DRSCAB Flashcards
D.R.S.C.A.B
D: Danger R: Response S: Shout for help C: Circulation A: Airway B: Breathing
D: Danger
- Dr : PPE - gloves, apron, mask
- Patient : Move to safe environment
R: Response
- verbal
- shoulder tap
- pain stimulus
- check carotid pulse
- check breathing simultaneously (listen & feel)
- apply v/s monitoring: cardiac monitor, pulse oximeter
S: Shout for help
- The most senior person becomes team leader
- HO 1 / You; always by patient side
- HO 2 : inform MO overview of patient - so Mo can determine most probable cause to narrow down management
- Nurse : bring emergency trolley
Others : prepare for CPR ( + PPE ) - take turn to perform
Drugs in Emergency Trolley
DO NOT discard the ampules/vials (ask SN first - required to return to pharmacy for replacement with new ampules/vials).
- Inj. Adenosine 6mg/mL - PSVT
- Inj. Adrenaline 1 mg/ml - Cardiac arrest/anaphylaxis
- Inj. Amiodarone 150 mg/3ml - VFib chemical cardioversion
- Inj. Atropine 1mg/ml - Heart block, asystole, symptomatic bradycardia
- Inj. Dextrose 50%/10ml - Unconscious Acute Hypoglycemia
- Inj.Dobutamine 250mg/20ml - CCF
- Inj.Dopamine 200mg/5ml - Bradycardia, Hypotension
- Inj.Frusemide 20mg/ml - APO
- Inj.Labetalol 25mg/5 ml - Hypertension
- Inj Lignocaine 100mg/5ml - VT, Pulseless VT, VFib
- Inj. Sodium Bicarbonate8.4%/10ml - Hyperkalemia, Met Acidosis with bicarbonate loss, Hypoxic Lactic Acidosis
C: Circulation
Compression:
- center of sternum
- push hard ( 1/3 AP diameter chest )
- push fast ( 12o bpm )
- allow full recoil of chest
*2 mins , every 2 mins, rest 5s to check pulse and breathing. No pulse, cont. CPR
Cannulation:
- importance of all patient having a working branula:
- hard to insert branula when patient asystole/shock due to centralization of blood flow ( collapsed peripheral vein )
-IV adrenaline 1mg ( 1 amp = 1 mg ) ,non diluted
give every 3 to 5 mins
( if resuscitation 30 mins , 6 to 10 mg adrenaline must’ve been given )
-No maximum dose
-Can give adrenaline before start compression, no need to wait for 3 mins
Ventricular Fibrillation ( VF )
•may happen during resuscitation
•during 5s rest
•cardiac monitoring machine will automatically print out paper when it detects VF
•HO need to defibrillate the patient
-aim to achieve asystole
•Steps:
-set to defib mode
-150 to 360J
-apply abundant gel to patient’s body, not the pads
-1/I’m Clear, 2/You Clear (person handling oxygen), 3 Clear(the rest of the team)
-Charge the pads and deliver shock
-If unsuccessful after 3rd shock
•IV Amiodarone 300mg in 100cc NS in 1H after 3rd shock
Placement of cardiac monitor
- RA:RED electrode placed under right clavicle near the right shoulder within the rib cage frame
- LA: YELLOW electrode placed under left clavicle near the left shoulder within the rib cage frame
- LL: GREEN electrode placed on left side below lower edge of left pectoral muscles
Size & colours of branula
Orange : 14G - 310ml/min (flow rate) Grey : 16G - 200ml/min White : 17G - 140 ml/min Green : 18G - 105/100 ml/min Pink : 20G - 64 ml/min Blue : 22G - 38 ml/min Yellow : 24G - 16/22 ml/min Violet :26G - 12/15ml/min
A: Airway
- head tilt chin lift
- clear airway from foreign body,dentures, vomitus
- insert Oropharyngeal airway; NPA
B: Breathing
- bag valve mask (BVM)
- always check for faulty BVM
- give 15L oxygen either from O2 tank or wall mount
- 1 breath every 5 second
OPA insertion technique
1.Measure for correct size
-The OPA is sized by measuring from the center of the mouth to the angle of the jaw,
or
- from the corner of the mouth to the earlobe.
·
2. Open the mouth
-The mouth is opened using the “crossed or scissors” finger technique.
- Insert the OPA without pushing the tongue back
-The OPA is inserted in the patient’s mouth upside down so the tip of the OPA is facing
the roof of the patient’s mouth.
- As the airway is inserted it is rotated 180 degrees until the flange comes to rest on the patient’s lips and/or teeth.
- The OPA may be inserted
with the pharyngeal curvature if a tongue blade is used to depress the tongue.
-If patient begins to retch/gag, remove the OPA!
NPA insertion technique
- Select the proper size airway
-Select the proper size airway by measuring from the tip of the patient’s earlobe to the tip of the patient’s nose.
-The diameter of the airway should be the largest that will fit.
-To determine this, select the size that approximates the diameter of the patient’s little
finger. - Lubricate the airway with a water-soluble lubricant.
- Insert the airway
- With the patient’s head in a neutral position, gently pull back the tip of the patient’s
nose.
- Insert the airway; bevel toward the nasal septum, into the right nostril following the natural curvature of the nasal passage.
- The flange should rest against the nasal opening.
*If an obstruction or resistance is encountered, do not force the airway.
The airway should be removed and inserted in the left nostril.
*Nasal airways are contraindicated in-patients with
severe trauma to the head and/or face.
ALS vs BLS
BLS :
- CPR
- Artificial Ventilation
- O2 admin.
- Basic Airway Mx
- Spinal mobilisation
- Vital Signs
- Bandaging/splinting
- Obstetrics
- Blood Glucose Monitoring
- Salbutamol treatments
ALS vs BLS
BLS :
- CPR
- Artificial Ventilation
- O2 admin.
- Basic Airway Mx
- Spinal mobilisation
- Vital Signs
- Bandaging/splinting
- Obstetrics
- Blood Glucose Monitoring
- Salbutamol treatments
ALS:
- All BLS skills plus
- ECG Monitoring
- Manual defibrillation
- Advanced airway management
- External transcutaneous pacing
- Fluid therapy
- Needle chest decompression
- Admin. of critical care medication ( adrenaline, etc)
