ABCDE Assessment and Airway Obstruction

ABCDE Assessment

• The method for assessing critically ill patients is consistent.
• Use the ABCDE approach for assessment and treatment.
• Perform a thorough initial assessment.
• Regularly reassess the patient, starting with life-threatening problems before moving to other areas.
• Evaluate the effect of the treatment given.
• Anticipate needing extra help early on.
• The initial assessment aims to keep the patient alive and improve their condition, allowing time for further treatment and diagnosis.
• Work as a team and utilize all team members simultaneously for various tasks.
• Airway obstruction is an emergency. Untreated, it can lead to hypoxia and damage to the brain, kidneys, and heart. This can result in cardiac arrest and death.

Airway Obstruction

• Airway obstruction causes paradoxical chest and abdominal movements and the use of accessory respiratory muscles.
• Partial airway obstruction results in reduced air entry and noisy sounds.
• Complete airway obstruction leads to a silent chest.
• Central cyanosis is a late sign of airway obstruction.
• Obtain expert help immediately.
• Simple airway clearance methods, such as head tilt, chin lift, and jaw thrust, may be necessary.

Airway Management (methods)

• Insertion of oropharyngeal or nasopharyngeal airways can be used.
• More advanced methods, such as laryngeal mask and tracheal intubation, might be needed.

Breathing

• Assess respiratory rate, chest expansion, and chest deformity (including flail chest).
• Palpate for crepitus and tenderness in the chest wall.
• Percussion can detect hyperresonance (suggestive of pneumothorax) or dullness (suggestive of pleural effusion) in the lungs.
• Auscultation involves listening to lung sounds in various areas.
• Record the inspired oxygen concentration via pulse oximetry.
• Pulse oximetry does not detect hypoxemia.

Circulation

• Inspect the skin color of hands and digits for signs of compromised circulation, and assess vein condition (collapsed or congested).
• Measure capillary refill time to evaluate peripheral perfusion.
• Prolonged capillary refill time could indicate poor peripheral perfusion, which may be due to cold conditions, inadequate lighting, or patient age.
• Assess limb temperature and count the patient's pulse rate.
• Palpate central and peripheral pulsations.
• Measure blood pressure bilaterally; even in shock, it may remain normal.
• Assess for abnormal heart sounds (murmurs).
• Insert two or more wide-bore intravenous cannulae.

Other Procedures

• Take blood samples for cross-matching, blood chemistry tests, hematological studies, and coagulation tests.
• Give a rapid fluid challenge (for example, 500 cc for normal blood pressure in 5–10 minutes or 1000 cc for hypotension in 5–10 minutes). Smaller fluid volumes could be indicated as well.
• If a heart failure patient is involved, administer smaller fluid volumes slowly.
• Evaluate the patient after each fluid administration to assess for any changes, particularly crackles.
• If the patient presents with primary chest pain and suspected acute coronary syndrome (ACS), record a 12-lead ECG immediately and treat with morphine, supplemental oxygen, nitroglycerin, and aspirin.
• Assess the patient's conscious level via the AVPU method (Awake, Verbal, Pain, Unresponsive).
• Use the Glasgow Coma Scale to evaluate the patient's responsiveness, using both adult and pediatric scales.
• Inspect the pupils for size, equality, and light responsiveness.

Neurological Functions

• Identify signs of lateralization indicating neurological deficits, such as aphasia or stroke-related symptoms.
• Measure random blood sugar levels to rule out hypoglycemia.
• Examine patients for any other potential causes of unconsciousness, including hypoxia, hypercapnia, and cerebral hypoperfusion.

Secondary Survey

• Examine detailed information on the patient's condition, medical history, chronic diseases, previous hospital admissions, medications and allergies, and family history.
• Perform a structured examination of organ systems (respiratory, cardiovascular, abdomen & genitourinary, central nervous, musculoskeletal).
• Order further investigations (laboratory and radiological tests).

Other Important Considerations

• Ensure the patient's full exposure is performed while maintaining comfort and dignity and preventing heat loss.
• Safe transfer to the intensive care unit (ICU) must be considered.
• Remember to reassess the patient frequently.