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Acute assessment > general primary assessment > Flashcards

general primary assessment Flashcards

1
Q

Pre-assessment (5 fts)

A

(1) Identity of patients
(2) Basic info - NEWS score/PC
(3) Introduce yourself - to pt and ward
(4) PPE + handwashing
(5) general assessment of severity

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2
Q

Pre-assessment main three outcomes

A
  • arrest/peri-arrest (based on vitals/observation) - send out arrest call
  • poorly but not arresting - A-E
  • Fairly comfortable - general A-E approach + focused history
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3
Q

Assessment of airways

A
  • maintains airway = talking

- compromised airway = reduced consciousness; additional noises (gargling, snoring, stridor, secretions)

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4
Q

Action in A - obvious obstruction

A
  • vomit/fluid = suction

- object/food = use forceps if confident it is accessible

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5
Q

Action in A - additional noises

A

= opening airways

  • if no concerns about C-spine injury = head tilt, chin lift
  • if ? C-spine injury = jaw thrust
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6
Q

Action in A - persistant occlusion or reduced consciousness

A

= airway adjunts

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7
Q

List types of airway adjuncts

A
  • Nasopharyngeal airway
  • Oropharyngeal airway/Guddel
  • Laryngeal Mask Airway (LMA)/iGel
  • Endotracheal tube (ET) = requires anaesthetist
  • Surgical circothyroidectomy
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8
Q

Indications and contraindications for a Nasopharyngeal airway

A

Indication: more conscious (better tolerated)
Contraindication: ?basal skill fracture (panda eyes, mastoid bruising, ear bleeding) bc can go through the cribiform plate

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9
Q

Indication for an Oropharyngeal airway/Guddel

A

if tongue is obstructing airway (less consciouss)

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10
Q

Indications for a supraglottic airway - Laryngeal Mask Airway (LMA)/iGel

A
  • more definitive airway w/out specialist needed
  • closes off epiglottis = prevents aspiration (unconsciouss + secretions)
  • can aspirate stomach contents
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11
Q

Indications for an endotracheal tube (ET)

A
  • unable to protect airway (GCS < 8, risk aspiration, need muscle relaxants)
  • potential for obstruction (airway burns/haematoma, epiglottitis)
  • inadequate ventilation/oxygenation (severe resp failure/head injury)
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12
Q

Indications for surgical cricoidectomy

A
  • acute upper airway obstruction prevents the insertion of an ET
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13
Q

Breathing assessment

A
  • General - cyanosis; increased WOB
  • pulse oxymetry - >94%; if known resp disease >88
  • respiratory rate - 12-22bpm
  • chest examination - cyanosis (perihperal/central); tracheal deviation; chest - accessory muscles, expansion, palpation, auscultation
  • calf tenderness
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14
Q

Causes of bradypnoea

A

= depressed respiratory drive

  • reduced consciousness
  • drug-induced = benzodiazepines or opiates -> counter w/ naloxone
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15
Q

Breathing - investigations to order (3)

A

(1) gas - ABG if underlying resp disease/very low sats; otherwise VBG
(2) CXray - consider if portable is needed
(3) sputum culture

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16
Q

Breathing - management of hypoxia

A
  • proning (sitting up)
  • Oxygen therapy - 15L non rebreathe mask; if known retainer/underlying resp start with 2-4L venturi aiming for stats 88-92%
  • if continues hypoxic/hypercapnic at max therapy = non-invasive/invasive ventilation
  • treat obvious cause
17
Q

Breathing management - wheeze

A

bronchodilator therapy

  • Salbutamol 2.5mg neb
  • Ipratropium 500mg neb
18
Q

Circulation assessment (6)

A
  • BP - hypovolaemia <100 systolic
  • HR - 60-100bpm; regularity
  • Central cap refill/peripheral temperature
  • JVP <4cm over sternal angle
  • Heart auscultation
  • Hydration - dry/overloaded - check mucous membranes + peripheral oedema
  • press on abdomen to ?bleed
19
Q

Circulation general management

A
  • fluid balance - record intake and excretion
  • place wide bore Cannula + take bloods (VBG +/- cultures)
  • any arrhythmia = 3-lead cardiac monitoring
20
Q

Circulation management of hypotension

A

fluid challenge

  • 500mL Hartman’s/Saline 0.9% STAT
  • if very small/known risk of overload (HF/frail elderly)= 250mL
  • monitor response by HR, BP and urine output
21
Q

Circulation - management of shock

A
  • 2 larger bore cannulae
  • take bloods - VBG + G&S/crossmatch
  • fluid challenge = 1L Hartman’s/Saline 0.9%
  • if blood loss replace blood : typing takes 15mins so start with O neg + 2222/lab to activate massive blood loss protocal (for red cells + FFP +/- platelets)
22
Q

Circulation - reassessing/escalation

A
  • responds fully: give maintenance fluids
  • responds by BP falls again: more fluids - usually 20-30mL/kg STAT
  • No response: escalate – may be overloaded (needs inotropes), may be very depleated (needs vasopressors)
23
Q

Circulation - initial investigations (5)

A
  • ECG
  • Serum troponin
  • BNP levels (if not known)
  • ECHO cardiogram
  • CXray if not already done - fluid/cardiomegally
24
Q

Disability assessment

A
  • Consciousness - AVPU + ; if more confused use GCS
  • DEFG!! - should be on VBG or do BM
  • Temperature
  • Pupil reactivity
  • Pain
  • Consider NBM
25
Q

Disability - analgesia

A
  • paracetamol - IV over 15mins every 4-6 hrs
    >50kg = 1g, max 3g/day
    <50 is 15mg/kg, max 60mg/kg/day
  • severe pain = morphine 10mg in 10mL saline given slowly
26
Q

Everything else assessment

A
  • Exposure: bleeds, rashes, injuries
  • Focused exam
  • Escalate - handover/inform senior and refer to colleague
  • Document - brief came summary; under A-E headings with findings and managmeent
  • Review results
27
Q

Investigatigations format

A

BOXES

  • Bloods - mark as urgent; ABG (if low sats) or VBG; group&save; FBC, U&E, CRP, LFTs, Clotting + other; capillary glucose; blood cultures (if pyrexial)
  • Orifice tests: test relevant excretions (sputum, urine dip, faeces culture)
  • Xray /imaging
  • ECG +/- 3 lead monitoring
  • Special tests: depending on likely cause

Acute assessment (3 decks)

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