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Patient assessment and the ABC approach

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Cosmo Scurr

on 12 July 2010

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Transcript of Patient assessment and the ABC approach

Assess the patient Are they sick? Look around the bed for clues
medication
breathing equipment
lines/drains
Look at the patient
Are they responsive?
Are the pale and calmmy?
Are they drowsy? Well patient Unwell patient Make a full assessment History Examination Do they respond at all? No Call for help
Use BLS/ALS guideline approach Yes http://www.resus.org.uk/SiteIndx.htm AIRWAY BREATHING CIRCULATION DISABILITY EXPOSURE You must ASSESS and CORRECT at each step before moving on Airway assessment: Is the airway maintained and safe?

The airway can be unsafe from:
recuded GCS
foreign body obstruction
airway swelling

Breathing Initiate treatment with OXYGEN

Is the patient making respiratory effort?
Is the chest movement normal?
Equal, normal ratio, fast or slow - RR

Cyanosis, wheeze, air entry, added sounds
Tracheal deviation

Saturations monitor (pulse oximetry)
Arterial blood gas - depending on time Circulation Summary:

1. Ascertain if the patient is well or unwell

2. Get help with unwell patients

3. Follow the ABCDE approach but ensure you treat the patient at each stage

4. If the situation changes go back and start from Airway again

SELF MAINTAINED AIRWAY:

Move onto breathing AIRWAY AT RISK:

Support the airway with the
following measures
Treat the underlying cause Airway manouvres
Head tilt
Chin Lift
Jaw thrust if C-spine injury possible

Airway adjuncts
Oropharyngeal airway
Nasopharyngeal airway
Supraglottic airway: LMA, combitube

Definitive airways
Endotracheal tube
Tracheostomy tube

MOVE ONTO BREATHING ONCE AIRWAY OPEN
If there is no breathing problem move onto CIRCULATION
They may still need oxygen if they are unwell If there is a breathing problem then the patient will need help with OXYGENATION and/or VENTILATION ALL sick/unstable patients should be treated with 100% oxygen

If they have an oxygenation problem:
Reservoir/non-rebreather mask
10/15L/min of oxygen


If they have a ventilation problem:
Reservoir /non-rebreather mask
10-15L/min oxygen
assist ventilation as needed: BVM, CPAP, BiPAP


Treat the underlying cause

Move onto CIRCULATION once initial treatment started Examine the patient:

Cool peripheries
Capilliary refill
Blood pressure
Pulse rate and rhythm
Look at charts for past observations
Look at previous ECG
Look at charts for urine output
Low GCS may be a due to poor circulation

Cannulate the patient:

To take relevant blood tests
To give medications

To resuscitate with fluids

Catheterise if needed
Examine for:

Pupils (resting size, equality, reactions)

Temperature

Glasgow Coma Score

AVPU Disability Exposure Look for:

Rashes
Swellings/Injuries
Recent operation sites
Hernias
Signs of internal or external haemorrhage
DVT The Primary Survey Dr. Cosmo Scurr
Full transcript