Clinical 8: ABCDE and NEWS2 Flashcards
What intervention can be used for a compromised airway?
Jaw thrust/chin lift
Oropharyngeal airway
Recovery position
What intervention can be used for compromised breathing?
Apply oxygen
Consider ventilatory support (NIV, CPAP, IPPV)
Consider sepsis and give IV antibiotics
What is the intervention for a compromised circulation?
IV fluids
Intravenous access
Consider sepsis and give IV antibiotics
What is the intervention for a compromised neurological status? (disability)
Secure airway
Check blood glucose
Consider sepsis and give IV antibiotics
What would you look for in an airway exam?
Obstructions
Swellings
Secretions
See swaing
Colour (Cyanosis around mouth)
What are some examples of added airway signs?
Snoring - arises when the pharynx is partially occluded by the tongue or palate
Stridor
Gurgling
What is stridor?
An additional airway sound
High pitched upper airway obstruction
More commonly heard in inspiration.
Can be caused by croup, foreign body obstruction, epiglottitis.
What causes the gurgling airway sound?
If the patient has liquid (blood, vomit) this could cause gurgling
What causes a choking lound sound?
Due to obstruction in the upper airway
In a hospital setting what should you do if a patient has a compromised airway?
Immediate crash call
Uregent anaesthetic input to secure the airway
ENcourage to cough and clear their own obstruction
Adjust position -e.g recovery position or sit upright
Airway adjuncts - nasopharyngeal airway or oropharyngeal airway.
Suction for secretions
Remove visible obstructions
What are some common causes of upper airway obstruction?
Tumour
Anaphalyaxis
CNS depression
Foreign body inhalation
Secretions
Infection (epiglottitis, pharyngeal abscess)
Larynogospasm
Trauma
Blocked trachestomy
What are the different indication of use between a nasopharyngeal airway and a oropharyngeal airway?
Naso -semi conscious
Oro - if able to tolerate, indicates seriously unwell as no gag reflex
What are the risk of an oropharangyeal airway?
Aspiration
Gagging
What should you do to assess patient breathing?
Oxygens aturation and respiratory rate
Respiratory distress - sweating, central cyanosis, accessory muscles
Ausulatate both lungs
Palpate and percuss to assess chest expansion of both sides
What is the potential cause of tachypneoa?
Hypoxia or hypercapnia
Nay be caused by infection
What is the potential cause of bradypnoea?
Impaired consciousness or drugs which affect respiratory drive (opioids)
What are the different abnormal percussion noises in a pneumothorax?
Hyperresonance - pneumothorax
Dull - fluid/infection/blood
What does crackles in the lung indicate?
Coarse crackles - pus in lungs
Fine crackles - fluid
What is a pleural rub lung sound indicate?
Pleural effusion
Snow crunching sound
What is the cause of a wheeze as a respiratory sound?
Bronchocontrsitction - if polyphinic
Distal airway obstruction - if monophonic
What causes reduced respiratory drive?
Reduced conscious level
CO2 narcosis
What causes reduced respiratory effort?
Chest wall deformities, kyphosis, scoliosis
Neuromuscular disorders
Trauma (fractured ribs)
What are some common causes of respiratory pathology?
Infection - pneumonia, empyema
Pulmonary embolus
Pneumothorax, Haemothorax
What are some common causes od respiratory failure?
Reduced respiratory effort
Pathology
Reduced respiratory drive
What investigations might you do if a person has compromised breathing?
Arterial blood gas
Chest x-ray.
In a hospital setting what interventions should you do to assist breathing?
Oxygen through a non-rebreath mask - aim for above 94% in otherwise health and aim for 88-92% in COPD
Assissted ventilation through a bag-valve-mask: 12-15bpm
How do you assess a patients circulation?
Look of digit colours
Look for signs of bleeding
Ausultate heart
Feel peripheral and central pulses (rate, rhythm, character, volume)
Check blood pressure and capillary refill time
What investigation will you do on a patient with suspected circulation?
Blood sample
Heart rhythm on ECG
What are some signs of circulatory problems?
Abnormal HR
Adbnormal BP
Pulse variation in rhythm, volume, character of absent
Decreased or absent urine output
How should you take a blood test from a patient with suspected circulatory problems and what should you test for?
When cannulated
Troponin 1 or T (from damaged cardiac cells in MI)
FBC - Hb, platelets, infection (CRP)
Urea and electrolytes - renal function
Liver function tests and clotting
Serum glucose
In a hospital setting what intervention should you use for a patient with a compromised circulation?
Secure IV acess - 2 large bole cannulas
IV fluids - Hartmanns
How to assess disability in a patient?
Blood glucose
Pupillary reflexes and appearance
AVPU or GCS
What can cause vasoconstriction of the pupils?
Bilateral pin point - secondary to opiates
What can cause vasodilation of the pupils?
Cocaine, anphetamine - recreational drugs
Overdose from prescription drugs normally anti-depressants
Brain injury
What are some common causes of unconsciousness?
TIPPS Vs vowels
Trauma
Infection
Poision
Psychiatric
Shock
Vascular
Alcohol
Epilepsy
Insulin
Opiods
U/Es
(in hospital also just check if asleep)
How do you check the exposure of a patient?
Check temperature
Urine output
Expose to check for bleeding, rashes, injuries and bruises
How should you handover a patient?
ISBAR
Identity of patient - name,age,ward,team
Situation - symptom, problem, stability, level of concern
Background - history of presentation, date of admission and diagnosis, relevant past medical hx
Assessment and Action - impression of the situation, what have you done so far
Response and rational - what investigation need doing, what needs monitoring, plan depending on results
What six physiological parameters are included in the NEWS score?
Respiratory rate
Oxygen saturation
Temperature
Systolic blood pressure
Pulse rate
Level of consciousness
What additional considerations should be made when looking at news score?
End of life patient - tend to have higher scores
Impaired consciousness due to drugs/sedation after surgery - decreased disability score
COPD - lower O2 sats - higher would be damaging
What are the appropriate NEWS thresholds and responses?
O-4 indicates low risk - ward based response
Score of three in any individual - low to medium risk - urgent ward based response (training in acutely ill care and when to escalate to critical care)
5-6 - medium risk - key threshold for urgent response (critical care skills such as airway management)
7 plus - urgent or emergency response
What is the score range of a NEWS chart?
0-18
How does the NEWS score value indicate how often vitals should be monitored?
O - minimum 12 hours
1-4 - min 4-6 hours
3 in single parameter - every hour
Total 5 or more - every hour
Total 7 or more - continuous
