A-E Assessment Flashcards
State what each of the letters in A-E stands for
- Airway
- Breathing
- Circulation
- Disability
- Exposure
Usually, if you are performing A-E on an acutely unwell pt you will have received a handover from whoever has called you (e.g. nurse) which includes name, age, background and reason to review. What should your next steps be before you even start your A-E assessment?
- Ensure pts notes, drug charts etc.. are accessible and if not ask the nurse to get them for you at the end of handover
- Introduce yourself to pt
- Ask how they are feeling
How do you assess the airway?
- Can pt talk?
- If talking fine, airway is patent
- If struggling to talk, consider is airway threatened?
- If unable to talk and no inspiratory effort airway is obstructed
If the patient is unable to talk and you think the airway is compromised, what should you then look for?
- Open mouth & inspect for obstruction
- Any signs of airway obstruction:
- Cyanosis
- Accessory muscles
- Diminished breath sounds
- Added sounds
State some possible causes of a compromised airway
- Inhaled foreign body: symptoms may include sudden onset shortness of breath and stridor.
- Blood in the airway: causes include epistaxis, haematemesis and trauma.
- Vomit/secretions in the airway: causes include alcohol intoxication, head trauma and dysphagia.
- Soft tissue swelling: causes include anaphylaxis and infection (e.g. quinsy, necrotising fasciitis).
- Local mass effect: causes include tumours and lymphadenopathy (e.g. lymphoma).
- Laryngospasm: causes include asthma, gastro-oesophageal reflux disease (GORD) and intubation.
- Depressed level of consciousness: causes include opioid overdose, head injury and stroke.
If you find an airway is compromised, you must escalate immediately. What other things can you do to try and maintain the airway?
- Head tilt chin lift
- Jaw thrust (if pt been in trauma and there is potential spinal trauma)
- Oropharyngeal (Guedel) airway (only if pt unconscious)
- Nasopharyngeal airway (not to be used if you suspect pt may have skull base fracture)
- CPR (if pt loses consciousness and there are no signs of life)
- Other e.g. in anaphylaxis give IM adrenaline
What do you assess in the breathing section of your A-E?
- Work of breathing & general appearance
- SpO2
- Trachea
- RR
- Expansion, auscultation, percussion
What investigations may you order to complete the breathing section of your A-E assessment?
- Arterial blood gas
- Portable CXR
If during your assessment of breathing, you found the pt had low saturations what would you do?
- Oxygen
- If want to give 15L must use non-rebreathe mask
- If pt has COPD aim sats for 88-92% and consider venturi mask (24% for about 2-3L, 28% for about 4L)
- Sit pt upright if possible
- If asthma, COPD etc… consider use of inhalers
What do you assess in the circulation part of your A-E assessment?
- HR
- BP
- Heart sounds/auscultate
- Fluid status:
- Cap refill
- JVP
- Urine output
- Peripheral oedema
What investigations/procedures may you order to complete the circulation part of your A-E assessment?
- ECG
- Get a cannula in
-
Blood tests you should always order:
- FBC
- U&E
- LFTs
- Blood tests you may order dependent on pt:
- Sepsis: CRP, lactate and blood cultures
- Haemorrhage or surgical emergency: coagulation and cross-match
- Acute coronary syndrome: troponin
- Arrhythmia: calcium, magnesium, phosphate, TFTs, coagulation
- Pulmonary embolism: D-dimer (if appropriate based on Well’s score)
- Overdose: toxicology screen (e.g. paracetamol levels)
- Anaphylaxis: consider serial mast cell tryptase levels
- Consider catheter if you don’t have strict fluid balance info
- Consider pregnancy test in woman of child bearing age with evidence of shock, abdo pain or gynae symptoms
During your assessment of circulation, you find the pt is hypovolaemic. What do you do?
- Administer fluids (0.9% saline or Hartmann’s):
- 500ml over 15 mins
- 250ml over 15 mins if pt at increased risk of heart failure
Repeat up to 4 times, re-assessing each time before you administer more. In your assessment you should look at BP, cap refill but also look for signs of fluid overload e.g. raised JVP or lung crackles). If pt isn’t responding or there is negative response (e.g. increased chest crackles seek senior input.
What do you assess in the disability stage of your A-E assessment?
- AVPU (alert, voice, pain, unresponsive)
- GCS
- Pupils
What investigations may you do to support your disability section of the A-E assessment?
- BMs
- CT head
What do you assess in the exposre part of your A-E assessment?
- Temperature
-
Inspection:
- Rashes
- Bruises
- Signs of infec
- IV lines
- Surgical wounds
- Drains/catheters
- Calves
- Abdomen
- Bleeding e.g. PR bleed
