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ABCDE Breathing Causes of breathing problems: Decreased respiratory drive (CNS depression, 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: SOB Hypoxia Hypercarbia Irritability Confusion Lethargy Cyanosis Management of breathing problems: Give oxygen 15 L/min through a non rebreathe bag mask Aim 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 heart abnormalities. Cardiac arrest is most commonly secondary to MI. Commonest arrest rythm is VF (ACS, hypertensive cardiac disease, valve disease, drgs, etc.) Diagnosis of circulation problems: Capillary refill, pulse, BP Signs & symptoms: Chest pain SOB Tachycardia Bradycardia Inreased RR Hypotension Syncope Decreased GCS Management of circulation problems: Cannula insertion Bloods (FBC, U&E, LFTs, cardiac markers > 6hrs) Fluids if hypotension (be wary of fluids in cardiac problems - possibility of fluid overload. Try fluid challenge of 250ml but if unsure wait for expert help) If cardiac arrest then follow ALS algorithm Disability Common causes of unconciousness: Profound hypoxia Profound hypercapnia Cerebral hypoperfusion Drugs (sedatives, analgesics) Diagnosis of disability (unconciousness): A - alert V - response to verbal communication P - response to pain U - unresponsive Pupils (size, equality and reaction to light) Glucose (diabetes) Management of Disability (unconciousness): Reassess A, B, & C Treat underlying causes Exposure: Examine the patient thoroughly! Remember to respect the patients dignity Minimise heat loss Handover: It is important to give a structured description about the patient & situation to seniors S -situation B - background A - assessment R - recomendation Airway Causes of airway obstruction: Mechanical (eg. Blood, vomitus, foreign bodies) Trauma (bamage to airways) Anaphylaxis (angioedema) Infection (epiglotitis) CNS depression Neurological (Guillame-Barre, myasthaenia gravis) Laryngospasm Bronchial secretions Diagnosis of airway obstruction: Patient choking Cyanosis Stridor Patient straining to breathe "see saw" breathing (uncoordinated chest & abdominal breathing Management of airway obstruction: Head tilt / chin lift Removal of obstruction (finger sweep, suction) Recovery position Nasopharyngeal airway (better tolerated than Guedel) Oropharyngeal (Guedel) Help: If unable to solve threat quickly call anaethetist to insert airway www.mqlearn.co.uk

ABCDE Approach

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Page 1: ABCDE Approach

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

www.mqlearn.co.uk