ALS Prevention an arrest ABCDE approach Chain of
ALS Prevention an arrest ABCDE approach
Chain of survival
Early recognition of the deteriorating patient may prevent cardiac arrest Most of cardiac arrests are predictable In 50 - 80% of cardiac arrests there was a patient’s deterioration Hypoxia and hypotention are warning signs Delay information
ABCDE approach in a deteriorating patient Airway Breathing Circulation Disability Exposure
Initial assessment Personal safety Patient’s response
ABCDE approach: Airway Patient response: oxygen Patient does not response
ABCDE approach: Airway Causes of airway obstruction: Deep sedation Blood Vomiting Foreign body Trauma Oedema Infection Laryngospasm Bronchospasm
ABCDE approach: Airway Recognition of airway obstruction Noisy breathing Abnormal breathing Respiratory failure
ABCDE approach: Airway Treatment Suction Open airway Stomato/oropharyngeal airways Advanced airways – eg. LMA, endotracheal tube oxygen capnography
ABCDE approach: Breathing Listening for abnormal sounds RR Sp. O 2
ABCDE approach: Breathing Causes Decreased respiratory drive – Deep sedation Decreased respiratory effort – Muscle dysfunction – Nerve damage – Pain due to fractures Problems of lungs – – – – Pneumothorax Hemothorax Infection COPD crisis Asthma Pulmonary embolism ARDS
ABCDE approach: Breathing Treatment Airway Oxygen Cause management Breathing support Eg bag-mask ventilation Continuous monitoring (Sp. O 2, RR)
ABCDE approach: Circulation RCT HR AP IV/IO access Tests Monitoring Urine output
ABCDE approach: Circulation Causes of circulation problems: Primary Secondary – – – – Acute coronary syndromes Arrhythmias Hypertensive heart disease Valve disease Hereditary cardiac diseases (Drugs) (Electrolyte/acid base abnormalities) Asphyxia Hypoxaemia Blood loss Hypothermia Septic shock (Drugs) (Electrolyte/acid base abnormalities)
ABCDE approach: Circulation Recognition of circulation problems: Look at the patient Pulse - tachycardia, bradycardia Peripheral perfusion - capillary refill time Blood pressure Organ perfusion – Chest pain, mental state, urine output Bleeding, fluid losses Record and document an ECG
ABCDE approach: Circulation Treatment of circulation problems: Airway, Breathing Oxygen IV/IO access, take bloods Establish ECG monitoring Treat cause Fluid challenge Haemodynamic monitoring Inotropes/vasopressors Aspirin/nitrates/oxygen (if appropriate) and morphine for acute coronary syndrome
ABCDE approach: Disability Recognition AVPU Alert Voice Pain Unresponsive
ABCDE approach: Disability Recognition AVPU or GCS Pupils Lateralising signs Treatment ABC Treat underlying cause Blood glucose – If < 4 mmol l-1 give glucose Consider lateral position Check drug chart
ABCDE approach: Exposure Environment Expert
ABCDE approach: Exposure Remove clothes to enable examination – e. g. injuries, bleeding, rashes Avoid heat loss Maintain dignity
Αναγνώριση ασθενούς που επιδεινώνεταιEarly Warning Scoring Systems Example of early warning scoring (EWS) system* * From Prytherch et al. Vi. EWS—Towards a national early warning score for detecting adult in-patient deterioration. Resuscitation. 2010; 81(8): 932 -7
Αναγνώριση ασθενούς που επιδεινώνεται Early Warning Scoring Systems Example Escalation Protocol based on early warning score (EWS)
Summary Early recognition of the deteriorating patient may prevent cardiac arrest Most patients have warning symptoms and signs before cardiac arrest Airway, breathing or circulation problems can cause cardiac arrest ABCDE approach to recognise and treat patients at risk of cardiac arrest
Questions Which is correct (C) or false (F)? Early recognition of the deteriorating patient may prevent cardiac arrest C The most common warning symptoms and signs before cardiac arrest are fever and hypoxia F If patient does not response, the first step is to administer oxygen F Regarding ABCDE approach the monitoring for B is the clinical observation of RR F Airway, breathing or circulation problems can cause cardiac arrest C
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