The ABCDE Approach Flashcards
1
Q
What does ABCDE stand for
A
Airway
Breathing
Circulation
Disability
Exposure
2
Q
How do we assess the Airway
A
- Initial observation
- Audible sound
- Visual inspection
3
Q
How do we assess breathing
A
- Pulse oximetry
- Respiratory rate
- Peak expiratory flow
4
Q
How do we assess circulation
A
- Reported symptoms
- Heart rate/ rhythm
- Blood pressure
- Capillary refill time
5
Q
How do we assess disability
A
- Capillary blood glucose
- AVPU
- Pain
6
Q
How do we assess exposure
A
- Visual inspection
- Professional judgement review
7
Q
How do we investigate Airway
A
- Initial observation
- Audible sound
- Visual inspection
8
Q
How do we assess initial observations when looking at airway
A
Usually patient self reports symptoms of:
1. Breathing difficulty
2. Swallowing difficulty
3. Unusual sensation like something is stuck, itching or burning
9
Q
What are we looking at when assessing audible sound for airway abnormalities
A
- Inability to complete a full sentence in one breath
- Altered voice quality eg sudden hoarseness, rasping
- Unusal sounds when breathing
10
Q
What can speech difficulty be a sign of
A
Airway compromise
11
Q
Describe the sound of normal breathing
A
Usually a quiet state
12
Q
Give examples of different sounds we may here if a patient has an airway problem
A
- Wheeze
- Stridor
- Gurgle
- Cough
- Snore
13
Q
What could potentially cause a wheeze
A
Bronchospasm
14
Q
What could potentially cause a stridor
A
Laryngeal spasm/ swelling/ obstruction
15
Q
What could potentially cause a gurgle
A
Wet foreign body
16
Q
What could potentially cause a COUGH
A
Foreign body or irritant
17
Q
What could potentially cause a snore
A
Partial airway occlusion due to reduced conscious level
18
Q
How do we visually inspect the airway
A
Ask the patient to one their mouth and look for signs of:
1. Swelling
2. Irritation
3. Injury
4. Presence of a foreign body
19
Q
How do we investigate breathing
A
- Pulse oximetry
- Respiratory rate
- Peak expiratory flow
20
Q
What does pulse oximetry allow for
A
Continuous monitoring of oxygen saturations and heart rate
21
Q
What are normal ranges of oxygen saturations dependent on
A
The patients risk for hypercapnia
22
Q
What is hypercapnia
A
Abnormally high levels of carbon dioxide in the blood
23
Q
Who is at higher risk of developing hypercapnia
A
Patients with long term conditions such as COPD
24
Q
A patient at low risk for hypercapnia should have an oxygen saturations of what
A
94-98%
25
A patient at high risk for hypercapnia should have an oxygen saturations of what
88-92%
26
What does respiratory rate tend to respond to
Increased demand of oxygen
27
What is the normal respiratory range for an adult
12-20bpm
28
How does a Childs respiratory rate compare to an adults
Usually children have a higher respiratory rate than adults
29
What does a respiratory rate over 20 suggest
1. Normal response to increased demand
OR
2. Compensatory response to health compromise
30
What does a respiratory rate below 12 suggest
1. Normal response to decreased demand
OR
2. Respiratory exhaustion after prolonged period of compromise
31
In whom do we measure peak flow
Only in patients suspected of asthma
32
What is peak flow
A 'crude' measurement of lung function based on age, height and gender
33
In which patients could peak Flow save lives
Can help us identity "Covert asthmatics' and save lives
34
What can happen to covert asthmatics
They may have a life threatening exacerbation of their asthma without presenting with any of the typical features or appearing outwardly ill
35
What is the problem with peak flow measurements
They only have value when the measurement collected can be compared to a patients normal or best predicted value taken before emergency
36
How do we use emergency peak flow measurements
(Current peak flow/ normal peak flow)* 100 so that we can establish what percentage of the patient’s normal value has been achieved
37
How do we investigate circulation
1. Reported symptoms
2. Heart rate/ rhythm
3. Blood pressure
4. Capillary refill time
38
What symptoms might a patient elf report that could indicate circulation problems
1. Nausea
2. Lethargy
3. Dizziness
4. Faint/ lightheaded
5. Short of breath
6. Palpitations
7. Chest pain
8. Visual disturbances
9. Auditory disturbance
39
What does heart rate respond to
Increased oxygen demand and to changes in circulating volume
40
What is circulating volume also known as
Blood pressure
41
What is the normal heart rate for an adult
60-100bpm
42
How do we measure heart rate
By counting beats at pulse points
43
Name the 2 most comply used pulse points in dental settings
Radial pulse point (wrist)
Carotid pulse point (neck)
44
Where is the radial pulse point found
Wrist
45
Where is the carotid pulse point found
Neck
46
