Whilst approaching the patient, you should be…
DR
- Assessing for any DANGER. Is it safe for you to approach?
- Making a general assessment of the patient. Are they RESPONSIVE to you entering the room and speaking to them? Do they appear well?
If there is no response, what should you do?
- Try to rouse the patient whilst asking if they’re okay.
- If they are unconscious/unresponsive, pull the emergency buzzer.
- Look for signs of life for 10 seconds(Look, listen and feel). If none, lay flat, manually displace uterus to left side to reduce aortocaval obstruction and start CPR immediately.
If they do respond but are acutely unwell, still pull emergency buzzer, lay the bed flat, place into left lateral
Begin A-E assessment.
What does the A stand for?
Airway
If the patient can talk to you normally, it indicates that their airway is…
Patent, they are breathing and have brain perfusion.
If the patient appears to be unconscious and unresponsive, their airway may be…
Obstructed. If you haven’t already done so, call for emergency help! Open airway with head tilt and chin lift and Start CPR. (30:2-compressions 100-120bpm)
An obstructed airway, if not treated promptly, can lead to…
Hypoxia- causing damage to the brain, kidneys and heart leading to cardiac arrest and death.
When assessing for Airway obstruction, check for…
- Are there any noises present? With partial obstruction (such as swelling) air entry is diminished and often noisy.
- If there are no noises from the nose or mouth, the airway is likely completely obstructed.
- ‘See-saw’ movements of the chest
- use of the accessory muscles for respiration
- Signs of central cyanosis- blue discolouration of body/mucous membranes indicates tissues are poorly perfused of oxygen (generally cardiorespiratory problem)
- start 15l of oxygen non breatheable mask
What should be performed by a trained professional if the patient’s airway is obstructed?
- Airway suction
- Insertion of an oropharyngeal or nasopharyngeal airway.
- Tracheal intubation may be required when these fail.
‘B’ stands for Breathing. What are the general signs of respiratory distress?
-Difficulty speaking in full sentences
-Sweating,
-Central cyanosis
-Use of the accessory muscles of respiration, and abdominal
breathing.
What should you do to assess the patients breathing?
- Look for signs of respiratory distress/assess symmetry of chest movements and use of accessory muscles
- Depth of breaths
- Any pleuritic pain?
- Check their respiratory rate and pattern- 11-20 normal range PROMPT.
- Check the depth of their resps
- Maintain SpO2 reading. 95-100% normal range on PROMPT meows.
- Check for signs of cyanosis
- Administer high flow oxygen 15L/min
C is for circulation. What should you do to assess the patients circulation?
- Assess colour of the hands and digits
- Manual pulse (normal range 50-99 PROMPT) and BP (systolic 100-149, diastolic up to 99- however, NICE recommends aim for BP below 140/90mmHg) reading, repeat every 5 mins
- Check CRT. Apply cutaneous pressure for 5s before releasing (should be <2seconds). If >2s, it indicates poor peripheral perfusion due to peripheral vasoconstriction. ? Hypovolemic shock.
- Assess for any obvious or concealed bleeding
- Ensure IV access x2 large/wide bore cannulas for faster infusion
- Begin fluid resuscitation (2L crystalloid- depending on situation. Reduced amount for PET or cardiac disorders)
- Take bloods (depending on possible diagnosis)
- Check urine output. Insert indwelling catheter with urometer and begin strict fluid balance.
When palpating the patients pulse, what are you assessing?
- Presence
- Rate
- Quality
- Regularity
- Equality
A barely palpable pulse suggests…
Poor cardiac output (Hypovolemia?)
A bounding pulse could be an indicator of…
An infection- such as sepsis.
Circulation. In almost all medical and surgical emergencies, consider hypovolaemia to be the primary cause of shock, until proven otherwise. What should you consider/look for? (Resus council)
-Signs of haemorrhage, obvious or concealed.
IV access should be sought using…
2x large bore cannulae (grey)
D is for Disability. Assess neurological response using AVPU mnemonic. What does this stand for?
- Alert- are they alert?
- Voice- do they respond to vocal stimuli?
- Pain- do they respond to pain stimuli? Supra-orbital pressure or a trapeze squeeze can be used
- Unconscious- are they unresponsive to all above?
Other than AVPU, what should you assess for disability?
-Pupil size, equality and reaction to light
-Glucose levels to exclude
hypoglycaemia (should be >4mmol/L)
- Check for signs of seizures
- Check drugs chart- have any recent medications been administered? could they be the cause? could this be anaphylaxis? (If so, stop any medication immediately, regular obs to observe improvement/deterioration. Consider adenaline via BLS protocol)
- Check temperature- PROMPT meows states normal range from 36-37.9c. NICE states that a recording of 37.5- 37.9c on 2x occasions taken 1 hour apart also indicates pyrexia.
- monitor fetal wellbeing- continnuous CTG if AN
E is for…
Exposure! Do a thorough head to toe examination of the patient from front to back and reassess.
What do you need to look out for when assessing for exposure?
- Any rashes?
- Bruising
- Any sign of infection (LSCS wound?)
- Any sign of injury
- Any swelling
- palpate uterus
- Check vagina for trauma/bleeding
