ABCDE Approach

Question 1

Airway
1.) First question to ask?

2.) Signs of airway compromise.

Answer 1

1.) Can they talk - if yes - airway patent.

Look for signs of compromise: Cyanosis, paradoxical chest movements, use of accessory muscles, diminished breath sounds.

Question 2

What are the causes of airway compromise?

Answer 2

Inhaled foreign body
Blood in the airway
Vomit/secretions in the airway
Soft tissue swelling: Causes are: Anaphylaxis, infection (quinsy, nec fasciitis).
Local mass effect - Tumours and lymph nodes.
Laryngospasm - causes are GORD, asthma, Intubation.
Depressed levels of consciousness - opioid overdose, head injury and stroke.

Question 3

What interventions are there for Airway compromise?

Answer 3

Anaesthetist and crash team.

Head tilt and chin lift - remove obstruction with finger or suction for blood, vomit etc

Jaw thrust

Oropharyngeal airway (Guedel)

Nasopharyngeal Airway

Question 4

1. ) How would you assess breathing? Normal values?
2. ) What are the causes of Bradypnoea and Tachypnoea
3. ) What are the causes of hypoxaemia?

Answer 4

1.) RR and Pulse oximeter. Inspection, palpation, percussion, auscultation.

Clinical Assessment:
Resp rate - 12-20
O2 sats - 99-94% OR 88-92% for COPD.

2.) Bradypnoea - Opioid overdose, Raised ICP, Exhaustion due to COPD.
Tachypnoea - Infection, airway obstruction, asthma, pneumonia, pneumothorax, pulmonary oedema, HF, anxiety.

Hypoxia causes - PE, pneumonia, sepsis, ARDS, asthma, pulmonary oedema.

Question 5

1. ) What are the signs of respiratory distress, that you are observing on general inspection?
2. ) Cyanosis results from:
3. ) Causes of Central cyanosis and peripheral cyanosis.

Answer 5

• Cyanosis
• SOB - Use of accessory muscles, nasal flaring, inability to speak fully, tripod position.
• Cough
• Stridor
• Cheyne-stokes respiration
• Kussmaul’s breathing

2.) Poor circulation or Obstruction (e.g. peripheral vasoconstriction secondary to hypovolaemia) OR inadequate oxygen supply.

3.) Central: CNS: IC haem, Drug overdose (Opioid), Tonic-clonic seizures. Resp: Asthma, COPD, Infection, Bronchiectasis, Pulmonary Htn. Heart: MI, VHD, Pulmonary Oedema, Hypotension & HF. Blood: Polycythaemia Others: Hypothermia and Obstructive Sleep apnoea.
Peripheral - As above and Vascular obstruction: Arterial - Raynauds and PVD. Venous: DVT.

Question 6

What are the main causes of stridor

Answer 6

Acute - Croup, Anaphylaxis, Foreign body inhalation.

Chronic - Laryngomalacia and Tumour.

Question 7

Tracheal position

1. ) Diseases causing deviation away from pathology?
2. ) Towards pathology?

Answer 7

1. ) Pneumothorax and Pleural Effusion

2. ) Lobar collapse and pneumonectomy.

Question 8

1. ) Dull percussion
2. ) Stony Dull
3. ) Hyper-resonant.

Answer 8

1. ) Consolidation, tumour.
2. ) Pleural effusion
3. ) Pneumothorax.

Question 9

1. ) Bronchial Breathing
2. ) Reduced breath sounds
3. ) Wheeze
4. ) Rhonchi - low pitched
5. ) Pleural rub
6. ) Crackles
7. ) Fine inspiratory crackles

Answer 9

1. ) Consolidation
2. ) Pneumothorax and pleural effusion.
3. ) Asthma, COPD.
4. ) Pneumonia, CF.
5. ) Constrictive pericarditis.
6. ) COPD, Pneumonia, pulmonary oedema.
7. ) Pul fibrosis

Question 10

What investigations are required to rule out or diagnose breathing pathology?

Answer 10

1. ) Chest x-ray

2. ) ABG’s - If sp02 is low.

Question 11

Interventions -

Answer 11

Oxygen
Non-rebreather mask - 15L/min
Venturi mask - 24% or 28% - 10L/min.