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Patient assessment and the ABC approach
Transcript of Patient assessment and the ABC approach
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:
foreign body obstruction
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
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
Treat the underlying cause Airway manouvres
Jaw thrust if C-spine injury possible
Supraglottic airway: LMA, combitube
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:
10/15L/min of oxygen
If they have a ventilation problem:
Reservoir /non-rebreather mask
assist ventilation as needed: BVM, CPAP, BiPAP
Treat the underlying cause
Move onto CIRCULATION once initial treatment started Examine the patient:
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
Pupils (resting size, equality, reactions)
Glasgow Coma Score
AVPU Disability Exposure Look for:
Recent operation sites
Signs of internal or external haemorrhage
DVT The Primary Survey Dr. Cosmo Scurr