Breathing Tutorial Flashcards
What does A-E stand for?
Airway Breathing Circulation Disability Exposure
How is airway assessed?
What would you do?
Look for signs of traction
Snoring / stridor
Is the person breathing? - no breathing, switch to CPR
Why is it A-E order?
The order of which will kill you i.e. airway obstruction will kill you before bleeding / circulation blockage
How is breathing assessed?
Look - RR, O2 sats, signs of respiratory distress, trachea deviation, symmetrical chest expansion
Listen - wheeze, crackles (expansion and collapsing of the lungs due to fluid / pus in the lungs)
Feel - percuss the chest for resonance (pneumothorax), put hands on person’s chest to fee for symmetrical chest expansion
Measure - chest x-ray, arterial blood gas
Treat - dependent on what you find, main stay management = O2
How is circulation assessed?
Look - raised JVP, capillary refill test = <2s
Listen - heart sounds
Feel - pulse
Measure - ECG, blood tests
Treat - depends on what you found, main stay management = fluid
How is disability assessed?
Look - alertness (formal GCS), pupils equal and reactive to light, blood sugars
Listen -
Feel -
Measure - BGL, blood tests
Treat - the underlying cause e.g. hypoglycaemia, hypovolaemia etc.
How is exposure assessed?
Assessment of everything else
Proper look of the skin for bruising, bleeding
Neuro and abdo examination
Anything else obviously contributing to their condition
What happens after the A-E assessment?
Continuous reassessment - ensure treatment is working / making them feel better
Unless an AGP is needed, what PPE should the doctor be wearing?
What is AGP?
Gloves, apron, surgical mask, eye protection
Aerosol generating procedure - e.g. CPR
How do we assess this person’s airway quickly?
Get them to talk
What is a NEWS2 score?
How do you calculate a NEWS2 score?
Standardised measure of an acutely unwell patient
RR - 2 O2 - 2 HR - 1 BP - 0 Temp - 0 Alertness - 0
NEWS2 = 5
Score of 5 = regular monitoring
What is most worrying in the patient’s NEWS2 score?
What will be the relevant treatment for this?
O2 sats
Give oxygen
How is the patient given the oxygen for 93% O2 sats and why?
Non-rebreathe mask
Scuba mask
Simple face mask
Nasal cannulae
Non-rebreathe mask = always given to acutely unwell patients due to importance of getting the O2 sats up as quickly as possible
With this mask, must give high flow oxygen 15L/min - then once O2 is brought up as quickly as possible, titre O2 given down, maybe change masks
Non-rebreathe allows for higher O2 delivery than simple face mask as you don’t rebreathe what you exhale
Young, male patient has symmetrical chest expansion, wheeze on both sides
What is the likely diagnosis?
Asthma
COPD
Pneumothorax
Asthma
Young = less likely to be COPD
Less likely to be pneumothorax due to symmetrical lung expansion, and would not expect a wheeze
Patient given salbutamol nebuliser treatment.
Ciculation:
Cold peripherals, regular pulse, JVP not raised
Disability:
Normal pupillary response, normal BGL
Exposure:
General assessment = fine
What happens now?
Reassess
Document
Use SBAR format to handover
