Abcde and Recognition of Critically Ill Patient

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    ABCDE ,causes andPrevention CardiacArrest

    FLS

    ByDr Noha

    Elsharnouby

    Associateprofessor ofanesthesia andICU , Ain Shams

    university

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    Objectives

    The causes of cardiorespiratory

    arrest Identify and managing patientsat risk using the ABCDE

    approach

    FLS

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    FLSEarly recognition of the critically ill

    patient

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    Recognition of critically illpatients

    UPVACNS

    > 37.536.6-37.4

    35.1-36.5

    < 35Temp C

    > 3021-2915-209 -14< 8Respiratory

    Rate

    > 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 arrest

    Airway

    Breathing

    Circulation

    FLS

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    Causes of

    cardiorespiratory arrestAirway problems

    Obstruction caused by:

    CNS depression Blood Vomit Foreign body Trauma Infection Inflammation Laryngospasm

    FLS

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    Causes of cardiorespiratory arrestBreathing problems

    Decreased respiratory

    drive CNS depression

    Decreased respiratoryeffort muscle weakness nerve damage

    restrictive chest defect

    pain from fractured ribs

    Lung disorders pneumothorax haemothorax

    infection

    acute exacerbationCOPD

    asthma pulmonary embolus

    ARDS

    FLS

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    Global InjurySolutions

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    Global InjurySolutions

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    Causes of cardiorespiratoryarrestCirculatory problems

    Primary

    Acute coronarysyndromes Dysrhythmias Hypertensive heart

    disease Valve disease Drugs Electrolyte / acid base

    abnormalities

    Secondary Hypoxaemia Blood loss Hypothermia

    Septic shock

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    ABC

    DE

    The ABCDE approach to thecritically ill patient

    FLS

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    ABCDE approachRules

    Call for help earlyPriority of treatmentComplete initial assessmentReassessment

    safety

    Patient responsiveness to

    treatment

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    ABCDE approach

    Airway

    Recognition of airway obstruction Talking

    Difficulty breathing, distressed, choking Shortness of breath

    Noisy breathing

    stridor, wheeze, gurgling

    See-saw respiratory pattern,

    accessory muscles

    AFLS

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    ABCDE Approach

    Airway

    Treatment of airway obstruction Oxygen

    Airway opening- i.e. head tilt, chin lift, jaw thrust

    Simple adjuncts

    Advanced techniques

    - e.g. LMA, tracheal tube

    AFLS

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    ABCDE approach

    Breathing

    Recognition of breathing problems Look

    Inspect respiratory distress, accessory muscles,cyanosis, respiratory rate, chest deformity, consciouslevel

    Listen Auscultate breath sounds, noisy breathing

    Feel palpat expansion, percussion, tracheal position

    Pulse oxymetry

    BFLS

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    ABCDE approach

    Breathing

    Treatment of breathing problems

    Airway

    Oxygen

    Treat underlying cause

    - e.g. drain pneumothorax

    - e.g . Nebulizers Support breathing if inadequate

    - e.g. ventilate with bag valve mask

    BFLS

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    ABCDE approach

    Circulation

    Look at the patient Pulse central pulse (carotid)

    peripheral pulse Peripheral perfusion

    capillary refill time

    ( normally

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    ABCDE approach

    Circulation

    Airway, Breathing Oxygen IV access, take blood sample

    and lab investigations Treat cause

    Give fluids Haemodynamic monitoring MONA if acute coronary

    syndrome

    Treatment

    CFLS

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    ABCDE approach

    Disability

    AVPU or GCS?

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    Global InjurySolutions

    Examination Points

    Eye opening

    Spontaneous

    To speech

    To pain

    None

    4

    3

    21

    Best motor response

    Obeys commands

    Localizes

    WithdrawsAbnormal flexion

    Extends

    None

    6

    5

    4

    3

    2

    1

    Best verbal response

    Oriented

    Confused

    Inappropriate

    Incomprehensible sounds

    None

    5

    4

    3

    2

    1

    Total Glasgow Coma Score Best score =15

    Worst score =3

    Disability

    GlasgowComa

    Score

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    ABCDE approach

    Disability

    AVPU or GCS, and pupils

    Treatment - ABC

    Treat underlying cause

    Blood glucose

    if < 3 mmol l-1

    give glucose

    DFLS

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    ABCDE approach

    Exposure

    Remove clothes to enableexamination

    - e.g. injuries, bleeding, rashes Avoid heat loss Maintain dignity

    EFLS

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    Anyquestions

    FLS

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    Summary

    Early recognition of patients at risk mayprevent cardiorespiratory arrest

    Airway, breathing or circulation problemscan cause cardiorespiratory arrest

    ABCDE approach to recognise and treatpatients at risk of cardiorespiratory arrest

    FLS

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