PERI - EWS & Assessment of the critically ill patient (ABCDE)

Question 1

Early Warning Score

Criterias
Thresholds for Assessment

Answer 1

1. ) Criteria
   - temp: 0 = 36-38, 3 = <35
   - HR: 0 = 50-90, 3 = >130,
   - sysBP: 0 = 110-220, 3 = <90 or >220
   - RR: 0 = 12-20 , 3 = >25 or <8
   - spO2: 0 = >96, 3 = <91, any additional O2 = 2
   - AVPU: 0 = A, 3 = V, P, U
2. ) Thresholds for Assessment
   - low (0-4): continue to monitor 4-6 hourly
   - medium (5+/3in1): need seeing, monitor 1 hourly
   - high (7+): must be assessed immediately (A-E)

Question 2

Airway

Clinical Assessment
Interventions
Other Interventions

Answer 2

1. ) Clinical Assessment
   - can the patient talk? if so move on to breathing
   - signs: cyanosis, see-saw breathing, using accessory muscles, added/↓breath sounds
   - inspect for anything obstructing the airway
2. ) Interventions - seek immediate help from an anaesthetist and crash team
   - head-tilt chin-lift manoeuvre or jaw thrust
   - airway adjunct: oropharyngeal (Guedel) or nasopharyngeal airway (contraindicated in basilar skull fractures)
   - laryngeal mask airway, endotracheal tube
   - CPR if unconscious and no signs of life
3. ) Other Interventions
   - IM adrenaline (500mg) if anaphylaxis

Question 3

Breathing

Clinical Assessment
Investigations
Interventions

Answer 3

1. ) Clinical Assessment
   - RR, spO2
   - cyanosis, SOB, cough, stridor/wheeze, auscultation, percussion, chest expansion, tracheal position
2. ) Investigations
   - ABG (low spO2), portable CXR (lung pathology)
3. ) Interventions
   - oxygen, see management of acute severe asthma and acute exacerbation of COPD

Question 4

Circulation

Clinical Assessment
Investigations
Interventions/Common Conditions

Answer 4

1. ) Clinical Assessment
   - HR, BP, fluid balance assessment, auscultation
   - pallor, oedema (limbs, abdomen/ascites)
   - temperature, CRT, pulses, JVP
2. ) Investigations
   - blood tests, ECG, bladder scan, preg test
   - other cultures/swabs, catheter (monitor urine output)
3. ) Interventions/Common Conditions
   - hypovolaemia (fluid resus), sepsis (6), fluid overload (diuretics), ACS, haemorrhage, AF (digoxin + bisoprolol)
   - vasopressors: noradrenaline, adrenaline

Question 5

Disability

Consciousness
Investigations/Interventions

Answer 5

1. ) Consciousness
   - AVPU, GCS, pupillary light reflexes, review drug chart
   - GCS <8 requires expert help from anaesthetist, also make sure their airway remain patent
2. ) Investigations/Interventions
   - DKA: meaure BM and ketones, give IV fluids + insulin
   - hypoglycaemia: glucose
   - intracranial pathology: CT head
   - opioid toxicity: naloxone

Question 6

Exposure

Clinical Assessment

Answer 6

1. ) Clinical Assessment
   - pain, rashes, bruising, active bleeding
   - DVT, signs of infection, temperature
   - review surgical wounds: bleeding, infection