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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