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ABCDE
Breathing
Causes of breathing problems:
Decreased respiratory drive (CNSdepression, drugs)Decreased respiratory effort (neurological,muscular, weakness)Lung disorders (asthma, COPD, ARDS)Tension pneumothorax
Diagnosis of breathing problems:
Look, Listen, Feel, ABG, pulse oximetry
Signs & symptoms:SOBHypoxiaHypercarbiaIrritabilityConfusionLethargyCyanosis
Management of breathing problems:
Give oxygen 15 L/min through a nonrebreathe bag maskAim for sats of 94-98%
Treat cause (salbutamol/ipratropium -asthma, adrenaline -anaphylaxis)
Call for expert help early
Circulation
Causes of circulation problems:
Primary heart disease or secondary heartabnormalities. Cardiac arrest is mostcommonly secondary to MI.Commonest arrest rythm is VF (ACS,hypertensive cardiac disease, valvedisease, drgs, etc.)
Diagnosis of circulation problems:
Capillary refill, pulse, BP
Signs & symptoms:Chest painSOBTachycardiaBradycardiaInreased RRHypotensionSyncopeDecreased GCS
Management of circulation problems:
Cannula insertionBloods (FBC, U&E, LFTs, cardiac markers >6hrs)Fluids if hypotension (be wary of fluids incardiac problems - possibility of fluidoverload. Try fluid challenge of 250ml but ifunsure wait for expert help)
If cardiac arrest then follow ALS algorithm
Disability
Common causes of unconciousness:
Profound hypoxiaProfound hypercapniaCerebral hypoperfusionDrugs (sedatives, analgesics)
Diagnosis of disability (unconciousness):
A - alertV - response to verbal communicationP - response to painU - unresponsive
Pupils (size, equality and reaction to light)
Glucose (diabetes)
Management of Disability (unconciousness):
Reassess A, B, & CTreat underlying causes
Exposure:
Examine the patient thoroughly!Remember to respect the patients dignityMinimise heat loss
Handover:
It is important to give a structureddescription about the patient &situation to seniors
S -situationB - backgroundA - assessmentR - recomendation
Airway
Causes of airway obstruction:
Mechanical (eg. Blood, vomitus, foreignbodies)Trauma (bamage to airways)Anaphylaxis (angioedema)Infection (epiglotitis)CNS depressionNeurological (Guillame-Barre, myasthaeniagravis)LaryngospasmBronchial secretions
Diagnosis of airway obstruction:
Patient chokingCyanosisStridorPatient straining to breathe"see saw" breathing (uncoordinated chest &abdominal breathing
Management of airway obstruction:
Head tilt / chin liftRemoval of obstruction (finger sweep,suction)Recovery positionNasopharyngeal airway (better toleratedthan Guedel)Oropharyngeal (Guedel)
Help:
If unable to solve threat quickly callanaethetist to insert airway
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