ABCDE Approach in Clinical Assessment
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Questions and Answers

Which technique is appropriate for relieving a complete airway obstruction in an unconscious patient?

  • Jaw thrust maneuver (correct)
  • Head tilt, chin lift
  • Deliver back blows
  • Use of oropharyngeal airway

Which of the following is a sign of partial airway obstruction?

  • Cyanosis of the lips
  • Stridor (correct)
  • Silent breathing
  • Paradoxical breathing

What is the primary assessment to check the status of an airway?

  • Level of consciousness
  • Heart rate
  • Cough effectiveness
  • Pattern of breathing (correct)

Which condition commonly causes airway obstruction in an unconscious patient?

<p>Vomit blocking the airway (C)</p> Signup and view all the answers

Which method is NOT recommended for airway management if there is a risk of cervical injury?

<p>Head tilt, chin lift (B)</p> Signup and view all the answers

What is the immediate action to take when a patient is choking and can still cough effectively?

<p>Encourage coughing (B)</p> Signup and view all the answers

What is the primary purpose of using airway adjuncts in emergency situations?

<p>To prevent further obstruction (C)</p> Signup and view all the answers

Which accessory muscle involvement would indicate difficulty in breathing?

<p>Sternocleidomastoid (B)</p> Signup and view all the answers

What is characterized by profound hypoxemia due to inadequate alveolar ventilation?

<p>V/Q mismatch or shunt (C)</p> Signup and view all the answers

Which ECG lead configuration is considered the gold standard for accurate results?

<p>12 lead (A)</p> Signup and view all the answers

What does the PR interval in an ECG represent?

<p>Speed of electrical impulse through AV node (B)</p> Signup and view all the answers

What is the recommended compression-to-breath ratio during CPR?

<p>30 compressions to 2 breaths (B)</p> Signup and view all the answers

Which of the following is NOT one of the '4 Hs' that can cause cardiac arrest?

<p>Hydration (B)</p> Signup and view all the answers

Which emergency condition is indicated by air in the pulmonary space?

<p>Tension pneumothorax (C)</p> Signup and view all the answers

What is the normal potassium level range in millimoles per liter (mmols)?

<p>3.5-5.5 mmols (B)</p> Signup and view all the answers

What is the first step in the bystander CPR process after assessing the environment?

<p>Check for response (B)</p> Signup and view all the answers

What is crucial for managing a tracheostomy patient to ensure airway patency?

<p>Ensure emergency protocols are established (D)</p> Signup and view all the answers

What characteristic defines a fenestrated tracheostomy tube?

<p>Has holes allowing air to pass through the vocal cords (A)</p> Signup and view all the answers

Which of the following is NOT a symptom of anaphylaxis?

<p>Insomnia (A)</p> Signup and view all the answers

What is the minimum frequency for changing and cleaning the inner cannula of a tracheostomy tube?

<p>Every 4 hours (C)</p> Signup and view all the answers

In case of anaphylaxis, what is the recommended medication to administer first?

<p>Adrenaline (1:1000) (C)</p> Signup and view all the answers

What is the primary purpose of a nasopharyngeal airway?

<p>It can be used without inducing gag reflex in conscious patients. (C)</p> Signup and view all the answers

What is an indicator of respiratory distress that involves abnormal muscle use?

<p>Use of accessory muscles (D)</p> Signup and view all the answers

Why should the nasopharyngeal airway be inspected for nasal polyps before insertion?

<p>To prevent potential obstructions and complications. (C)</p> Signup and view all the answers

What is a key feature of the laryngeal mask airway?

<p>It is a supraglottic airway device. (B)</p> Signup and view all the answers

How often should a tracheostomy tube be changed to ensure proper care?

<p>At least every 30 days (B)</p> Signup and view all the answers

For a stable patient, what is the normal range for respiratory rate?

<p>12-20 bpm (D)</p> Signup and view all the answers

Which airway management technique is considered the gold standard for securing the airway?

<p>Endotracheal tube intubation. (A)</p> Signup and view all the answers

What is the advantage of using a cuffed tracheostomy tube?

