Osce Year 2 Airway Flashcards
(28 cards)
First approach
Wash hands, use PPE if needed,
introduce yourself,
Explain assessment,
Gain consent.
Airway 1. Talk?
Is patient talking to you? If so, no obstruction.
If not, assess airway using look, listen, feel.
Airway 2. Look.
Look for signs of obstruction:
Paradoxical breathing;
Laboured breathing.
Airway 3. Listen
Listen - abnormal sounds such as snoring, grunting, wheezing, strider, gurgling.
Silence?
Airway 4. Feel.
Feel - hand over patient’s mouth. Is air moving in and out? Airway is patent if so.
If not, airway is obstructed.
Airway 5. Actions.
If obstruction, call crash team.
Check for foreign bodies or use suction if needed.
Head tilt/chin lift or jaw thrust to open airway.
Airway adjuncts - Guedel airway or nasopharyngeal airway.
Breathing 1.
Obs.
Take respiratory rate and oxygen saturation.
Normal 12-20. Normal 95-99%. COPD 88-92%
Breathing 2.
Look at breathing.
Look at rhythm, depth, symmetry and any abnormal pattern, such as seesaw breathing or apnoea.
Breathing 3.
Effort.
Does patient look distressed? Look for accessory muscle use, nasal flaring, pursed lips,
Breathing 4.
Patient’s colour.
Look at skin colour and mouth and mucous membranes. Cyanosis.
If blueish centrally - may indicate poor oxygenation.
If blueish peripherally - may indicate poor circulation.
Breathing 5.
Cough.
Ask patient if they have a cough. How long for, when they cough.
Ask about sputum. Obtain sample, look for frothiness, infection, blood.
Breathing 6.
Ask patient.
Ask patient how their breathing feels to them. Is it normally like this?
Or are they feeling breathless?
Circulation 1.
Heart Rate
Take pulse manually for rate. Normal 60-100 bpm.
Regularity, strength. Weak and thready, bounding? Any chest pain?
Circulation 2.
BP
Take BP, systolic and diastolic pressure. Normal systolic 100-139 mmHg, normal diastolic 60-90mmHg.
Pulse pressure? Normal 35-45 mmHg.
Circulation 3.
Capillary refill
Capillary refill time - normal 2secs / extended / shortened?
Peripheries - colour? Pallor/cyanosis?
Peripheries - cool, warm, sweaty, clammy.
Circulation 4
Temperature
Central temperature reading?
Pyrexia above 37.5
Hypothermia below 35.5.
Circulation 5
Fluid status.
Urine output normal (1/2 ml urine per kilo per hour) - Fluid input.
Fluid balance chart - negative or positive pressure?
Dehydration or overload - skin turbot, mucous membranes dry? Oedema?
If hypotension and in negative fluid balance needs IV fluids.
Disability 1.
AVPU
AVPU or GCS
Disability 2.
Pain
Pain assessment
Disability 3
CBG
Take blood glucose measurement.
Disability 4
Meds.
Medication review, also check for opiates.
Exposure 1.
Bleeding
Check for signs of bleeding and check any drains.
Exposure 2
Oedema
Check for fluid overload, oedema in arms, legs, hands, feet.
Pitting oedema at ankles
Exposure 3
Allergy
Check for allergic reactions or rashes, urticaria.