How does a Childs heart rate compare to an adults
As a rule children’s heart rates are higher than adults
47
What can a heart rate above 100bpm suggest
1. Normal response to increased demand
OR
2. Compensatory response to health compromise
48
What can a heart rate below 60bpm suggest
1. Normal response to decreased demand
OR
2. Cardiovascular exhaustion after prolonged periods of compromise
49
Other than heart rate what else can a pulse show us
Abnormal heart rhythm
50
Give an example of an abnormal heart rhythm
Presence of an arrhythmia
51
What is blood pressure a measure of
Circulatory status
52
What does systolic blood pressure measure
The force as the heart contracts
53
What does diastolic blood pressure measure
When the heart relaxes and refill
54
What does systolic blood pressure assess
Perfusion status during acute illness
55
State a normal systolic blood pressure range
111-219
56
What category does a systolic blood pressure of below 90 fall into during acute illness
Critically low
57
What category does a systolic blood pressure of 91-100 fall into during acute illness
Very low
58
What category does a systolic blood pressure of 101-110 fall into during acute illness
Low
59
What category does a systolic blood pressure of below 111-219 fall into during acute illness
Normal
60
What category does a systolic blood pressure of over 220 fall into during acute illness
High
61
What is a critically low systolic blood pressure and what can it suggest
Below 90
Can suggest critical cardiovascular collapse and risk of organ failure
62
What is a very low systolic blood pressure and what can it suggest
91-100
Suggests signs of cardiovascular collapse
63
What is a low systolic blood pressure and what can it suggest
101-110
Can suggest early signs of cardiovascular collapse
64
What is a high systolic blood pressure and what can it suggest
Over 220
Can suggest acute risk of:
1. ACS
2. stroke
3. Kidney damage
4. Eye damage
5. Seizure
65
What is capillary refill time
A 'pride' measurement of circulatory status
66
When do we carry put capillary refill time
When more accurate blood pressure monitoring is not available
67
What are the 2 types capillary refill time
Peripheral and central
68
What is a normal capillary refuel time
Less than 2 seconds
69
How do we calculate peripheral capillary refill time
1. Take the limb to the level of the heart
2. Pinch at the end of the digits (fingernail) for 5 seconds until blanched
3. Release
4. Count how many seconds it takes for the blanched area to return to normal colour
70
How do we calculate central capillary refill time
1. Press on the chest wall for 5 seconds
2. Release
3. Count how many seconds it takes for the blanched area to return to normal colour
71
What does a peripheral CRT of more than two seconds AND a central CRT of less than 2 seconds suggest
Circulation is compromised but is compensating sufficiently to maintain normal central perfusion
72
What does a peripheral CRT of more than two seconds AND a central CRT of more than 2 seconds suggest
Circulation is compromised and is compensating insufficiently so normal central perfusion is not maintained
73
What factors can affect capillary refill time
1. Environment temperature
2. Patient temperature
3, Age
4. Gender
5. Co morbidities
74
How do we investigate disability
1. Capillary blood glucose
2. AVPU
3. Pain
75
When is capillary blood glucose indicated
Indicated in all circumstance when a person has become unwell
76
How is capillary blood glucose taken
Using a glucometer
77
What is a normal capillary blood glucose range
4-8mmol/L
78
What is a capillary blood glucose of less than 4 suggestive of
Hypoglycaemia
79
What is a capillary blood glucose of more than 8 suggestive of
Hyperglycaemia
80
What is AVPU used for
Rapid assessment of consciousness
To establish what level of stimulus is required of a patient to reach an alert state
81
What do we mean by alert state
When a patient can open their eyes and attempt to communicate (conversation or noise)
82
When is an AVPU assessment terminated
As soon as a response has been achieved
83
What does AVPU stand for
Alert
Voice
Pain
Unresponsive
84
Talk through the order in which you would give different stimuli to assess AVPU
1. No stimulus (A)
2. Loud voice (V)
3. Shouting (V)
4. Touch (P)
5. Firm shake (P)
6. ear lobe pinch (P)
If no response to wear lobe pinch we say patient is unresponsive
85
How do we assess pain
SOCRATES
86
What does SOCRATES stand for
Site
Onset
Characteristic
Radiation
Associating symptoms
Time
Exacerbating or reliving factors
Severity
87
How do we investigate exposure
1. Visual inspection
2. Professional judgement review
88
When is a full visual inspection indicated
1. Asthma vs anaphylaxis
2. Acure cardiac ischemia vs anaphylacis
3. Identify potential injuries
4. Hyperventilation vs anaphylaxis
