possible causes of acute compromise
What are some signs of circulatory failure?
Tachycardia/bradycardia
Weak or absent peripheral pulse
Irregular pulse
Hypo/hypertension
Heart murmurs
Delayed Capillary Refill time
Oliguria or anuria
What blood tests are normally taken from a patient?
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
What is shown in the following ECG?
Normal sinus rhythm
What is shown in the following ECG?
Ventricular tachycardia
What is shown in the following ECG?
Ventricular fibrillation
What are the common methods of intervention for circulatory problems?
Secure intravenous access - 2 large bore cannulas
If haemodynamically unstable - adminster IV fluids (Hartmanns solution or NaCl 0.95)
How do you check for disability in the patient?
Check blood glucose levels
Asses pupils for size and equal expansion, reaction to light
Assess consciousness (GCS or AVPU)
What is the cause of bilateral pinpoint pupils?
Opiates
What can cause the dilation of pupils?
Secondary to brain injury
Overdose of prescription medication (antidepressants)
Recreational drug use (cocaine and amphetamines)
What is the AVPU screening for patient consciousness?
A - awake
V - responds to voice
P - responds to pain
U - completely unresponsive
What is normally measured in a GCS?
Eyes opening - spontaneous, speech, pain, not
Verbal response - oreintated, dissorietnated, inapproprate, incomprehensible, no
Best motor response - obeys commands, localised pain,abnormal
What are the common causes of unconsciousness?
TIPPS V ‘vowels’
Trauma
Infection
Poison
Psychaitric
Shock
Alcohol
Epilepsy
Insulin
Opiods
Urine - metabolic problem with electrolytes
How do you check a patients ‘exposure’ in the ABCDE assessment?
Inspection - expose and check for injury etc
Temperature
Urine output
What is the framework for handing over a patient?
Identity
Situation
Background
Assessment and action
Response and rationale
What does each section of ISBAR stand for?
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
