Cme Lecture Abcde and Recognition of Critically Ill Patient

ABCDE ,causes and ABCDE ,causes and Prevention Cardiac Prevention Cardiac

ArrestArrest

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By Dr Noha

Elsharnouby Associate

professor of anesthesia and ICU , Ain Shams

university

ObjectivesObjectives

The causes of cardiorespiratory arrest

Identify and managing patients at risk using the ABCDEABCDE approach

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FLSEarly recognition of the critically ill patient

Recognition of critically ill Recognition of critically ill patientspatients

UPVACNS

> 37.536.6-37.435.1-36.5< 35Temp °C

> 3021-2915-209 -14< 8RespiratoryRate

> 200101-19981-10071-80< 70Systolic BP mmHg

> 130111-130101-11051-10041-50< 40Pulse

3210123

Track score - a score of > 4 triggers a review by doctor

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Causes of cardiorespiratory arrestCauses of cardiorespiratory arrest

AirwayBreathingCirculation

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Causes of Causes of cardiorespiratory arrest cardiorespiratory arrest

Airway problems Airway problems Obstruction caused by:CNS depression Blood VomitForeign bodyTraumaInfectionInflammationLaryngospasm

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Causes of cardiorespiratory arrest Causes of cardiorespiratory arrest BreathingBreathing problems problems

Decreased respiratory drive

◦CNS depression

Decreased respiratory effort

◦muscle weakness ◦nerve damage◦restrictive chest defect◦pain from fractured ribs

Lung disorders◦pneumothorax◦haemothorax ◦infection◦acute exacerbation

COPD◦asthma◦pulmonary embolus◦ARDS

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Global Injury Solutions

Global Injury Solutions

Causes of cardiorespiratory Causes of cardiorespiratory arrestarrestCirculatory problemsCirculatory problems Primary

Acute coronary syndromes

DysrhythmiasHypertensive heart

diseaseValve diseaseDrugsElectrolyte / acid base

abnormalities

SecondaryHypoxaemiaBlood lossHypothermiaSeptic shock

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A…B…C…D…E…

The ABCDE approach to the critically ill patient

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ABCDE approachABCDE approachRules Rules

Call for help earlyPriority of treatmentComplete initial assessmentReassessmentsafetyPatient responsiveness to treatment

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ABCDE approachABCDE approachAirwayAirway

Recognition of airway obstructionTalkingDifficulty breathing, distressed, chokingShortness of breathNoisy breathing

◦stridor, wheeze, gurgling See-saw respiratory pattern, accessory muscles

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ABCDE ApproachABCDE ApproachAirwayAirway

Treatment of airway obstructionOxygenAirway opening

- i.e. head tilt, chin lift, jaw thrustSimple adjunctsAdvanced techniques

- e.g. LMA, tracheal tube

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ABCDE approachABCDE approachBreathingBreathing

Recognition of breathing problemsLook

◦Inspect respiratory distress, accessory muscles, cyanosis, respiratory rate, chest deformity, conscious level

Listen◦Auscultate breath sounds, noisy breathing

Feel◦ palpat expansion, percussion, tracheal position

Pulse oxymetry

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ABCDE approachABCDE approachBreathingBreathing

Treatment of breathing problemsAirwayOxygenTreat underlying cause

- e.g. drain pneumothorax - e.g . Nebulizers Support breathing if inadequate

- e.g. ventilate with bag valve mask

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ABCDE approachABCDE approachCirculationCirculation

Look at the patientPulse – central pulse (carotid) peripheral pulse Peripheral perfusion capillary refill time ( normally <2 sec)Blood pressureMonitor

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ABCDE approachABCDE approachCirculationCirculation

Airway, Breathing Oxygen IV access, take blood sample

and lab investigations Treat cause Give fluids Haemodynamic monitoring MONA if acute coronary

syndrome

Treatment

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ABCDE approachDisabilityDisability

AVPU or GCS?

Global Injury Solutions

Examination Points Eye openingSpontaneousTo speechTo painNone

4321

Best motor responseObeys commandsLocalizesWithdrawsAbnormal flexionExtendsNone

654321

Best verbal responseOriented Confused Inappropriate Incomprehensible soundsNone

54321

Total Glasgow Coma Score Best score =15Worst score =3

DisabilityGlasgow

Coma Score

ABCDE approachABCDE approachDisabilityDisability

AVPU or GCS, and pupilsTreatment - ABCTreat underlying causeBlood glucose

◦if < 3 mmol l-1 give glucose

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ABCDE approachABCDE approachExposureExposure

Remove clothes to enable examination

- e.g. injuries, bleeding, rashes

Avoid heat lossMaintain dignity

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Any questions

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SummarySummary

Early recognition of patients at risk may prevent cardiorespiratory arrest

Airway, breathing or circulation problems can cause cardiorespiratory arrest

ABCDE approach to recognise and treat patients at risk of cardiorespiratory arrest

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