Clinical 8: ABCDE and NEWS2

Question 1

What intervention can be used for a compromised airway?

Answer 1

Jaw thrust/chin lift
Oropharyngeal airway
Recovery position

Question 2

What intervention can be used for compromised breathing?

Answer 2

Apply oxygen
Consider ventilatory support (NIV, CPAP, IPPV)
Consider sepsis and give IV antibiotics

Question 3

What is the intervention for a compromised circulation?

Answer 3

IV fluids
Intravenous access
Consider sepsis and give IV antibiotics

Question 4

What is the intervention for a compromised neurological status? (disability)

Answer 4

Secure airway
Check blood glucose
Consider sepsis and give IV antibiotics

Question 5

What would you look for in an airway exam?

Answer 5

Obstructions
Swellings
Secretions
See swaing
Colour (Cyanosis around mouth)

Question 6

What are some examples of added airway signs?

Answer 6

Snoring - arises when the pharynx is partially occluded by the tongue or palate
Stridor
Gurgling

Question 7

What is stridor?

Answer 7

An additional airway sound
High pitched upper airway obstruction
More commonly heard in inspiration.
Can be caused by croup, foreign body obstruction, epiglottitis.

Question 8

What causes the gurgling airway sound?

Answer 8

If the patient has liquid (blood, vomit) this could cause gurgling

Question 9

What causes a choking lound sound?

Answer 9

Due to obstruction in the upper airway

Question 10

In a hospital setting what should you do if a patient has a compromised airway?

Answer 10

Immediate crash call
Uregent anaesthetic input to secure the airway
ENcourage to cough and clear their own obstruction
Adjust position -e.g recovery position or sit upright
Airway adjuncts - nasopharyngeal airway or oropharyngeal airway.
Suction for secretions
Remove visible obstructions

Question 11

What are some common causes of upper airway obstruction?

Answer 11

Tumour
Anaphalyaxis
CNS depression
Foreign body inhalation
Secretions
Infection (epiglottitis, pharyngeal abscess)
Larynogospasm
Trauma
Blocked trachestomy

Question 12

What are the different indication of use between a nasopharyngeal airway and a oropharyngeal airway?

Answer 12

Naso -semi conscious
Oro - if able to tolerate, indicates seriously unwell as no gag reflex

Question 13

What are the risk of an oropharangyeal airway?

Answer 13

Aspiration
Gagging

Question 14

What should you do to assess patient breathing?

Answer 14

Oxygens aturation and respiratory rate
Respiratory distress - sweating, central cyanosis, accessory muscles
Ausulatate both lungs
Palpate and percuss to assess chest expansion of both sides

Question 15

What is the potential cause of tachypneoa?

Answer 15

Hypoxia or hypercapnia
Nay be caused by infection

Question 16

What is the potential cause of bradypnoea?

Answer 16

Impaired consciousness or drugs which affect respiratory drive (opioids)

Question 17

What are the different abnormal percussion noises in a pneumothorax?

Answer 17

Hyperresonance - pneumothorax
Dull - fluid/infection/blood

Question 18

What does crackles in the lung indicate?

Answer 18

Coarse crackles - pus in lungs
Fine crackles - fluid

Question 19

What is a pleural rub lung sound indicate?

Answer 19

Pleural effusion
Snow crunching sound

Question 20

What is the cause of a wheeze as a respiratory sound?

Answer 20

Bronchocontrsitction - if polyphinic
Distal airway obstruction - if monophonic

Question 21

What causes reduced respiratory drive?

Answer 21

Reduced conscious level
CO2 narcosis

Question 22

What causes reduced respiratory effort?

Answer 22

Chest wall deformities, kyphosis, scoliosis
Neuromuscular disorders
Trauma (fractured ribs)

Question 23

What are some common causes of respiratory pathology?

Answer 23

Infection - pneumonia, empyema
Pulmonary embolus
Pneumothorax, Haemothorax

Question 24

What are some common causes od respiratory failure?

