This document provides information on assessing and managing critically ill patients using the ABCDE approach. It discusses: - Common early signs of critical illness including hypoxia and hypotension. - The ABCDE approach which prioritizes establishing a patient's airway, breathing, circulation, disability level and exposure for examination. - Techniques for assessing and intervening on airway, breathing and circulation issues including providing oxygen, treating underlying causes, and starting IV fluids. - The importance of continuous reassessment, calling for help early, and following basic life support protocols when indicated to stabilize critically ill patients.

1. By: Dr.Wesam Abdelaziz

2. Early Signs of a critically ill patient
Initial management of a critically ill
patient
ABCDE Approach

4.  Most cardiac arrest cases are predictable
 Hypoxia and Hypotension are the most
common causes
 Medical Emergency Team (MET)

5.  A: Airway
 B: Breathing
 C: Circulation
 D: Disability
 E: Exposure

6.  Safety
 Treat life-threatening problems
 Assess effects of treatment/interventions
 Call for help early
 Continuous assessment is very important

7. Causes of airway obstruction:
1. CNS depression
2. Blood
3. Vomit
4. Foreign body
5. Trauma

8. Talking means patent airway
Difficulty breathing, distressed, choking
Shortness of breath
Noisy breathing
 Stridor, wheeze, gurgling
See-saw respiratory pattern, accessory
muscles

9.  Head Tilt and chin lift
 Jaw thrust if Trauma
 Oro-pharyngeal Airway
 Naso-pharyngeal Airway
 Suction
 Laryngeal Mask Airway (LMA)
 Endotracheal tube
 Oxygen

11.  Causes if breathing problems:
 Decreased respiratory drive
 CNS depression
 Decreased respiratory effort
 Muscle weakness
 Nerve damage
 Restrictive chest
defect
 Pain from fractured
ribs
 Lung disorders
 Pneumothorax
 Hemothorax
 Infection
 COPD
 Asthma
 Pulmonary
embolus
 ARDS

12.  Inspection:
• Respiratory Rate
• Chest expansion
• Working accessory
muscle
• Deformity
 Palpation:
• Tenderness
• Surgical emphysema
• Crepitus
 Percussion:
• Dullness or hyper-
resonance
 Auscultation:
• For breath sounds and
equality

13.  Open Airway
 Oxygen Supply
 Treat Underlying Problem:
 Bronchodilator Nebulizer is wheezy chest
 Needle Thoracocentesis if Tension
Pneumothorax
 Assisted Ventilation if inadequate breathing

15.  Causes of circulation problems:
Primary
 Acute coronary syndromes
 Arrhythmias
 Hypertensive disease
 Valve disease
 Drugs
 Inherited cardiac diseases
 Electrolyte/acid base
abnormalities
Secondary
 Aasphyxia
 Hypoxemia
 Blood loss
 Hypothermia
 Septic shock

16.  Pulse :
 Central & peripheral
 Rate, Rhythm, Equality
 Blood pressure
 Peripheral perfusion - capillary refill time ( < 2 sec)
 Organ perfusion
– Chest pain, mental state, urine output
 Look at the patient : Pallor, Bleeding

17.  Airway ,Oxygen
 Breathing
 IV/IO access, take bloods
 Treat cause : ACS
 Fluid challenge
 Monitor

18. Recognition:
AVPU
A: Alert
V: Responsive to verbal Stimuli
P: Responsive to Painful stimuli
U: Unresponsive
Pupils
Blood glucose
Normally is 4 mmol/ L (70 mg/dl)
Treatment:
 ABC
 Treat underlying
Cause:
 Check for drug chart

19.  Remove clothes to enable examination
e.g. injuries, bleeding, rashes
 Avoid heat loss
 Maintain dignity
 Indication of complete Exposure

20. • Consult Specialist and Admission
• Investigations
• Continuous Assessment

24.  Follow the ABCDE in assessment of any
patient.
 Assess and re-assess all the time.
 Don’t delay Calling senior Help

26.  Basic Life Support
 The ALS algorithm
 Treatment of shockable and non-shockable rhythms
 Potentially reversible causes of cardiac arrest
 Role of resuscitation team

28. Approach safely
Check response
Open airway
Check breathing
Call 123
30 chest compressions
2 rescue breaths

30.  Patient response
 Open airway
 Look, Listen, Feel
 Check for normal breathing
 Caution agonal breathing
 Check for signs of life

31.  Pulse check if trained to do so
 Take less than 10 seconds for
assessment
 Call for help early

34.  30:2
 Compressions
 Centre of chest
 5-6 cm depth
 2 per second (100-120 min-1)
 Maintain high quality compressions
with minimal interruption
 Continuous compressions once
airway secured
 Switch compression provider
every 2 min to avoid fatigue

35. Team Means:
Monitor
Skilled Persons
Drugs
Start With Monitor

37. MINIMISE INTERRUPTIONS IN CHEST COMPRESSIONS
START PAUSE
Assess
rhythm
Shockable
(VF / Pulseless VT)
Non-Shockable
(PEA / Asystole)
CPR

38.  Bizarre irregular
waveform
 No recognisable QRS
complexes
 Random frequency and
amplitude
Uncoordinated electrical
activity
Coarse/fine
Exclude artefact
– Movement
– Electrical interference

39.  Monomorphic VT
– Broad complex rythm
– Rapif rate
– Constant QRS morphology
 Polymorphic VT
– Torsade de pointes

40. MINIMISE INTERRUPTIONS IN CHEST COMPRESSIONS
Assess
rhythm
IMMEDIATELY
RESTART CPR
MINIMISE INTERRUPTIONS IN CHEST COMPRESSIONS

41. CPR for 2 min
CPR for 2 min
During CPR
Adrenaline 1 mg IV
Amiodarone 300 mg IV
Deliver 2nd shock
Deliver 3rd shock

42. Assess
rhythm
Shockable
(VF / Pulseless VT)
Non-Shockable
(PEA / Asystole)
MINIMISE INTERRUPTIONS IN CHEST COMPRESSIONS

43.  Absent ventricular (QRS) activity
 Atrial activity (P waves) may persist
 Rarely a straight line trace
 Adrenaline 1 mg IV then every 3-5 min

44. Clinical features of cardiac arrest
ECG normally associated with an output

45.  Adrenaline 1 mg IV every 3-5 min
 Continue chest compression and ventillation
 Assesment of rhythm every 2 minutes

48. Any questions