Please enable JavaScript.
Coggle requires JavaScript to display documents.
ABCDE management (SBAR handover (Background Brief summary of patient PC…
ABCDE management
SBAR handover
Background
Brief summary of patient
PC and admission
PMH and relevant medications
Assessment
Findings on ABCDE
Current vital signs
NEWS score
Situation
Who and what you are
Clarify taling to correct person
Problem and what needed (advice etc,)
Recommendations
What you have done so far
What you would like them to do for you
B: Breathing
Examination
Inspection
Wheeze, accessory muscle use, cyanosis,
pursed lips, nasal flare, fail chest etc.
cardiorespiratory arrest
Observations
Oxygen sats: on air or supplemental O2
RR: normal 12-18
Palpation
Pulse
CRT, temperature
Tracheal deviation
Chest expansion
Percussion
Resonant, dull, stony dull, hyper-resonant
Auscultation
Reduced sounds, bronchial breathing,
wheeze, fine/coarse crackles
Investigations
ABG
Indication: signs of breathing difficulties
CXR
Indication: signs of breathing issue
Management
Oxygen
Indication: respiratory compromise (<94%) E.g. 15L non-rebreathe mask (aim >94%); if COPD,
keep close eye with regular ABGs, may need Venturi
Needle thoracotomy
Indication: tension pneumothorax
MOA: 2nd ICS MCL
Chest drain
Indication: pneumothorax/pleural effusion
MOA: contact on-call reg for chest drain
C: Circulation
Examination
Palpation
Pulse, RR
CRT (peripheral, central)
temperature (warm, cold)
Peripheral oedema
Auscultation
Heart sounds, additional sounds
Inspection
Pallor, cyanosis, sweats, JVP,
signs of blood loss (chest, abdo, long bones, pelvis, floor)
Observations
HR: high/low
BP: non-invasive or invasive monitoring
Cardiac monitoring: obvious abnormalities
Investigations
ECG
Indication: suspected CV issue
(e.g. tachycardic, BP change)
Bloods
FBC, CRP, U+E, LFTs,
clotting, group&save, crossmatch
Management
IV fluids
Indication: hypovolemic
E.g. crystalloids, blood
Initial 500mL bolus, if two boluses dont
help then contact ITU
Catheterisation
Meausure UO
IV access
Cannulate all patients
Wide bore e.g. grey, orange
If not possible, try IO using EZ-IO kit
(humoral head if possible), may need CV access
Major haemorrhage protocol
If major blood loss
Urgent O- blood provided, urgent crossmatching of several units, provision of clotting factors as well as red cells
Secondary
assessment
History (AMPLE)
Allergies, medications, PMH,
last oral intake, events leading up
Check notes and charts and
investigations
Discuss with colleagues
and reassess from A to E
A: Airway
Examination
Inspection
Ability to talk/complete sentances
Stridor, cough, cyanosis, hoarseness,
profound drooling, cardiorespiratory arrest
Call for help (2222) if no patent airway
Management
Airway adjuncts
Oropharyngeal (incisor to angle of mandible; if poor gag)
Nasopharyngeal (nose to earlobe, if semi intact gag; but
not if suspected basal skull fracture)
Definitive airway
Cricothyrodotomy, emergency tracheostomy
Intubation and ventilation orotracheal tube
Airway manoeuvres
Head tilt, chin lift (not if C-spine injury)
Jaw thrust
Remove objects
Solids with forceps
Liquid with suction
D: Disability
Investigations
Blood glucose
Bedside capillary BM
Temperature
Bedside probe
Check drug chart
?drug induced LOC
Examination
Pupils
PEARL?
GCS and basic neuro exam
AVPU: alert, voice, pain, unresponsive
GCS: motor (6), voice (5), eyes (4); if <8, contact ITU
Obvious CN abnormalities, tone, power, reflexes,
co-ordination, focal signs, abnormal posturing
Definition
Initial assessment and management
method for an acutely unwell patient
Manage identified issues as they arise
E: Exposure
Examination
Legs
Oedema, calf tenderness/swelling
Groin and perineum
Injury, infection etc.
Malaena, urethral bleeding
Abdominal exam
Inspect, palpate, percuss, auscultate
Bruising, wounds, signs of obstruction/perforation
Back
Log roll to check