SIM prep ABCDE

Question 1

What does the ABCDE approach stand for?

Answer 1

Airway
Breathing
Circulation
Disability
Exposure

Question 2

What is the purpose of an A-E assessment?

Answer 2

Primary survey
Fast, focussed examination of an acutely unwell patient.
Identifies and aims to treat the most life-threatening problems first.

Question 3

What are the initial steps in a SIM scenario?

Answer 3

Introduce yourself and ask for some patient background
Prep - aks nurse for full set of obs including a BM
Intercation - ask patient if they are responsive how they are doing.

Question 4

What is included in the Airway assessment?

Answer 4

CE - cyanosed, speech, abnormal sounds, mouth and neck
Investigations
Interventions - head tilt, chin lif, OPA,NPA, iGel, Suction

Question 5

What shoud always be included in an assessment of breathing?

Answer 5

Resp 12-20 norm
O2 sats 94-98% or 88-92%
Chest movement should be equal
Ausculation, air entry, wheeze
Give oxygen, ABG, CXR

Question 6

What is the ideal amount of oxygen to typically administer in an A-E assessment?

Answer 6

Start with a 15L via a non-rebreath mask and titrate according to response, aiming for 94-98% or 88-92% if they have COPD.

Question 7

What is included in the circulation assessment for an A-E assessment?

Answer 7

Pulse rate
Blood pressure
Hydration status (mouth dry)
Capillary refill ,2 seconds (peripheral and central)

May need to establish large bore access, give fluid and an ECG.
Full set of bloods

Question 8

What is the normal SIM scenario response to low BP and high HR?

Answer 8

Questoin haemorrhage and infection
Ask for IV access and 500ml fluid challenge of normal saline please, then recheck observations

Question 9

How can the A(c)VPU scale be used to assess a patients consciousness?

Answer 9

A = alert
C =confusion - new onset or worse confusion than usual
Veral - some kind of response when talk to them
Pain - responds to painful stimulus
Unresponsive - does not show any evidence of an eye, voice or motor response to pain.

Question 10

In disability assessment in A-E what is important to consider about the pupils?

Answer 10

Are the equal and reactive, are they pin point.

Question 11

What do we check for during the exposure section of an A-E assessment?

Answer 11

Rashes
Surgical drains and dressings
Examine abdo for signs of distention/bruising
Check legs - swelling/evidence of DVT/cellulitis
Temp - hot v cole
Allergies

Question 12

What is the emergency treatment for sepsis and asthma attack and anaphylaxis in a SIM?

Answer 12

Antibitoics
Salbutamol nebuliser
Adrenaline