DRABCDE - DKA Flashcards
You have been asked by staff in Emergency to assess a patient
who has just been brought in. The ambulance was called by a colleague who
found the patient slumped at his desk. He has not accompanied the patient and
no other history is available at this time.
first thing you do
ask for the latest OBS -
Latest observations: HR 110, BP 90/ 60, RR 32, Sats 99% on air, Temp 37.3
Patient meets PERT criteria (BP and RR)- student should call for help.
what are the PERT criteria
RR 25 br/min or under 8
HR 125 b/min or under 50
systolic BP under 90 or more than a drop of 40
decreased conscious level
after obtaining the latest jobs on entry what are the next 2 steps
D Washes hands, safe to approach.
R Patient is responsive but confused.
airway management
I want to asses the patency of the Airway:
Look
Feel
Listen
Airway is clear (patient talking).
assess breathing
Breathing:
Look Feel Listen Measure Treat
look - SOB and struggling. Trachea central. Rapid chest movements.
feel - Symmetrical chest movement. Nil on percussion.
listen - Clear
measure - RR 33, Sats 99% on air.
treat - Administer high concentration of O2 via non-rebreathe mask (oxygen mask with reservoir bag) unless contraindicated. If choosing a fixed oxygen method student titrates accordingly. ABG. CXR.
assess the circulation
Circulation:
Look Feel Listen Measure Treat
look - Pale/ clammy, JVP not visible, no oedema.
feel - Warm peripheries, regular rapid pulse with normal volume.
listen - Normal heart sounds.
measure (list all of these) - HR 110, BP 90/ 60, cap refill 5 secs, urine output 50+mls/ hr, Temp 37.3. ECG
Cannulate, bloods (FBC/ U+E), start fluid challenge.
assess disability and then expose
Disability
AVPU
Voice (confused/ drowsy), BM 34 mmols.
Pale/ clammy.
Suggests: Rapid IV fluids. Stat dose insulin/ commence sliding
scale. High dependency ward, hourly blood sugars, fluid balance.
Full systems examination. Write notes, look in medical notes, hand over.
