Clinical 8: ABCDE and NEWS2 Flashcards by Elizabeth McCabe

What intervention can be used for a compromised airway?

Jaw thrust/chin lift
Oropharyngeal airway
Recovery position

How well did you know this?

Not at all

Perfectly

What intervention can be used for compromised breathing?

Apply oxygen
Consider ventilatory support (NIV, CPAP, IPPV)
Consider sepsis and give IV antibiotics

How well did you know this?

Not at all

Perfectly

What is the intervention for a compromised circulation?

IV fluids
Intravenous access
Consider sepsis and give IV antibiotics

How well did you know this?

Not at all

Perfectly

What is the intervention for a compromised neurological status? (disability)

Secure airway
Check blood glucose
Consider sepsis and give IV antibiotics

How well did you know this?

Not at all

Perfectly

What would you look for in an airway exam?

Obstructions
Swellings
Secretions
See swaing
Colour (Cyanosis around mouth)

How well did you know this?

Not at all

Perfectly

What are some examples of added airway signs?

Snoring - arises when the pharynx is partially occluded by the tongue or palate
Stridor
Gurgling

How well did you know this?

Not at all

Perfectly

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.

How well did you know this?

Not at all

Perfectly

What causes the gurgling airway sound?

If the patient has liquid (blood, vomit) this could cause gurgling

How well did you know this?

Not at all

Perfectly

What causes a choking lound sound?

Due to obstruction in the upper airway

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What are the risk of an oropharangyeal airway?

Aspiration
Gagging

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What is the potential cause of tachypneoa?

Hypoxia or hypercapnia
Nay be caused by infection

How well did you know this?

Not at all

Perfectly

What is the potential cause of bradypnoea?

Impaired consciousness or drugs which affect respiratory drive (opioids)

How well did you know this?

Not at all

Perfectly

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