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