<p>It creates a seal in the trachea to protect the lungs. (A)</p> Signup and view all the answers

In what situation is nasal intubation preferred over oral intubation?

<p>For prolonged intubation. (A)</p> Signup and view all the answers

What should be done if resistance is felt while inserting a nasopharyngeal airway?

<p>Stop and try the other nostril. (C)</p> Signup and view all the answers

What is the main purpose of a tracheostomy?

<p>To create an artificial opening for airway maintenance. (B)</p> Signup and view all the answers

What is a common medication used for rate control in treating arrhythmias?

<p>Digoxin (A)</p> Signup and view all the answers

What is a significant potential outcome of Acute Kidney Injury (AKI)?

<p>Elevated urea leading to seizure (B)</p> Signup and view all the answers

Which symptom is indicative of appendicitis?

<p>Constant sharp pain that migrates to the right iliac fossa (B)</p> Signup and view all the answers

What does the ABCDE assessment prioritize?

<p>Establishing airway, breathing, and circulation (C)</p> Signup and view all the answers

Which condition is most likely to cause oliguria?

<p>Acute Kidney Injury (C)</p> Signup and view all the answers

What is a common treatment for managing hyperkalemia in patients with AKI?

<p>Insulin and glucose (A)</p> Signup and view all the answers

What is the Glasgow Coma Scale (GCS) score indicating a comatose state?

<p>3-8 (C)</p> Signup and view all the answers

Which symptom is typically associated with cholecystitis?

<p>Right upper quadrant pain radiating to the back (A)</p> Signup and view all the answers

What type of medication is used to control the rhythm in a patient with arrhythmias?

<p>Amiodarone (C)</p> Signup and view all the answers

What complication can arise from renal colic?

<p>Severe flank pain (D)</p> Signup and view all the answers

What method is generally used to assess a patient's level of consciousness?

<p>Glasgow Coma Scale (GCS) (A)</p> Signup and view all the answers

Which of the following is a classic sign of metabolic acidosis in renal dysfunction?

<p>Peaked T waves on ECG (C)</p> Signup and view all the answers

What is not a typical risk factor for diverticulitis?

<p>Younger age (A)</p> Signup and view all the answers

What is the normal serum range for urea?

<p>2.5-6.6 mmol/L (C)</p> Signup and view all the answers

What is a key indicator of hypoxia that involves changes in skin color?

<p>Cyanosis (B)</p> Signup and view all the answers

Which treatment is NOT associated with managing hypovolaemia?

<p>Oxygen therapy (B)</p> Signup and view all the answers

What is the first step in treating hypothermia?

<p>Check core temperature (B)</p> Signup and view all the answers

Which symptom is NOT typically associated with hypoxia?

<p>Low blood pressure (C)</p> Signup and view all the answers

What is a significant cause of cardiac arrest in opioid overdose?

<p>CNS depression (B)</p> Signup and view all the answers

Which electrolyte disturbance would most likely be indicated by tall T waves on an ECG?

<p>Hyperkalaemia (A)</p> Signup and view all the answers

What is an effective method for shifting potassium into cells during hyperkalaemia?

<p>Insulin and glucose IV infusion (C)</p> Signup and view all the answers

Which of the following is NOT a symptom of hypovolaemia?

<p>Nausea (D)</p> Signup and view all the answers

What immediate intervention follows assessing a person's core temperature in cases of hypothermia?

<p>Remove wet clothes (A)</p> Signup and view all the answers

In hypoxia, what is the recommended target SpO2 level to be aware of during monitoring?

<p>92-96% (A)</p> Signup and view all the answers

Which ECG finding is NOT typically associated with hypokalaemia?

<p>Peaked T waves (A)</p> Signup and view all the answers

What indicates a loss of more than 20% of blood volume?

<p>Hypotension (A)</p> Signup and view all the answers

What laboratory test is used to assess electrolyte imbalances prominently?

<p>U and E blood test (C)</p> Signup and view all the answers

During oxygen therapy for hypoxia, what type of mask provides the highest concentration of oxygen?

