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Abcde approach-to-the-critically-ill-patient
The document outlines the ABCDE approach for assessing and treating critically ill patients, focusing on airway, breathing, circulation, disability, and exposure. It emphasizes the importance of rapid assessment, immediate life-saving interventions, and continuous reassessment. Additionally, it discusses the primary and secondary survey processes, detailing specific interventions for various life-threatening conditions.
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Abcde approach-to-the-critically-ill-patient
- 1. The approach to thecritically ill patient
- 2. Objectives The rational ofABCDE The process of primary & secondary survey Recognition of life threatening events Treatment of life-threatening conditions Handover 2
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- 4. The ABCDE approach A B C D E Airway& oxygenation Breathing & ventilation Circulation & shock management Disability due to neurological deterioration Exposure & examination 4 4
- 5. The principles Perform primaryABCDE survey (5 min) Instigate treatment for life threatening conditions as you find them Reassess when any treatment is completed Perform more detailed secondary ABCDE survey including investigations If condition deteriorates repeat primary survey 5 5
- 6. The primary survey ABCDEassessment looking for immediately life threatening conditions Rapid intervention usually includes max O2, IV access, fluid challenge +/- specific treatment Should take no longer than 5 min Can be repeated as many times as necessary Get experienced help as soon as you need it If you have a team delegate jobs 6 6
- 7. The secondary survey Performedwhen patient more stable Get a brief relevant HPC & Hx More detailed examination of patient (ABCDE) Order investigations to aid diagnosis IF PATIENT DETERIORATES RETURN TO PRIMARY SURVEY 7 7
- 8. Airway - causes GCS Body fluids Foreign body Inflammation Infection Trauma 8 8
- 9. Airway - assessment Unresponsive Addedsounds ◦ Snoring, gurgling, wheeze, stridor Tracheal tug Accessory muscles See-saw respiratory pattern 9 9
- 10. Airway – interventions (basic) Headtilt chin lift Jaw thrust Suction Oral airways Nasal airways 10 10
- 11. Airway – interventions (advanced) GETHELP!!! Nebulised adrenaline for stridor LMA Intubation Cricothyroidotomy ◦ Needle or surgical 11 11
- 12. Once airway open... Give15 litres of oxygen to all patients via a non-rebreathing mask For COPD patients re- assess after the primary survey has been complete & keep Sats 90-93% 12 112
- 13. Breathing - causes GCS Resp depressions Muscle weakness Exhaustion Asthma COPD Infection Pulmonary oedema Pulmonary embolus ARDS Pneumothorax Haemothorax Open pneumothorax Flail chest 13 13
- 14. Breathing - assessment Look ◦Rate (<10 or >20), symmetry, effort, SpO2, colour Listen ◦ Taking: sentences, phrases, words ◦ Bilateral air entry, wheeze, silent chest other added sounds Feel ◦ Central trachea, Percussion, expansion 14 14
- 15. Breathing - interventions Considerventilation with AMBU™ bag if resp rate < 10 Position upright if struggling to breath Specific treatment ◦ i.e.: β agonist for wheeze, chest drain for pneumothorax 15 15
- 16. Circulation - assessment Lookat colour Examine peripheries Pulse, BP & CRT Hypotension (late sign) ◦ sBP< 100mmHg ◦ sBP < 20mmHg below pts norm Urine output Consider compensation mechanisms 16 16
- 17. Circulation – shock Lossof volume ◦ Hypovolaemia Pump failure ◦ Myocardial & non-myocardial causes Vasodilatation ◦ Sepsis, anaphylaxis, neurogenic BP = HR x SV x SVR Inadequate tissue perfusion 17 17
- 18. Circulation - interventions Positionsupine with legs raised ◦ Left lateral tilt in pregnancy IV access - 16G or larger x2 ◦ +/- bloods if new cannula Fluid challenge ◦ colloid or crystalloid? ECG Monitoring Specific treatment 18 18
- 19. Disability - causes Inadequateperfusion of the brain Sedative side effects of drugs BM Toxins and poisons CVA ICP 19 19
- 20. Disability - assessment AVPU(or GCS) ◦Alert, responds to Voice, responds to Pain, Unresponsive Pupil size/response Posture BM Pain relief 20 200
- 21. Disability - interventions Optimiseairway, breathing & circulation Treat underlying cause ◦ i.e.: naloxone for opiate toxicity ◦ Caution if reversing benzo’s Treat BM ◦ 100ml of 10% dextrose (or 20ml of 50% dextrose) Control seizures Seek expert help for CVA or ICP 21 211
- 22. Exposure Remove clothes andexamine head to toe front and back ◦ Haemorrhage (inc concealed), rashes, swelling etc Keep warm (unless post cardiac arrest) Maintain dignity 22 222
- 23. Secondary survey Repeat ABCDEin more detail History Order investigations ◦ ABG, CXR, 12 lead ECG, Specific bloods Management plan Referral Handover 23 233
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- 25. Situation Check you aretalking o the right person State your name & department I am calling about... (patient) The reason I am calling is... 25 255
- 26. Background Admission diagnosis anddate of admission Relevant medical history Brief summary of treatment to date 26 266
- 27. Assessment • The assessmentof the patient using the ABCDE approach 27 277
- 28. Recommendation I would likeyou to... Determine the time scale Is there anything else I should do? Record the name and contact number of your contact 28 288
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- 30. Summary Assess ABCDE inturn Instigate treatments for life-threatening problems as you find them Reassess following treatment If anything changes go back to A 30 30