DRABCDE pneumonia

Question 1

A nurse has called to ask you to see an 83 yr old woman (Mrs.
Bentley) who has been admitted to the care of the elderly ward. The patient has
had a productive cough for 48hrs and feels short of breath (no chest pain)
Pmx: fit and well, non smoker, hypertensive, bendrofluazide.

Answer 1

Latest observations: HR 125, BP 100/ 60, RR 36, Sats 86% on air, Temp 39.4

Patient meets PERT criteria- student should call for help.

D Washes hands, safe to approach.
R Patient is fully responsive but confused.

Question 2

airway assessment

Answer 2

Look
Feel
Listen
Measure
Treat

Airway is clear

Question 3

breathing assessment

Answer 3

Breathing
Look
Feel
Listen
Measure
Treat

Cyanosed, trachea is central, normal chest expansion.
Symmetrical chest movement, dull percussion to right base.
Bronchial breathing to right base.
RR 36, Sats 86% on air

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 (sats improve to 94%). PEFR. ABG. CXR. Sputum sample.

Question 4

circulation assessment

Answer 4

Look
Feel
Listen
Measure
Treat

Pale, JVP not visible.
Hot to the touch, rapid pulse with normal volume.
Normal heart sounds.

HR 125, BP 100/ 60, cap refill 4 secs, urine output 50mls/ hr,
Temp 39.4.

Cannulate, bloods (FBC/ U+E/ Cultures), start fluid challenge,
? Broad spectrum IV antibiotics, paracetamol.

Question 5

disability assessment

Answer 5

Disability
AVPU
Alert, BM 5mmols.

Question 6

exposure assessment

Answer 6

Exposure
Treat
Flushed, sweaty.
Full systems examination. Write notes, looks in medical notes,
handover.