ABCDE protocol and handovers

Question 1

Airways - what do you check for?

Answer 1

airway obstruction - paradoxical chest movements during respiration, central cyanosis, lack of breath sounds

Question 2

how do you clear the airway

Answer 2

remove anything in the mouth, head tilt and chin up, jaw thrust, opening manouvres

Question 3

what do you check for in breathing

Answer 3

RR, chest expansion, raised JVP, SpO2, palpate, percuss, auscultate, deal with life-threatening conditions

Question 4

what do you check for in circulation?

Answer 4

• primary cause of shock = normally hypovalaemia
• count HR
• measure BP, palpate peripheral and central pulses
• auscultate heart
• external and concealed haemorrhage

Question 5

how do you treat a CV collapse

Answer 5

fluid replacement, haemorrhage control, and restoration of tissue perfusion

large cannulae - high flow rate
bolus of 500ml of warmed crystalloid solution (hartmann’s solution, 0.9% NaCl) over <15 min if patient is hypotensive

re-assess HR and BP every 5

repeat fluid and seek expert help

Question 6

what do you do if signs of cardiac failure occur after shock

Answer 6

decrease fluid infusion rate or stop altogether

inotropes or vasopressors

Question 7

what do you do when assessing disability

Answer 7

exclude or treat hypoxia and hypotension
AVPU or GCS score
pupil size and reactivity
blood glucose or ABG if peri-arrested

IN LATERAL POSITION IF AIRWAY IS NOT PROTECTED

Question 8

what are the local protocols for management of hypoglycaemia

Answer 8

start 10% glc IV at 200ml/hour if conscious

if unconscious - 200ml/15 min

Question 9

what does E mean

Answer 9

exposure

respect dignity and minimise heat loss however to examine patient properly, full exposure of body may be necessary

Question 10

what is the acronym for handovers

Answer 10

SBAR

Situation - your name, ward, patient DOB, reason, main concern

background - normal meds, pMH, etc

assessment - examination findings, treatment, doses and timings

recommendation - differentials, investigations, treatments, explain what you need !!