Answer 24

Reduced respiratory effort
Pathology
Reduced respiratory drive

Question 25

What investigations might you do if a person has compromised breathing?

Answer 25

Arterial blood gas
Chest x-ray.

Question 26

In a hospital setting what interventions should you do to assist breathing?

Answer 26

Oxygen through a non-rebreath mask - aim for above 94% in otherwise health and aim for 88-92% in COPD
Assissted ventilation through a bag-valve-mask: 12-15bpm

Question 27

How do you assess a patients circulation?

Answer 27

Look of digit colours
Look for signs of bleeding
Ausultate heart
Feel peripheral and central pulses (rate, rhythm, character, volume)
Check blood pressure and capillary refill time

Question 28

What investigation will you do on a patient with suspected circulation?

Answer 28

Blood sample
Heart rhythm on ECG

Question 29

What are some signs of circulatory problems?

Answer 29

Abnormal HR
Adbnormal BP
Pulse variation in rhythm, volume, character of absent
Decreased or absent urine output

Question 30

How should you take a blood test from a patient with suspected circulatory problems and what should you test for?

Answer 30

When cannulated
Troponin 1 or T (from damaged cardiac cells in MI)
FBC - Hb, platelets, infection (CRP)
Urea and electrolytes - renal function
Liver function tests and clotting
Serum glucose

Question 31

In a hospital setting what intervention should you use for a patient with a compromised circulation?

Answer 31

Secure IV acess - 2 large bole cannulas
IV fluids - Hartmanns

Question 32

How to assess disability in a patient?

Answer 32

Blood glucose
Pupillary reflexes and appearance
AVPU or GCS

Question 33

What can cause vasoconstriction of the pupils?

Answer 33

Bilateral pin point - secondary to opiates

Question 34

What can cause vasodilation of the pupils?

Answer 34

Cocaine, anphetamine - recreational drugs
Overdose from prescription drugs normally anti-depressants
Brain injury

Question 35

What are some common causes of unconsciousness?

Answer 35

TIPPS Vs vowels
Trauma
Infection
Poision
Psychiatric
Shock
Vascular
Alcohol
Epilepsy
Insulin
Opiods
U/Es

(in hospital also just check if asleep)

Question 36

How do you check the exposure of a patient?

Answer 36

Check temperature
Urine output
Expose to check for bleeding, rashes, injuries and bruises

Question 37

How should you handover a patient?

Answer 37

ISBAR

Identity of patient - name,age,ward,team
Situation - symptom, problem, stability, level of concern
Background - history of presentation, date of admission and diagnosis, relevant past medical hx
Assessment and Action - impression of the situation, what have you done so far
Response and rational - what investigation need doing, what needs monitoring, plan depending on results

Question 38

What six physiological parameters are included in the NEWS score?

Answer 38

Respiratory rate
Oxygen saturation
Temperature
Systolic blood pressure
Pulse rate
Level of consciousness

Question 39

What additional considerations should be made when looking at news score?

Answer 39

End of life patient - tend to have higher scores
Impaired consciousness due to drugs/sedation after surgery - decreased disability score
COPD - lower O2 sats - higher would be damaging

Question 40

What are the appropriate NEWS thresholds and responses?

Answer 40

O-4 indicates low risk - ward based response
Score of three in any individual - low to medium risk - urgent ward based response (training in acutely ill care and when to escalate to critical care)
5-6 - medium risk - key threshold for urgent response (critical care skills such as airway management)
7 plus - urgent or emergency response

Question 41

What is the score range of a NEWS chart?

Answer 41

0-18

Question 42

How does the NEWS score value indicate how often vitals should be monitored?

Answer 42

O - minimum 12 hours
1-4 - min 4-6 hours
3 in single parameter - every hour
Total 5 or more - every hour
Total 7 or more - continuous