ABCDE Approach Flashcards
2 communication methods for communicating emergency assessment
SBAR - situation, background, assessment, recommendation
RSVP - reason, story, vital signs, plan
Initial steps before ABCDE assessment
Visually assess if the patient appears unwell, then try to get them to respond. If awake = “how are you”, if unconscious = shake them + “can you hear me, are you alright?”
If critically unwell = attach equipment and insert cannula ASAP
Equipment for critically unwell patient
Pulse oximeter
ECG monitor
Cap glucose
Blood pressure monitor
IV cannula + take bloods
3 keys to Airway in ABCDE
1 - Look for signs of airway obstruction
2 - Treat airway obstruction as a medical emergency
3 - Give O2 at high concentration
Signs of airway obstruction
Paradoxical chest + abdominal movements
Use of accessory muscles in respiration
Complete obstruction = no breath sounds at mouth/nose
Partial obstruction = air entry is diminished + noisy
Central cyanosis is a late sign
How to effectively treat airway obstruction
Get expert help immediately
Airway opening manoeuvres, airway suction
Insert oropharyngeal or nasopharyngeal airway
Tracheal intubation if these fail
How to effectively give oxygen in managing Airway in ABCDE
15 L/min by reservoir/non-rebreather (same thing) mask
Aim for 94-98% sats, 88-92% if at risk of hypercapnic resp failure
Key points to assessing Breathing in ABCDE
Assess for signs of respiratory distress or dysfunction - high RR, use of accessory muscles, sweating, central cyanosis
Assess for symmetry - depth of breath, pattern/rhythm, and evenness of chest expansion of both sides
Check for JVP raise or tracheal deviation
Percuss and auscultate chest
Feel chest wall for subcut emphysema/crepitus (=pneumothorax)
COPD patient oxygen management
Venturi 28% mask (4 L/min) or 24% mask (4 L/min) initially and reassess, aiming for 88-92% sats
Take ABGs to assess
Consider non-invasive ventilation (BIPAP)
Assessment of Circulation in ABCDE
Limbs - colour, temperature, cap refill, pulse, blood pressure
Heart - auscultation
Other signs of low cardiac output = reduced conscious level (assess GCS), oliguria if they have catheter (<0.5ml/kg/hr)
Check for haemorrhage from wounds/drains, or evidence of concealed haemorrhage (internal)
Management of Circulation in ABCDE (hypovolaemia, cardiac failure, ACS, immediately life-threatening situations)
If hypovolaemic = 2 large bore IV cannulae (14G), 500ml bolus saline <15 mins, take blood, assess response
If cardiac failure = stop/slow infusion, give inotropes or vasopressors instead (norepinephrine)
If ACS = aspirin 300mg, GTN. If low sats give O2, if significant pain give morphine.
If immediately life-threatening (tension pneumothorax, septic shock, massive/continuing haemorrhage, cardiac tamponade) = immediate intervention if possible (centesis for pneumo/tamponade) or sepsis 6
Common causes of Disability in ABCDE
Hypoxia, hypercapnia
Cerebral hypoperfusion
Hypoglycaemia
Over-adminisation of sedatives/analgesics
Assessment of Disability in ABCDE
Review ABC (checking for hypoxia, hypotension)
Check drug chart for potential causes
Examine pupils
Assess AVPU/GCS
Assess cap glucose (if peri-arrest use venous/arterial blood sample as finger prick unreliable)
Treatment of Disability in ABCDE
Treat ABC causes (hypoxia/hypotension) if present
Reverse drug-related causes with antidotes
Give glucose options if hypoglycaemic
Place patients in recovery position if unconscious/seizing
Keys for adequate Exposure in ABCDE
Full exposure may be necessary but expose the patient only as required, and with respect to their dignity as well as to minimise heat loss.
