PSA (adequate)
Warm pink dry
HR: 60-100
BP: >100
A+O
PSA (borderline)
Cool pale clammy
HR: 50-100
BP:80-100
Alert and orientated
PSA (inadequate)
Cool, pale, clammy
HR: <50,>100
BP: 60-80
Alert and orientated or altered
PSA (extremely poor)
Cool pale clammy
HR: <50, >110
BP: <60
Altered unconscious
RSA (normal)
Appearance: calm/ quiet Speech clear, steady Sound quiet, no wheeze Auscultation no crackles RR 12-16 Rhythm regular WOB normal chest movement HR 60-100 Skin normal CS alert
RSA (mild distress)
Appearance: calm/anxious Speech: full sentences Sound: cough Auscultation: LVF- fine basal crackles ASTHMA- mild exp wheeze RR: 16-20 Rhythm: slight prolonged exp phase WOB: slight increase in chest movement HR: 60-100 Skin: normal CS: alert
RSA (moderate distress)
Appearance: distressed/anxious Speech: short phrase Sound: able to cough Auscultation: ASTHMA- exp wheeze +/- insp LVF- basal/ midzone crackles RR: >20 Rhythm: increase exp phase WOB: marked chest movement +/- use of accessory muscles HR: 100-120 Skin: pale/ sweaty CS: altered
RSA ( severe distress)
Appearance: distressed, anxious, exhausted
Speech: words/ unable to speak
Sound: unable to cough
Auscultation: ASTHMA- same as mod+ no breath LVF- full field UPPER AIRWAY OB- stridor
RR: >20 <8
Rhythm: slight prolonged exp phase
WOB: marked chest movement, intercostal use, retraction, tracheal tugging
HR: bradycardia or >120
Skin: pale sweaty cyanotic
CS: altered/ unconscious
Critical illnesses
Cardiac arrest/ resus Major trauma/ head injury Carbon monoxide poisonings Shock Anaphylaxis Severe sepsis Status epilepticus Decompression illness
Causes of PEA
Hypoxia Exanguination Asthma TPT Anaphylaxis Upper airway obstruction
Determinants of death (6)
No palpable carotid pulse No heart sounds heard for 2min No breath sounds heard for 2min Fixed/dilated pupils No response to centralised stimuli No motor response/ facial grimace to painful stimuli
Mental status assessment (11)
- safety
- Appearance
- Behaviour
- Affect
- Speech
- Thought process
- Cognition
- Thought content
- Self harm
- Perceptions
- Environment
High risk criteria ( time critical guidelines)
Motor/cyclist impact >30km High speed MCA >60km Ped impact Ejection from vehicle Prolonged extrication Fall from height >3m Struck on head by object falling >3m Explosion
Major trauma vital signs criteria
HR <60 >120 RR <10 >30 BP <90mmhg Sp02 <90% GCS <13
Major trauma criteria (Specific injuries)
- Penetrating injuries
2.Blunt injuries- more than 1 region, specialised care, decrease QOL - Limb amputation/ threaten
- Suspected spinal injury/ fracture
- Burns >20% or resp tract burns
- Crush
- High voltage burn
- Major compound fracture/ open dislocation ( fracture to 2 or more femur/ tibia/ humerus)
9 fractured pelvis