ABCDE Assessment

Question 1

What is the Chain of Prevention for in-hospital cardiac arrest?

Answer 1

1. Education
2. Monitoring
3. Recognition
4. Call for Help
5. Response

Question 2

What parameters are used for NEWS2 score?

Answer 2

1. RR
2. Sats
3. Air or O2
4. SBP
5. Pulse
6. Consciousness
7. Temp

Question 3

NEWS2 Score 3 - RR:

Answer 3

1. ≤ 8
2. ≥ 25

Question 4

NEWS2 Score 3 - SpO2 scale 1:

Answer 4

1. ≤ 91%

Question 5

NEWS2 Score 3 - SpO2 scale 2:

Answer 5

1. ≤ 83%
2. ≥ 97% on O2

Question 6

NEWS2 Score 3 - SBP:

Answer 6

1. ≤ 90
2. ≥ 220

Question 7

NEWS2 Score 3 - Pulse:

Answer 7

1. ≤ 40
2. ≥ 131

Question 8

NEWS2 Score 3 - Consciousness:

Answer 8

1. CVPU

Question 9

NEWS2 Score 3 - Temperature:

Answer 9

1. ≤ 35

Question 10

NEWS 2 score = 1- 4

Frequency of monitoring:

Clinical response:

Answer 10

Frequency of monitoring:
1. 4-6 hourly

Clinical response:
1. Nurse to assess pt.

Question 11

NEWS 2 score = 3 in single parameter

Frequency of monitoring:

Clinical response:

Answer 11

Frequency of monitoring:
1. Minimum 1 hourly

Clinical response:
1. Nurse to inform medical team
2. Medical team to R/V

Question 12

NEWS 2 score = 5 or 6

Frequency of monitoring:

Clinical response:

Urgent response threshold

Answer 12

Frequency of monitoring:
1. Minimum 1 hourly

Clinical response:
1. Urgent assessment by clinician skilled in care of acutely ill pts.
2. Provide clinical care
3. Monitoring facilities

Question 13

NEWS 2 score = ≥ 7

Frequency of monitoring:

Clinical response:

Emergency response threshold

Answer 13

Frequency of monitoring:
1. Continuous monitoring

Clinical response:
1. Nurse to immediately inform medical team at specialist registrar level
2. Emergency assessment by team with critical care skills (including advanced airway Mx)
3. T/F to HC or ICU or CCU
4. Provide clinical care
5. Monitoring facilities

Question 14

What does ABCDE assessment stand for?

Answer 14

1. Airway
2. Breathing
3. Circulation
4. Disability
5. Exposure

Question 15

What are the underlying principles of A-E assessment?

Answer 15

1. Call for help early
2. Complete an initial assessment
3. Rx life-threatening problems before moving onto the next part
4. Use team members so that interventions can be done simultaneously
5. Reassess the effects of interventions until senior help arrives
6. Monitor vital signs early - sats, ECG, NIBP
7. Communicate effectively
8. Keep calm

Question 16

What are the FIRST STEPS when considering ABCDE Approach?

Answer 16

1. Personal safety - gown, gloves & other PPE
2. First impression - how does the patient look?
3. Ask “How are you?”
4. Apply monitoring - Sats, RR, HR, BP, temp

Question 17

What to do if pt. is unconscious, unresponsive & not breathing normally on initial assessment?

Answer 17

1. Start CPR

Question 18

Airway - How to quickly assess if pt’s airway is patent?

Answer 18

1. Pt. is talking - air is able to pass through the vocal cords

Question 19

Airway - What is the consequence of airway obstruction?

Answer 19

1. Hypoxia
2. Leads to cardiac arrest

Question 20

Airway - If there’s an airway obstruction, what do you do?

Answer 20

1. Simple airway manoeuvres

Question 21

Airway - Complete Rx of airway obstruction:

Answer 21

1. Rx problem putting airway at risk - suction secretions
2. Turn pt. onto side
3. Give high flow O2 - 15 L/min
4. Simple airway manoeuvres
5. OP or NP airway

Sats range:
94-98% normal pt.
88-92% hypercapnic resp. failure

Question 22

Breathing - How to categorise breathing probelms?

Answer 22

1. Problems with respiratory drive - CNS depression
2. Problems with respiratory effort - mm. weakness or nerve damage (MG, GBS, MS)
3. Lung disorders - pneumonia, COPD, asthma, PE

Question 23

Breathing - How to recognise breathing problems?

Answer 23

1. Look
2. Listen
3. Feel

Question 24

Breathing - How to recognise breathing problems - What to Look for?

Answer 24

1. RDS
2. RR ≥ 25
3. Accessory mm. use
4. Low sats
5. Cyanosis
6. Chest deformity
7. Rising PaCO2 & decrease in pH

Question 25

Breathing - How to recognise breathing problems - What to Listen for?

Answer 25

1. Nosiy breathing 2. Equal breath sounds bilaterally

Question 26

Breathing - How to recognise breathing problems - What to Feel for?

Answer 26

1. **Trachea** position central 2. Equal chest **expansion** 3. Surgical **emphysema** 4. **Percussion**

Question 27

Breathing - How to treat breathing problems?

