Primary assessment 2.docx

Primary assessment Introduction The airway, breathing, circulation, disability, exposure (ABCDE) approach is a systemic approach to the immediate assessment and treatment of critically ill or injured patients. This approach is applicable in all clinical emergencies. It can be used in the street wi...

Primary assessment Introduction The airway, breathing, circulation, disability, exposure (ABCDE) approach is a systemic approach to the immediate assessment and treatment of critically ill or injured patients. This approach is applicable in all clinical emergencies. It can be used in the street without any equipment. Airway +-----------------------+-----------------------+-----------------------+ | Voice | Voice normal without | Hoarseness, snoring, | | | obstruction | stridor, obstruction | | Breath sounds | | (eg. Foreign body, | | | Tracheal, bronchial, | vomit blood, edema) | | | bronchovesicular, | | | | vesicular | Friction rub, | | | | crackles, wheeze, | | | | rhonchi, pleural rub | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | Assessment method | Normal finding | Abnormal finding | +=======================+=======================+=======================+ | Breathing | Symmetric no flaring | Deviated nasal | | | or narrowed...... | septum, nasal | | Inspection | | flaring, depressed | | | | nasal bridge, | | - Inspect nose for | | bleeding. | | general | | | | appearance, | | | | shape, symmetry | | | | and colour. | | | +-----------------------+-----------------------+-----------------------+ | Palpation | Noiseless, free | Nasal obstruction | | | exchange of air on | foreign body | | - Apply pressure to | each side | | | occlude one | | | | nostril: close | | | | mouth and sniff | | | | through the | | | | opposite nostril | | | | for checking | | | | patency. | | | +-----------------------+-----------------------+-----------------------+ | Inspection | Relaxed, comfortable | Restless, tripod | | | position quiet and | position, effortful | | - Inspect for | effortless breathing | breathing (hyper | | general | normal breathing | ventilation) | | appearance, | (eupnea) | tachypnea bradypnea, | | posture, | | asymmetrical chest | | breathing effort, | Rate 12-20 breaths/mm | expansion | | respiratory rate, | | (paradoxical | | chest expansion, | Symmetrical chest | breathing) chest | | shape of thorax, | expansion | retraction | | superficial | | | | veins, muscles of | No visible vein | | | respiration. | | | | | No use of accessory | | | | muscles | | +-----------------------+-----------------------+-----------------------+ | Percussion | Resonance sound | Hyper resonance in | | | | emphysema, dull tone | | - Percuss anterior | | in pneumonia, pleural | | and posterior | | effusion or | | thorax | | atlectasis. | +-----------------------+-----------------------+-----------------------+ | Auscultation | Normal breath sounds | Adventitious breath | | | vesicular, | sounds (crackles, | | - Auscultate the | bronchovesicular, | rales) wheezing, | | anterior, lateral | bronchial | rhonchi, pleural | | and posterior | | friction. | | chest | | | +-----------------------+-----------------------+-----------------------+ | Pulse oximetry | | | | | | | | - Check for oxygen | | | | saturation using | | | | a pulse oximetre | | | +-----------------------+-----------------------+-----------------------+ | CIRCULATION | Fair/dark/medium | Pallor, erythemia, | | | complexion, | cyanosis ,petechiae, | | Inspection | pigmentation | ecchymosis, jaundice. | | | | | | - Inspect for skin | | | | color | | | +-----------------------+-----------------------+-----------------------+ | Palpation | \25 | | | | | | - Capillary refill | | | +-----------------------+-----------------------+-----------------------+ | Palpation | 60 -- 100 bpm | Absent, weak, thread | | | | pulse, forcefull | | - Palpate pulse | | pulse, bounding | | rate | | pulse, asymmetric | | | | pulse | +-----------------------+-----------------------+-----------------------+ | Auscultation | Heard at all sites. | Murmurs S~3~ S~4~ | | | Expected range is | gallop | | - Auscultate for | 60-100 beats/mm S~1~ | | | heart sounds | and S~2~ sounds | | +-----------------------+-----------------------+-----------------------+ | Blood pressure | Less than 130/90 mmHg | \> 130-90 mmHg | | | | | | - Check for blood | Systolic: 100-130 | Hypertension | | pressure in | mmHg | | | extremities using | | \