Clinical approach Flashcards
Pre Arrival
Plan for case
Biases/human factors
Arrival
PPE
Dangers
Dynamic risk assessment
Rapid assessment for Adult and Paed
Adult
- skin
- Conscious state
- WOB
Paediatric
- APPEARANCE - Tone, interactiveness, consolability, look/gaze.speech/cry
WOB- Abodominal breathing, subcostal, nasal flarring,Abnormal breath sounds
CIRCULATION TO THE SKIN - pale, mottling, Cyanosis
Primary Assessment
If looks unwell
- Response
- Airway & C spine
- Breathing
- Circulation
- Disability
- Exposure & Hemorrhage
Immediate Mx and SITREP
Establish limitation of treatment
History (as appropriate)
Time line
Nature
Prodromal symptoms
History of similar episodes
Associated circumstances
Aggravating / relieving factors
Past history
R - Risk factors
A - Allergies
M - Medications
P - Past medical Hx
S - Social considerations
Assess
PSA
BP, GCS, HR, S
GCS
E 4, V 5, M 6
RSA
C,A,P,R,R,S,S
Adjuncts
- Weight
- Temp
- ECG
- BGL
- SPO2
- EtCO2
Focused Assessments
MASS
SIRS
RASH
AEIOUTIPS
Stroke mimics
Handover
IMIST - AMBO
- I - Identification
- M - Mechanism of injury / medical complaint
- I - Injuries / Information related to complaint
- S - Signs
- T - Treatment and Trends
- A - Allergies
- M - Medication
- B - Background history
- O - Other information
Adequate Perfusion
Skin Pink Warm Dry
HR 60 - 100
SBP > 100
GCS 15 alert and orientated to date and time
Borderline perfusion status assessment =
Skin - Pale cool clammy
HR - 50-100
SBP 80-100mmhg
GCS 15
Inadequate perfusion assessment
Skin - Cool Pale Clammy
HR - <50 - >100
SBP - 60 - 80
GCS - Altered / 15
Extremely poor perfusion assessment
Skin - Cool pale clammy
HR - < 50 - > 110
SBP < 60
Altered conscious state or unconscious
RSA mild
Appearance - Calm/anxious Speech - full sentences Sounds - able to cough, Asthma= mild wheeze, LVF = some crackles RR - 16-20 Rhythm - asthma pt may have a prolonged exp phase WOB - slight increase HR - 60 -100 Skin - normal GCS - 15
Moderate RSA
Appearance - distressed and anxious
Speech - short phrases
Sounds - still cough (Asthma + or - inspiratory and expiratory wheeze) (LVF crackles mid to lower fields )
Rate - > 20
Rhythm - Asthmatic pt long expiratory phase
WOB - marked chest movement + or - accessory involvement
HR 100-120
Skin - Pale and sweaty
GCS - mildly altered
Severe RSA
Appearance - anxious and fighting for breath potentially catatonic
Speech - single words or unable to speak
Sounds - unable to cough, (Asthma + or - inspo or expo wheeze or zero breath sounds) ( LVF full field crackles) upper airway obstruction = inspo stridor
RR - > 20 or bradypnoea < 8
Rhythm prolonged expiratory phase
WOB - full chest movement and all accessory muscles in use inc tracheal tug
HR >120 or Bradycardia is a late sign
Skin pale clammy sweaty and +- cyanosis
GCS altered or unconscious
GCS eyes
- Opens (4) spontaneously
- Opens to voice (3)
- Opens to pain (2)
- None (1)
Verbal GCS scoring
- Orientated (5)
- Confused (4)
- Inappropriate words (3)
- Inappropriate sounds (2)
- None (1)
GCS Motor assesment
- Obeys commands (6)
- Localises to pain (5)
- Withdraws from Pain (4)
- Flexion to Pain (3)
- Extension to Pain (2)
- None (1)
Clinical weights for Paed patient
Newborn - 3.5kg 3 month - 6 kg 6 month - 8 kg 12 month - 10 kg Above 1 is formula = Age x2 + 8 = 10 and 11 is x 3.3
Paeds age parameters
Small infant < 3 months
Large infant 3-12 months
Small child 1-4 year old
Medium Child 5-11 year old
Newborn (<24 hour) vitals
HR 110-170
SBP > 60
RR 25-60
Small infant (upto 3 months)
HR 110-170
SBP > 60
RR 25 - 60
Large infant (3-12 months)
HR 105 - 165
SBP > 65
RR 25- 55
Small child (1-4 year old)
HR 85 - 150
SBP >70
RR 20-40
Medium child (5-11)
HR 70 - 135
SBP >80
RR 16-34
Secondary survey
Neuro
Cardiac
Respiratory
Git
Urinary
Skin
Trauma
Secondary survey for Neuro
Dizzy
Headache
LOC
Pupils
Visual disturbance
Secondary survey for Cardiac
Palpitations
Pain with breathing in
Secondary survey for Resp
Px Cough
breathing difficulties
Secondary survey for GIT
N&V
Soft to palpate
Distended
Pain to touch
BAs- Normal in freq, color, smell
Secondary survey for Urinal
UTI symptoms
Pain when urinating
smell
color
Temps
Secondary survey for Skin
Pale
Sweaty
Rash’s
Secondary survey Trauma
Neuro Assessment
Limb Assessment
- P- Pain
- I - Irregularity
- L - Loss of movement of power
- S - Swelling
- D - Deformity
- U - Un natural movement
- C - Crepitus
- T - Tenderness
Neurovascular assessment
MASS
Facial drooping
Bilateral grip push pull
Speech
AEIOUTIPS
A- Alcohol
E - Epilepsy
I - Insulin
O - Overdose
U - Underdose
T - Trauma
I - Infection
P - Pain, Psychosis, Poison
S - Stroke
RASH
Sudden onset of 2 or more of the following to a suspected exposure to a antigen (under 30 min upto 4 hr)
R - Respiratory distress
A - Abdomen symtoms
S - Skin
H - Hypotension
OR
Isololated respiratory distress with known exposure to a Known Antigen
OR
Isolated Hypotension SBP < 90 and exposure to a known antigen
SIRS
2 of the following
Temp >38 or < 36
HR > 90
RR > 20
CO2< 32
Stroke Mimics
- Hyo/hyper glycaemia
- Seizure
- Migraine
- Sepsis
- Intoxication
- Brain Tumor
- Inner ear disorder (vertigo)
- Subdural Haematoma
- Syncope
- Electrolyte disturbance
- MS