Case 001 – ColorBall Type 1 ABCDE FGHIJ. Case 002 – ColorBall Type 2 ABCDE FGHIJ.
Cme Lecture Abcde and Recognition of Critically Ill Patient
Transcript of 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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