Emergency and CPR Flashcards
Signs of deterioration (7)
- pyrexia
- tachypneoa
- tachycardia
- bradycardia
- hypotension
- altered LOC
- oliguria
Deteriorating patient- Pyretic (normal range, s/s, for infants)
normal temp: 36.5 - 37.5
> 38 febrile (moderate to high)
> 40 hyperpyrexia (life threatening)
s/s: shivering, headache, delirium
infants: at risk of febrile seizures <5 yr
Deteriorating patient- Tachypnoeic (normal and abnormal range, s/s)
normal range: 12-20bpm
> 20= tachypnea
s/s: cyanosis, use of accessory muscles, intercostal ribs (infant)
Deteriorating patient- Tachycardia (normal range, possible causes, meds)
normal range: 60-90bpm
> 90bpm = tachycardia
possible cause: bleeding, heart failure, pulmonary embolism, sepsis, hypotension
meds: GTN, salbutamol, adrenaline
Deteriorating patient- bradycardia (value, causes, s/s)
normal range: 60-90bpm
<60bpm bradycardia
Possible causes: myocarditis, CHF, hypothyroidism, heart meds, inflammatory disease like lupus kr rheumatoid fever
S/s: SOB, fatigue, fainting, dizzy
Deteriorating patient- hypotensive
- indicates a compromise of body function
- determined by cardiac output and vascular resistance
- low BP may be due to organ failure from poor perfusion
- orthostatic hypotension: common in senior due to narrowed vasculatures
Deteriorating patient- altered level of consciousness (assessment tools, possible cause, s/s)
assessment tools:
1. Glascow coma scale E4 V5 M6
2. AVPU- awake, verbal, pain, unresponsive
possible cause: hypoglycemia, head injury, hypoxia
s/s: cofnusion, drowsiness, vagueness, restlessness
Deteriorating patient- Oliguric (patho, range)
patho: blood supply keep organs going. during deterioration blood focus on heart = decreased of other organ function (primary > secondary organs)
oliguric range: 100-400ml urine in 24 hrs
anuria: 0-100ml in 24hrs
- associated with low circulatory blood volume
General/Primary Survey
mnemonic: “Mentor Exercising Causes Sweating”
- Mentation (mental activity)
- earliest sign of inadequate oxygenation is change in mentation
- AVPU - Colour
- pigmentation and oxygenation and perfusion in the capillaries - Diaphoresis (sweating)
- sign of maximal sympathetic stimulation; using all energy to maintain vital signs - Effort and fatigability
- how hard the patient is working to maintain vital signs?
management of the deteriorating patient (11)
- early recognition
- ABCDE
- Call for help
- Oxygen if <94% O2sat
- Assess vital signs/ EWS/ protocol
- Assess LOC with GCS/AVPU
- Identify cause- check medication hx
- Lie flat/raise legs if hypotensive
- ECG
- Continuous monitoring
- Document everything
Deteriorating patient: A-G Physical Assessment + 3 extra steps COP
Airway
look: obstruction, mouth/neck swelling, hematoma, secure artificial airway
listen: noisy breathing
feel: presence of air, secure artificial airway
Breathing
Circulation
Disability
Exposure
Fluids
Glucose
Call for help
Oxygen
Position
What is SEPSIS?
- dysregulated immune response to an infection that leads to organ dysfunction
Common issues leading to SEPSIS (adult)
- lung infection
- UTI
- gut infection
- skin infection
Stages of SEPSIS
STAGE 1: Local to systemic inflammation
a local infection overcomes the body’s local defence mechanisms. Pathogenic germs and toxins produced leave the original site and enter the circulatory system
STAGE 2: organ dysfunction
general inflammatory response. some organs start to deteriorate or dysfunction
STAGE 3: Septic shock
multiple organ failure. sudden drop in blood pressure
SEPSIS quick recognition checklist and what vital signs might look like
Shivering, fever or feeling cold
Extreme pain or discomfort
Pallor, sweating, discoloration
Sleepy, lethargic, confused
I feel like dying
Shortness of breath
vital signs will look like:
high temp
high HR
low O2sat
low RR
low BP
Reporting acute deterioration- ISBAR
Identification: your role and patient
Situation: vital signs, observations, describe, test results
Background: relevant history of patient
Assessment: potential diagnosis
Recommendation
Hypothermia
- Temp below 35C
- This occurs when the body’s ability to generate heat by burning calories, muscle exertion and shivering is overwhelmed by heat loss.
complications:
- cardiac arrhythmias (heart muscle irritated) (may give amiodarone)
- low pulse, low RR
management:
- dry up
- warming techniques
- seek warm shelter / evacuate
- give food/sweets for more energy to compensate (if tolerable)
- encourage movements/exercise (if tolerable)
Deteriorating patient
Chain of safety
Measure observation and document
Recognise deterioration
Communicate/escalate appropriately
Respond effectively and reassess
Document
Resus guideline
ADULT basic life support: What is DRSABCD and appropriate guideline
Dangers: PPE, clutter, environment
Responsive: AVPU, tap clavicle, squeeze trapezoid
Send help: 111 or 777
Airway: head tilt, chin lift, jaw thrust
Breathing: look, listen, feel
CPR: 30 compression 2 breaths, 100-120bpm, depress 1/3 of chest, hand over lowersternum
Defibrillation
Resus guideline
PAEDS basic life support: What is DRSABCD and appropriate guideline
Dangers: PPE, clutter, environment
Responsive: speak loudly, pinch toes, NEVER shake
Send help: 111 or 777
Airway: chin lift, jaw thrust, neutral for infants
Breathing: look listen feel within 10 secs
CPR: 15 compression 2 breaths, 100-120bpm, depress 1/3 of chest, ONE hand over sternum (child) or 2 fingers/thumb circling (infant)
Defibrillation
Resus guideline
Management of airway obstruction (choking)
Conscious adult:
- encourage coughing
- 5 back blows between shoulder blades while person leans over
- 5 backward chest thrust fist closed encircle the person’s chest
Unconscious adult:
- CPR 30 compressions/2 breaths
Conscious child:
- cough out
- 5 back blows holding the infant in prone position head low
- 5 chest compression flipped over
Unconscious child:
- CPR 15/2
Head trauma- considerations
Opening airway: neck should be held in a neutral position and stabilised. Chin lift or jaw thrust.
Nasopharyngeal airway is not recommended
Resus guideline
AED/defib- definition, indication and considerations
Define: delivers electrical current thru the heart to establish normal cardiac rhythm
Indications: cardiac arrest
Considerations:
- Pad placement (Adult): upper R) chest and below L) chest; (Child): chest and back
- patient needs to be unconscious and not breathing
- remove all clothing
- chest dry
- shave excess hair
Resus guideline
airway management considerations
- Use of suction
- no more than 15 secs - Use of oxygen cylinders
- cardiopulmonary emergencies 10-15L.
- always start at 4L/min on face mask if unsure - Use of oropharyngeal airways (Guedel)
- complications: vocal cord spasm, damage to teeth lips throat, retching, vomiting, aspiration - Ambubag
- E C technique to hold down
- compress bag check that chest rises - Use of nasopharyngeal airway
- indications: control airway, clenched teeth, seizures, semi-conscious pt with compromised airway
