Optimising Function Flashcards
What is the ABCDE approach?
A - airway: head tilt chin life, suctioning, recovery position, oxygen, help
B - breathing: position, drugs, support ventilation (bag-valve-mask) (good lung down)
C - circulation: capillary refil, HR, BP, pulse palpation, urine output. Consider hypovolaemia (low fluid): large bore cannulae, bloods, fluid replacement, ECG.
D - disability: reversible causes, pupil size and reactivity, ACVPU or GCS, blood glucose: correct abnormal blood sugar levels, lateral position, consider airway support.
E - exposure: head to toe examination.
Then complete full history/review to handover.
What is sepsis?
Arises when the body’s response to an infection injures its own tissues and organs.
Organ dysfunction due to a dysregulated host response to infection.
Septic shock is when circulatory, cellular and metabolic abnormalities increase mortality.
What are the symptoms of sepsis?
S lured speech or confusion
E xtreme shivering or muscle pain
P assing no urine (in a day)
S ever breathlessness
I t feels like you are going to die
S kin mottled or discoloured
Will begin to be catabolic (lose muscle mass)
What are the common causes of sepsis?
Meningitis
Skin or soft tissue infection
Catheter related infection
Urinalysis tract infection
PNEUMONIA
Bloodstream infection
Abdominal infections (appendicitis, infectious diarrhoea, gallbladder infection).
What is the treatment of sepsis?
Fluids
Antibiotics
Vasopressors
Enteral feeding
Insulin therapy
Lung protective ventilation
Urinary catheter
What are the quality checks for a chest x-ray?
Inclusion - whole chest is in view
Projection - PA or AP (department vs mobile)
Rotation - clavicle equidistant from spinous processes
Exposure - should identify inter vertebral spaces
Adequacy of inspiration - taken full breath in so diaphragm is down - count 6 ribs anteriorly
Artefact -
What is the A to E assessment for analysing x wrays?
Airway
Bones and soft tissues - fractures, density, symmetry
Cardiac shadow - lingula
Diaphragm - cardiofrenic and costofrenic angles
Eventually - the lung fields. Upper, middle and lower zones (not lobes)
What is the hilar point in the lungs?
Enlarged could suggest oedema
What is consolidation on lung x rays?
Presents as white and patchy
Consistent with pneumonia
Often confined to segment or lobe
No shift in structures
May be air bronchogram (patent airway)
What is Atelectasis? And what does it look like on a lung x ray?
Lung collapse where small airways start to close
Presents as a more uniform white/opaque area
May be lobar or whole lung
What does a pneumothorax look like on a lung x ray?
Between visceral and parietal pleura is an air leak
What is pleural effusion? What does it look like on an x ray?
Fluid in the lungs
Dense white opaque area
Best seen in upright film
A meniscus of air/fluid level may be present
A large effusion may push structures over to the opposite side of the
What does hyperinflation look like on a lung x ray?
Dark lung fields
Flattened diaphragm
Elongated heart
Presents in obstructive lung disease eg ``COPD, `cg and Bronchiecstasis.
What does pulmonary oedema look like on a chest x ray?
Caused by fluid linking from the interstitial tissues into the alveolar and small airways, and manifests as consolidation
In acute pulmonary oedema, alveolar oedema radiates symmetrically from the hilar regions in a bats wing distribution of airspace shadowing.
What does gas transport and exchange require?
Ventilation (airflow, chest wall expansion, lung compliance)
Perfusion
Ventilation/perfusion matching
O2 delivery to the tissues (heart, vascular system, blood)
O2 extraction at the level of the tissue (perfusion)
