Recognising Deterioration and Preventing Cardiorespiratory Arrest

Question 1

Escalation protocol based on EWS Score - Score of 0?

Answer 1

Minimum 12 hourly

Continue routine NEWS monitoring

Question 2

Escalation protocol based on EWS Score - Score of 1-4?

Answer 2

Minimum 4-6 hourly

Inform registered nurse, who must assess the patient

Registered nurse decides whether increased frequency of monitoring and / or escalation of care is required

Question 3

Escalation protocol based on EWS Score - Score of 3 in single parameter?

Answer 3

Minimum 1 hourly

Registered nurse to inform medical team

Question 4

Escalation protocol based on EWS Score - Score of Total 5/6?

Answer 4

Minimum 1 hourly

Registered nurse to inform medical team caring for this patient

Urgent assessment with clinician with competencies of acute ill patient

Clinical care with monitoring facilities

Question 5

Escalation protocol based on EWS Score - Score of Total 7 or more?

Answer 5

Continuous vital sign monitoring

Immediately inform medical team - at least SpR level

Emergency assessment

Consider transfer to Level 2/3 care

Question 6

MET Calling Criteria - Airway?

Answer 6

Threatened

Question 7

MET Calling Criteria - Breathing?

Answer 7

All respiratory arrests

RR <5

RR >36

Question 8

MET Calling Criteria - Circulation?

Answer 8

All cardiac arrests

Pulse rate <40

Pulse rate >140

SBP <90

Question 9

MET Calling Criteria - Disability?

Answer 9

Sudden decrease in level of consciousness

Decrease in GCS >2 points

Repeated or prolonged seizure

Question 10

MET Calling Criteria - Exposure?

Answer 10

Any patient causing cancer who does not fit above criteria

Question 11

ABCDE Approach - Airway - Causes?

Answer 11

Complete or partial

Partial can cause cerebral or pulmonary oedema, exhaustion, secondary apnoea, hypoxia, cardiac arrest

CNS Depression
Head injury
Trauma
Blood/Vomit
Foreign body
Epiglottis
Hypercapnia
Depressant medications
Drugs (alcohol, opioids, GA)
Laryngospasm
Blocked tracheostomy

Question 12

ABCDE Approach - Airway - Look Listen Feel?

Answer 12

Choking
Distress

Partial - noisy breathing
Complete- silent

See-Saw or Rocking Horse pattern of chest and abdomen

Question 13

ABCDE Approach - Airway - Treatment?

Answer 13

Suction
Turn patient on side if blood/vomit
Oxygen 15L NRM
Simple airway manœuvres - head tilt/chin lift or jaw thrust
Oropharyngeal/Nasopharyngeal airway
Intubation/Tracheostomy

Question 14

ABCDE Approach - Breathing - Causes?

Answer 14

Chronic or acute respiratory issues (pneumonia, pneumothorax, haemothorax, ARDS, PE, Pulmonary oedema)
Decreased respiratory drive
Muscle Weakness (GBS, MND, MS)
Kyphoscoliosis
Fractured ribs
HYpoxaemia

Question 15

ABCDE Approach - Breathing - Look Listen Feel?

Answer 15

Hypercapnia - irritability, confusion, lethargy

RR >25

Look
- Sweating, central cyanosis, use of accessory muscles of respiration and abdominal breathing
- JVP

Listen
- Breath sounds near face, rattling, stridor, wheeze

Feel
- Percuss chest
- Chest expansion, pattern of breathing
Acidosis and rising CO2
- Tracheal position

Auscultation Chest

Question 16

ABCDE Approach - Breathing - Treatment?

Answer 16

O2 15L NRM (aim 94-98% or 88-92% in hypercapnia RF)

ABG

Early needle decompression for tension pneumothorax

Bag-Mask Ventilation if breathing inadequate or absent

NIV/I&V

Question 17

ABCDE Approach - Circulation - Causes?

Answer 17

Ischaemia
Arrhythmia
Hypertension
Valvular Disease
Drugs (Antiarrhythmic, TCA, digoxin)
Inherited cardiac conditions (Long QT)
Acidosis
Abnormal electrolytes
Hypothermia
Electrocution

Secondary - blood loss, hypoxia, sepsis

Question 18

ABCDE - Circulation - Recognition?

Answer 18

Look
- Colour of hands and digits
- JVP

Feel
- Limb temperature
- CRT centrally or peripherally
- Peripheral and central pulses (presence, rate, regularity, volume)
- Blood pressure

Listen
- Auscultation heart sounds

Urine output
Haemorrhage

Question 19

ABCDE Approach - Circulation - Treatment?

Answer 19

IV Access (Large bore 14/16G)/ IO if unable

Bloods

ECG

IV fluids to treat hypovolaemia 500ml warmed crystalloid over less than 15 minutes if shock (250ml if CCF)

Inotropic support

If ACS - Initiate TreatmentA

Question 20

ABCDE Approach - Disability - Assessment?

Answer 20

Check drugs chart

Examine pupils

AVPU/GCS

Blood glucose (10% glucose 250mls)

Question 21

ABCDE Approach - Exposure - Assessment?

Answer 21

Full exposure

Rashes

Take full history

Review notes/charts

Review level of care needed