<p>Non-rebreather mask (A)</p> Signup and view all the answers

Flashcards

ABCDE Approach

A systematic method for assessing and treating critically ill patients. It focuses on Airway, Breathing, Circulation, Disability, and Exposure.

Airway Obstruction

A blockage of the airway, either partial or complete, that prevents breathing.

Partial Airway Obstruction

A blockage that allows some air to flow through the airway.

Complete Airway Obstruction

A blockage that prevents any air from flowing through the airway.

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Oropharyngeal Airway

A medical device placed in the mouth to keep the airway open, especially in unconscious patients.

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Choking

A medical emergency caused by a blockage in the airway.

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Back Blows/Abdominal Thrusts

First aid steps in choking, where back blows and abdominal thrusts are used to push obstructions out.

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CPR

Cardiopulmonary resuscitation, a life-saving procedure used when a person's breathing or heartbeat stops.

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Nasopharyngeal Airway (NPA)

A temporary airway inserted into the nasal passage, resting just above the epiglottis.

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NPA sizing

Measured from the earlobe to the tip of the nostril; the flange should sit below the nostril.

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Laryngeal Mask Airway (LMA)

A supraglottic airway device placed above the vocal cords.

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Endotracheal Tube Intubation

The gold standard for a secured airway, inserted orally or nasally. Enables positive pressure ventilation.

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Tracheostomy

Surgical procedure making a stoma in the trachea for airway maintenance and protection.

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Tracheostomy Tube (Cuffed)

A tracheostomy tube with a cuff to seal the trachea preventing air from passing through the upper airway.

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Bite Block Placement

Positioned at the incisors level, reaching the jaw angle.

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Artificial Airways Purpose

Intended for more long-term use to secure the airway and prevent aspiration.

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Tracheostomy Tube Care

Regular care of a tracheostomy tube includes humidification, inner cannula changes, 25cm H2O cuff pressure limit, deflation before speaking, regular suction, and daily cleaning/dressing of the site.

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Tracheostomy Tube Types

Fenestrated tracheostomy tubes have holes allowing air to pass through vocal cords, enabling speech.

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Anaphylaxis Causes

Anaphylaxis can be triggered by foods (peanuts, nuts), medications (antibiotics), and insect stings.

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Anaphylaxis Management

Immediately seek help (999 for community, 6666 in hospitals), position the patient, administer adrenaline (1:1000), give fluids, and if needed give a second adrenaline dose after 5 minutes.

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Respiratory Rate

Respiratory rate is the number of breaths per minute. Normal range is 12-20 breaths/minute; it's important to assess for equal bilateral expansion while counting.

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Respiratory Distress Indicators

Indicators include accessory muscle use, central cyanosis, paradoxical breathing, leaning forward, inability to speak in full sentences, audible wheezing, rapid shallow breathing, and mouth breathing.

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Respiratory Failure Type 1

Lung failure, a type of respiratory failure.

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SpO2 Monitoring

Monitoring SpO2 measures the amount of oxygen in the blood. General population target is 94-98%, while COPD patients might have a lower target (88-92%).

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V/Q Mismatch

An imbalance between ventilation (airflow to the lungs) and perfusion (blood flow to the lungs). This can lead to inadequate oxygen levels in the blood.

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Shunt (Left-Right)

A condition where blood flows from the right side of the heart to the left without passing through the lungs. This means the blood doesn't pick up oxygen, resulting in low blood oxygen levels.

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Hypoxemia

Low oxygen levels in the blood.

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ECG - 3 Lead

A type of electrocardiogram used for continuous cardiac monitoring. It has three electrodes placed on the chest.

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ECG - 12 Lead

The gold standard ECG. It uses twelve electrodes to provide a more comprehensive picture of the heart's electrical activity.

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Cardiac Arrest

A condition where the heart stops beating effectively, causing the body to stop receiving oxygenated blood.

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Bystander CPR

CPR performed by someone witnessing a cardiac arrest. It includes chest compressions and rescue breaths to circulate blood and oxygen.

