ABCDE Assessment PDF

ABCDE Assessment Dr / Mohammed Fawzy Tantawy Emergency & Critical medicine Menoufia Faculty of  The approach to all critically ill patients is the same Use ABCDE approach to assess & treat the patients Do a complete initial assessment & Reassess regularly Start wit...

ABCDE Assessment Dr / Mohammed Fawzy Tantawy Emergency & Critical medicine Menoufia Faculty of  The approach to all critically ill patients is the same Use ABCDE approach to assess & treat the patients Do a complete initial assessment & Reassess regularly Start with the life threatening problems before moving to the next part of assessment Assess the effect of Treatment  Recognize when will you need extra help early The aim of the initial assessment is to keep the patient alive & achieve some clinical improvement which will buy time for further treatment & making diagnosis Work as Team & use all the team members to enable different actions simultaneously Airway  Airway obstruction is an emergency If untreated airway obstruction , it will cause HYPOXIA & risk damage to Brain , Kidneys , Heart leading to Cardiac arrest & Death.  Airway obstruction causes paradoxical chest & abdominal movement & Use of accessory muscles of respiration  Partial airway obstruction leads to diminished air entry & Noisy sounds  Complete airway obstruction leads to Silent chest  Central Cyanosis is a late sign  Obtain expert help  You may need simple methods for airway clearance e.g. :-  Head tilt , Chin left  Jaw thrust especially in Polytrauma patient with high risk of Cervical spine injury  Insertion of oropharyngeal or nasopharyngeal airway  Advanced method may be required e.g. Laryngeal mask & Tracheal intubation  Give Oxygen at high concentration Provide high O2 concentration using a Mask with O2 reservoir Breathing  Inspection Respiratory Rate Chest Expansion Chest Deformity Flail chest *****  Palpation Feel the chest wall for any crepitus or surgical emphysema Tenderness  Percussion Hyper-resonance may suggest Pneumothorax Dullness may indicate Pleural effusion Auscultation  O2 Saturation Record the inspired O2 concentration via Pulse Oximeter Pulse Oximeter doesn’t detect hypercapnia  ABG Arterial Blood Gas sample should be obtained as soon as possible Circulation  Inspection Look at the color of the hands & digits Assess the state of Veins as thy may be collapsed or congested Measure the capillary refill time - Normally it is usually < 2 s - Prolonged CRT suggest poor peripheral perfusion - D.D. for prolonged CRT are :- Cold surroundings , poor lighting & old age  Palpation Assess the limb temperature by feeling patient’s hands Count the patient’s pulse rate Palpate central & peripheral pulsations  Auscultation Measure the patient’s blood pressure bilaterally Even in shock , the blood pressure may be normal A low Diastolic blood pressure suggests arteriolar vasodilatation as in Distributive shock A narrow pulse pressure indicates arteriolar vasoconstriction as in Cardiogenic & Hypovolemic shock  Auscultation Auscultate the heart for abnormal heart sounds & murmurs  Insert 2 or more Wide bore IV Cannulae  Take blood samples for Cross Matching , Biochemical , Hematological , Coagulation & Microbiological investigations  Give a rapid fluid challenge - If Normotensive  give 500 cc over 5 – 10 min - If Hypotensive  give 1000 cc over 5 - 10 min - If the patient is known to have Heart Failure  use smaller volumes of fluids 250 cc cautiously & auscultate the chest for crackles after each bolus Don’t miss to Reassess your patient regularly  If the patient has primary Chest pain & suspected AC$  record a 12 lead ECG early & treat initially with - Morphine - O2 - Nitroglycerine - Asprin Disability  Assess the patient’s conscious level Using :-  AVPU method  Glasgow Coma Scale score  Examine the Pupils ( Size , Equality , Reaction to light )  Signs of lateralization ***** Recognize the neurological deficits e.g. - Aphasia - Signs of stroke  Measure the Random Blood Sugar to exclude Hypoglycemia ( mainly ) & Hyperglycemia  Common causes of Unconsciousness include profound :- - Hypoxia - Hypercapnia - Cerebral hypoperfusion So, it is a must to review & treat the ABCs  Consider other causes of DCL like :-  administration of high dose of Sedatives  Electrolyte disorders  Metabolic disorder  Don’t forget to order the following investigations: - Blood glucose level - Electrolytes - Renal function tests - Liver function tests - ABG Exposure  To examine the patient properly , full exposure of the body may be necessary But respect the patient’s dignity & minimize heat loss  Always don’t forget to Reassess **** Secondary Survey  More detailed information about :- 1- The present complaint 2- Present history , Chronic diseases 3- Past history 4- Previous hospital admission 5- Medications & Allergies 6- Family history  Structured examination of organ systems 1- Respiratory system 2- Cardiovascular system 3- Abdomen & Genito-Urinary tract 4- Central nervous system 5- Musculoskeletal system  More investigations 1- Laboratory 2- Radiological  Always don’t forget to Reassess ****  Safe transfer to the ICU must be considered