A to E

Question 1

How do you assess ‘A’ (airway)?

Answer 1

1. Can the patient talk?
   a YES –> move on to B
   b NO –> look for signs of airway compromise eg cyanosis, accessory muscle use, open mouth and inspect

Question 2

What are causes of airway compromise?

Answer 2

Inhaled foreign body
Blood in the airway eg epistaxis, haematemesis
Vomit / secretions in airway
Soft tissue swelling
Local mass effect eg from tumour
Laryngospasm eg asthma, GORD

Question 3

What interventions can be done for someone with airway compromise?

Answer 3

1. Head-tilt chin-lift (+ sweep)
2. Jaw thrust (? spinal injury)
3. Guedel / NPA
4. CPR

Question 4

How do you assess ‘B’ (breathing)?

Answer 4

1. Review patient’s RR (Brady –> sedation, raised ICP, exhaustion) (Tachy –> asthma, pneumonia, PE, heart failure)
2. Review patient’s SpO2 (low in PE, aspiration, COPD, asthma)
3. Inspect
4. Tracheal position
5. Chest expansion
6. Percussion
7. Auscultation

Question 5

What investigations might you order for B?

Answer 5

ABG (if low SpO2)

CXR (if lung pathology suspected)

Question 6

What interventions can be done for someone with breathing compromise?

Answer 6

1. Sit patient up
2. Oxygen (15L non-rebreathe, or 4L Venturi mask in COPD/ non-invasive ventilation in T2 respiratory failure)
3. CPR
4. Nebulisers, steroids (asthma)
5. as above + abx in COPD exacerbations

Question 7

How do you assess ‘C’ (circulation)?

Answer 7

1. Review HR (Brady –> ACS, IHD, hypoK+, drugs) (tachy –> hypovolaemia, arrhythmia, infection, drugs, pain, hypoglycaemia)
2. Review BP (hypo –> hypovolaemia, sepsis, drugs) (hyper –> hypervolaemia, stroke, Cushing’s, pre-eclampsia)
3. Fluid balance assessment (urine output, oral / IV fluids)
4. General inspection (pallor, oedema)
5. Palpation (temp, cap refill)
6. Pulse and BP
7. JVP
8. Auscultation
9. Ankles and sacrum

Question 8

What investigations might you order for C?

Answer 8

1. Wide-bore cannula
2. FBC, U+E, LFT (+ others eg lactate, cultures, coagulation, troponin, group + save, D-dimer)
3. ECG
4. Bladder scan
5. Urine pregnancy test
6. Sputum / urine / line cultures
7. Fluid output / catheterisation

Question 9

What interventions can be done with someone with circulation compromise?

Answer 9

1. Fluid resus (hypovolaemia - Hartmann’s 500ml bolus, then 250ml after to avoid overload)
2. CPR
3. MONA for ACS
4. Sepsis 6 (BUFALO)
5. Blood products for haemorrhage
6. Diuretics for fluid overload
7. Rate / rhythm control for AF

Question 10

How do you assess ‘D’?

Answer 10

1. Assess consciousness (AVPU, GCS)

2. Pupils (size, symmetry, direct and consensual reflexes)

Question 11

What are causes of depressed consciousness?

Answer 11

Hypovolaemia
Hypoxia
Hypercapnia
Hypoglycaemia
Seizure
Raised ICP / stroke
Drug overdose / opiates (can be iatrogenic)

Question 12

What are causes of abnormal pupil responses?

Answer 12

Pinpoint pupils –> opioid overdose
Dilated pupils –> TCAD overdose
Asymmetrical pupils –> IC pathology eg stroke, SOL, raised ICP

Question 13

What investigations might you order for D?

Answer 13

1. Capillary blood glucose
2. Blood ketones
3. CT head

Question 14

What interventions can be done with someone with disability?

Answer 14

1. Maintain airway
2. CPR
3. Naloxone for opioid toxicity
4. IV glucose for hypoglycaemia
5. IV fluids and insulin for DKA

Question 15

How do you assess ‘E’ (exposure)?

Answer 15

1. Inspection (rashes, bruising, ulcers, lines, calf swelling, active bleeding, catheter, drains)
2. Bleeding - estimate total lost and rate of loss
3. Temperature - consider warming in hypothermia

Question 16

What interventions can be done for E?

Answer 16

1. Haemorrhage (large-bore IV access, request blood products)
2. Infection –> sepsis 6, local guidelines re abx
3. Well’s score for DVT
4. CPR