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4 Hs and 4 Ts

A mnemonic used to remember the reversible causes of cardiac arrest, including hypoxia, hypovolemia, hypothermia, hyper/hypokalemia, tension pneumothorax, thrombosis, tamponade.

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Hypoxia Symptoms

Confusion, tachycardia, rapid shallow breathing, cyanosis, coughing/wheezing, sweating, fatigue, anxiety.

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Hypoxia Treatment

Oxygen therapy, monitoring SpO2 levels, non-rebreather mask.

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Hypovolemia Symptoms

Pale skin, anxiety, cool temperature, low blood pressure, fast heart rate, prolonged capillary refill, decreased urine output.

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Hypovolemia Treatment

Control hemorrhage, stabilize blood volume with IV fluids and blood transfusions.

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Hyperkalemia

Elevated potassium levels in the blood, affecting heart function.

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Hyperkalemia Symptoms

Tall T waves on ECG, abnormal U & E blood test (Normal Ka range: 3.5-5.5 mmols).

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Hyperkalemia Treatment

Protect heart with calcium chloride, shift potassium into cells with insulin and glucose, sodium bicarbonate, beta 2 agonists, dialysis.

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Hypothermia Symptoms

Shivering, confusion, slurred speech, slow heart rate, slow breathing, loss of coordination.

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Hypothermia Treatment

Remove wet clothes, use foil blankets, warm IV fluids, warm environment.

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Electrolyte Imbalance

Disruption of electrolyte balance, affecting various bodily functions.

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Electrolyte Imbalance Management

Identify the specific imbalance, monitor vital signs, address the underlying cause, and administer appropriate therapy.

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Toxins

Substances that cause harm to the body.

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What is Atrial Fibrillation?

A type of irregular heartbeat where the upper chambers of the heart (atria) beat chaotically instead of in a coordinated way. This can lead to blood clots and stroke.

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How is Atrial Fibrillation treated?

Treatment focuses on either controlling the heart rate or restoring a regular rhythm. Medications like beta blockers and digoxin control the heart rate, while cardioversion (using electrical shocks) aims to restore normal rhythm.

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What is Acute Kidney Injury (AKI)?

A sudden decrease in kidney function, leading to a buildup of waste products in the blood. This can be caused by various factors, from dehydration to severe infections.

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What are some signs of AKI?

Reduced urine output (oliguria), elevated blood urea and creatinine levels, and various other symptoms including fatigue, nausea, and swelling.

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What is the 'DAMN' mnemonic for AKI?

Diuretics, ACE inhibitors, Metformin, NSAIDs. These medications can potentially worsen kidney function and should be used cautiously in patients at risk of AKI.

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What are potential complications of AKI?

Complications include heart rhythm problems, fluid buildup in the lungs and body, metabolic acidosis, and neurological issues like seizures or coma.

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What is Appendicitis?

Inflammation of the appendix, a small, finger-like pouch connected to the large intestine.

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What are the typical symptoms of Appendicitis?

Pain in the upper abdomen that gradually shifts to the lower right side, worsens with movement, and can become constant and sharp.

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What is Diverticulitis?

Inflammation of small pouches (diverticula) that can form in the wall of the colon.

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What are the typical symptoms of Diverticulitis?

Left lower abdominal pain, often worse with movement, common in older patients, and may have a history of recurrent episodes.

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What is a Bowel Obstruction?

A blockage in the intestines that prevents food and waste from passing through.

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What are the typical symptoms of a Bowel Obstruction?

Severe abdominal pain that may start as a dull ache and worsen, often worse after meals, and may be accompanied by vomiting.

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What is a Bowel Perforation?

A hole in the wall of the digestive tract, allowing contents to leak into the abdominal cavity.

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What are the typical symptoms of a Bowel Perforation?

Sudden, severe abdominal pain, often accompanied by a fever and signs of sepsis.

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What is Cholecystitis?

Inflammation of the gallbladder, a small organ that stores bile.

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What are the typical symptoms of Cholecystitis?

Pain in the right upper abdomen, often radiating to the back or shoulder, worse with breathing in, and can be recurrent.

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What is Pancreatitis?

Inflammation of the pancreas, a gland that produces important digestive enzymes and hormones.

