ABCDE Assessment - FINAL (1) PDF

A to E Assessment James Cullinane Learning Use Airway-Breathing-Circulation-Disability- Outcomes Exposure (ABCDE) approach to assess and treat the patient Complete initial assessment a...

A to E Assessment James Cullinane Learning Use Airway-Breathing-Circulation-Disability- Outcomes Exposure (ABCDE) approach to assess and treat the patient Complete initial assessment and re-assess regularly Treat life-threatening problems before moving to the next part of assessment Assess the effects of treatment Recognise when you need help. Call for appropriate help early Use all members of the multidisciplinary team to allow interventions to be undertaken simultaneously Communicate effectively - use the Situation, Background, Assessment, Recommendation (SBAR) ABCDE Respiratory Assessment Solent University 2  Most cardiorespiratory arrests in hospital are Why is ABCDE not sudden or unpredictable events: in important? ~80% of cases there is deterioration in clinical signs during the few hours before cardiac arrest. Document title goes here Solent University 3  All emergency admissions At Risk Patients Those with co-existing disease (e.g. asthma, COPD, IHD, AKI diabetes, immunocompromised) Elderly patients Specific acute illness (e.g. pancreatitis, sepsis, MI) Altered level of consciousness Major haemorrhage or requiring large volume of fluids/blood replacement Document title goes here Solent University 4 ABCDE Respiratory Assessment Solent University 5  Airway obstruction is an Emergency Untreated, airway obstruction causes hypoxia and risks damage to the brain, kidneys and heart, cardiac arrest, and death. The airway consists of: Nose/mouth Pharynx Larynx trachea It provides the route for the passage of the air from the atmosphere to the bronchial tree ABCDE Respiratory Assessment Solent University 6  Assessment Management Ensure airway is Is airway patent & patent & maintained? maintained Can the patient Simple airway speak? manoeuvres A Are there added noises? Suction Consider using Airway Is there a see- airway adjuncts & sawing movement position patient of the chest & O2 via high abdomen? concentration mask ABCDE Respiratory Assessment Solent University 7 Look for signs of Airway obstruction Treat Paradoxical chest and abdominal Give O2 at high movements concentration (‘see-saw’ respirations) Untreated, airway obstruction Use of the accessory muscles of causes hypoxaemia (low PaO2) respiration with the risk of hypoxic injury to Use a mask with oxygen Central cyanosis (late sign of airway the brain, kidneys and heart, reservoir (15 L min-1) obstruction) cardiac arrest, and even death. In In acute respiratory In complete airway obstruction, there most cases, only simple methods failure, aim to maintain are no breath sounds at the mouth or of airway clearance are required: an oxygen saturation of nose. airway opening manoeuvres (head 94–98%. In partial obstruction, air entry is tilt, chin lift & jaw thrust), airways In patients at risk of diminished and often noisy. In the suction, insertion of an hypercapnic respiratory critically ill patient, depressed oropharyngeal or nasopharyngeal failure (COPD ) aim for consciousness often leads to airway airway. Tracheal intubation may be an oxygen saturations obstruction required when these fail. of 88–92%. ABCDE Respiratory Assessment Solent University 8 Look for signs of Airway obstruction Any problem Treat with the patency and maintenance of the airway MUST be dealt Give O at high 2 with before moving on concentration ABCDE Respiratory Assessment Solent University 9  Treat During the immediate assessmentGive of O at high 2 breathing, it is vital to diagnose & concentration treat immediately life-threatening conditions (e.g. Acute severe asthma, pulmonary oedema, tension pneumothorax, and massive haemothorax) ABCDE Respiratory Assessment Solent University 10  Assessment Management Observe rate and Position patient pattern Consider Depth of physiotherapy and respiration nebulisers B Symmetry of chest movement Bag-valve mask Oxygen via high Breathing Use of accessory concentration muscles mask Colour of patient Oxygen saturation ABCDE Respiratory Assessment Solent University 11  Look Listen Feel Respiratory rate & pattern: Breath sounds a short Percuss the chest (if Count respiratory rate. Normal distance from his face: trained) rate = 12–20 breaths min-1. A Rattling airway noises Auscultate the chest (if high (>25 min-1) or increasing indicate the presence of trained) respiratory rate is a marker of airway secretions, usually Check the position of the illness and a warning that the caused by the inability of the trachea in the suprasternal patient may deteriorate patient to cough sufficiently or notch: deviation to one side suddenly. to take a deep breath indicates mediastinal shift Depth of each breath Stridor or wheeze suggests (e.g. pneumothorax, lung Pattern (rhythm) of partial, but significant, airway fibrosis or pleural fluid) respiration obstruction Feel the chest wall to Symmetrical chest detect surgical emphysema or movement crepitus (suggesting a Use of accessory muscles pneumothorax until proven Colour otherwise) O2 Saturation (SpO2) ABCDE Respiratory Assessment Solent University 12  If the patient’s depth or rate of breathing is judged to be inadequate, or absent, use: Bag-mask or pocket mask ventilation to improve oxygenation and ventilation, whilst calling immediately for expert help In cooperative patients who do not have airway obstruction consider the use of non-invasive ventilation (NIV) In patients with an acute exacerbation of COPD, the use of NIV is often helpful and prevents the need for tracheal intubation and invasive ventilation. ABCDE Respiratory Assessment Solent University 13  In almost all medical and surgical emergencies, consider hypovolaemia to be the primary cause of shock, until proven otherwise. Unless there are obvious signs of a cardiac cause, give intravenous fluid to any patient with cool peripheries and a fast heart rate. In surgical patients, rapidly exclude haemorrhage (overt or hidden). ABCDE Respiratory Assessment Solent University 14  Assessment Management Manual pulse and Cannulate BP 12 lead ECG Monitoring Take appropriate C Capillary refill time Urine output / fluid bloods Blood cultures if Circulation balance needed Temperature Fluid bolus – Ensure IV access administer – titrate ABCDE Respiratory Assessment Solent University 15  Look Listen Feel Colour - hands and digits: are Manual blood Pressure Even in Pulse - Count the patient’s pulse they blue, pink, pale or mottled? shock, the blood pressure may be rate Haemorrhage normal, because compensatory Pulse - Palpate peripheral and 12-lead ECG mechanisms increase peripheral central pulses, assessing for Urine output / fluid balance - resistance in response to reduced presence, rate, quality, regularity (urine volume < 0.5 mL kg-1 h-1) cardiac output and equality. Any evidence of infection? Auscultate the heart (if Temperature - Assess the limbs Insensible loss? trained) temperature by feeling the Patent IV access? patient’s hands: are they cool or warm? Capillary refill time (CRT) - The normal value for CRT is usually