DRABCDE

Question 1

general principles for approaching the acutely unwell patient

Answer 1

look, feel, listen, measure, treat, repeat for ABCDE of DR ABCDE

also, as soon as you think that the patient is outside of your control you must say that you would call the PERT team (critical care outreach). this can be right at the start if you are given the PTs jobs and they are bad, otherwise could be when you find airway obstruction or O2 desaturation etc.

Question 2

explain the DR steps

Answer 2

1- wash hands
2 - check for danger
3 - check patient response in an appropriate manner = shout, shake, gentle squeeze of traps.

“patient responds by speaking/ complaining of pain”

Question 3

step after DR?

Answer 3

Airway - look, feel, listen, measure, treat, repeat

1 - look - check for airway obstruction by opening mouth. anything in there? remove with suction but don’t use your fingers. don’t put the suction in any further if you can’t see the tip.

“airway is clear”

Question 4

step after airway assessment

Answer 4

B - breathing. look, feel, listen, measure, treat, repeat

1 - look - cyanosis, pallor, use of accessory muscles, tracheal tug, intercostal sucking, signs of resp distress.

“pale and clammy”

2 - feel - trachea position, chest expansion, percussion

3 - listen - for breath sounds, front and back.

“trachea central, percussion normal, symmetrical expansion”

4 - measure - resp rate, O2 sats.

“rr 30 sats 90”

5 - treat - if desaturated treat with O2 15litres non-rebreathe. (may also ask for a ABG and CXR)

6 - reassess

Question 5

step after breathing assessment

Answer 5

circulation - look, feel, listen, measure, treat, repeat

1- look - pallor, sweating, JVP, ankle oedema, haemorrhage.

“pale and sweaty, no visible JVP no oedema”

2 - feel - warmth of peripheries and pulse strength

“cool peripheries and weak pulse”

3 - listen - heart sounds and lung bases

“normal heart sounds, lungs clear”

4 - measure - pulse rate, BP, cap refill, urine output, temperature. request an ECG.

“examiner gives you the obs”

5 - this is usually the LATEST point at which you can acknowledge that the MET/PERT criteria are met and you should call them. (criteria are approx when the PTs BP, HR, RR or GCS are notably deranged, for GCS = 13/15)

6 - treat - 2 wide bore cannulae, one in each antecubital fossa, one to take bloods, the other to give fluids. give an IV fluid challenge of 250ml gelofusin. blood tests - FBC, U and E, LFT, cardiac enzymes. if you think its an MI then give MONA ( morhpine and antiemetic, oxygen, nitroglycerines, aspirin 300mg PO)

Question 6

what do you do after C of ABCDE

Answer 6

1- assess disability using AVPU
2 - measure BM
3 - expose the patient and carry out a top to toe examination
- at this point help should arrive in the OSCE.
- systematic handover using SBAR
- Do not leave the patient
- Look at notes and past medical history, write in notes
- Reassure patient and mention cardiology review/transfer to PCI suite if thought to be an MI