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What are the typical symptoms of Pancreatitis?

Severe, central upper abdominal pain, often worse with movement, and may be sudden onset or chronic.

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Study Notes

ABCDE Approach

  • A systematic assessment and treatment for acutely unwell/deteriorating patients
  • Progress through each stage, ensuring safety at each step
  • Uses ISBAR handover tool (Identity, Situation, Background, Assessment, Recommendation)
  • NEWS2 tool for assessment (Respiratory Rate, Heart Rate, Blood Pressure, O2 saturations, Temperature, ACVPU, On oxygen?)
  • The tool should be used with clinical judgment

Physiological Parameter Scoring

  • Respiration rate: Values ranging from ≤8 to ≥25 breaths per minute, each with a corresponding score
  • SpO2 Scale 1 & 2 (%): Values with associated oxygen requirements and scores; values range from less than 91 to ≥97
  • Systolic blood pressure (mmHg): Values ranging from ≤90 to ≥220, with scores assigned
  • Pulse (per minute): Values from ≤40 to ≥131, each with an assigned score
  • Consciousness: From Alert to CVPU (Circulation, Ventilation, Perfusion, and Unresponsiveness), with increasing degrees of impairment
  • Temperature (°C): Ranges from ≤35.0 to ≥39.1, with corresponding scores.

Airway Assessment

  • Airway obstruction is a medical emergency
  • Assess for airway obstruction by observing breathing patterns, speaking ability, accessory muscle use, and skin color changes.
  • A clear airway is the first concern in acute situations
  • Airways are divided into upper and lower airways.

Causes of airway obstruction

  • External pressure: Swelling of soft tissues, neck tumors, enlarged thyroid, or physical pressure.
  • Internal blockage: Vomit, blood, secretions, inhaled foreign bodies, airway swelling, or tongue blockage in unconscious patients.
  • The airway is assessed by observing the patient's breathing patterns, ability to speak, and use of accessory muscles.

Management of Airway

  • Head tilt, chin lift (avoid if cervical injury suspected.)
  • Jaw thrust.
  • Airway adjuncts, oxygen.
  • Choking intervention (5 back blows, 5 abdominal thrusts for conscious, CPR for unconscious patient)
  • Gentle suction with wide-bore device.
  • Oropharyngeal Airway

Artificial Airways

  • Used for longer-term airway protection
  • Includes Laryngeal Mask Airway (LMA), supraglottic airway device above glottis; quick and easy intubation.
  • Endotracheal Tube (ETT) intubation is the gold standard; inflated cuff prevents aspiration, appropriate for unconscious or heavily sedated patients.
  • Tracheostomy creates a surgical opening into the trachea; used for long-term airway maintenance and protection.

Weaning from Ventilation

  • Various tracheostomy tubes are used, with specialized tubes for particular needs (cuffed for lung protection, uncuffed for improved airway, etc).
  • Necessary equipment should be available at bedside.
  • Inner cannulas need regular cleaning.
  • Cuff pressure should be less than 25cm H20 to prevent permanent damage to trachea.
  • Regular suction and site care are important. Tubes should be changed every 30 days at minimum.

Anaphylaxis

  • Food (peanuts, tree nuts, shellfish, cows milk), medications (antibiotics, contrast dyes), insect stings, or other triggers often cause anaphylaxis.
  • Life-threatening reaction often involving airway, breathing, or circulation
  • Typically shows typical skin symptoms and other associated symptoms
  • Immediate emergency treatment includes getting help, positioning, adrenaline, and fluids.

Relevant Vital Signs

  • Respiratory rate assessment for deterioration risk; normal range 12-20 breaths/min
  • SpO2 monitoring assessed based on a two scale method with target range

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Related Documents

Care of the Acutely Ill Revision Guide PDF

Description

This quiz focuses on the ABCDE approach for assessing and treating acutely unwell or deteriorating patients. It covers the systematic steps ensuring safety, the ISBAR handover tool, and the NEWS2 assessment tool for monitoring physiological parameters. Test your knowledge on this critical method used in clinical settings.

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