Answer 27

1. **O2** 2. **Rx underlying cause** - ABx for pneumonia or salbutamol nebulisers for acute asthma attacks 3. **Support breathing** if inadequate - ventilate with a self-inflating bag

Question 28

How to give O2 to pt. with hypercapnic respiratory failure (COPD)?

Answer 28

1. Give O2 via **Venturi mask** 2. Sats tange **88-92%** ## Footnote 28% Venturi mask = 4L/min 24% Venturi mask = 2L/min

Question 29

Circulation - Primary Causes of Circulation probelms:

Answer 29

1. ACS 2. Arrhythmias 3. HTN 4. Valvular disease 5. Inherited cardiac disease

Question 30

Circulation - Secondary Causes of Circulation probelms:

Answer 30

1. Asphyxia 2. Hypoxaemia 3. Hypothermia 4. Hypovolaemia 5. Septic shock

Question 31

Initial Rx of ACS:

Answer 31

1. **ASA** 300 mg 2. S/L **GTN** 3. **O2** 4. **Morphine** IV 5. **Anti-emetic**

Question 32

Circulation - Recognising circulation problems:

Answer 32

1. **Pulse** (central + peripheral) - rate, rhythm, volume, character 2. **CRT** 3. Feel **peripheries** - cold & clammy 4. **BP** 5. Assess **organ perfusion** - chest pain, mental state, urine output 5. Assess for signs of **bleeding** 6. Assess **fluid losses** 7. **ECG** (3 lead / 12 lead)

Question 33

What does a low diastolic pressure suggest?

Answer 33

1. **Arterial vasodilation** - sepsis, anaphylaxis

Question 34

What does a narrow pulse pressure suggest?

Answer 34

1. **Arterial vasoconstriction** - hypovolaemia, cardiogenic shock ## Footnote Normal pulse pressure = 35-45 mmHG

Question 35

Circulation - Treating circulation problems:

Answer 35

1. **IV** access 2. Consider a **fluid bolus** 3. **Bloods** for investigation 4. **Rx underlying cause**

Question 36

How to give fluid bolus?

Answer 36

1. **14G** or **16G** IV cannula 2. Bolus of **500 ml warmed crystalloid solution** - Hartmann's solution or 0.9% NaCL 3. Over **≤ 15 min** 4. Recheck **BP & PR** 5. Aim **SBP ≥ 100** mmHg 6. No change - **repeat** bolus ## Footnote HF pt's - give 250 ml fluid bolus

Question 37

Disability - Abnormal conscious level can be caused by:

Answer 37

1. Profound **hypoxia** 2. **Hypercapnia** 3. **Hypoglycaemia** 4. **Postictal** state following seizures 5. **Cerebral hypoperfusion** due to a low blood pressure 6. **Drugs** - sedatives or analgesics

Question 38

Disability - Recognising neurological problems:

Answer 38

1. **ACVPU** or **GCS** 2. **Pupil** size and reactivity to light 3. Blood **glucose** 4. **Drug** chart

Question 39

Disability - Treating neurological problems:

Answer 39

1. **R/V** and treat **ABC** 2. **Correct** blood **glucose** if level is < 4.0 3. If the airway is not protected - place pt. in **L lateral position** to prevent aspiration 4. **Give antidote** for any drug-induced causes of low conscioussness

Question 40

How to Rx hypoglycaemia if blood glucose ≤ 4?

Answer 40

1. **Initial** dose - **50 ml** of **10%** glucose IVI 2. Further doses - use 10% glucose 3. **Total** dose - **250 ml 10%** glucose

Question 41

Exposure - Recognising exposure problems:

Answer 41

1. Perform a **head-to-toe examination** of the pt. 2. Check both their **front** & **back passages** 3. **Remove clothing** - look for bleeding, rashes, limb swelling 4. Maintain pt's **dignity** 5. Measure pt's **temp**

Question 42

Exposure - Treating exposure problems:

Answer 42

1. **Address** any **issues** from examination 2. Remember to maintain pt's **dignity** 3. **Avoid heat loss**

Question 43

A colleague calls you over to help with Sunita, a 22-year-old patient. She is feeling very short of breath and is wheezy. She has a past medical history of asthma and a recent cold. You ask your colleague to call for extra help and start an A-E assessment. Which of the following suggests that her airway is not obstructed ## Footnote She is able to speak/ She is wheezy/ She is short of breath

Answer 43

1. She is able to **speak** ## Footnote To be able to speak, you have to have air move across the vocal cords. Even though someone might not be able to speak in full sentences, being able to speak in a normal tone suggests that the upper airway is clear. Wheezing arises from lower airway constriction and is heard in expiration. Partial upper airway obstruction may be associated with stridor which is an inspiratory noise. Shortness of breath is a non-specific symptom which can occur in breathing or circulatory problems. It cannot be used alone to assess airway patency.

Question 44

You move on to assess Sunita's breathing. She is clearly distressed and unable to talk in full sentences. Her respiratory rate is 35 breaths min-1, and she has an audible wheeze. You recognise that Sunita is having an acute asthma attack. What do you do next? ## Footnote Apply sats probe/ Administer O2/ Take full medical Hx/ Prescribe salbutamol nebuliser

Answer 44

1. Apply **sats** probe 2. Administer **O2** 3. Prescribe **salbutamol** nebuliser ## Footnote Sunita is having an acute asthma attack & treating her with O2 is important whilst further assessment& treatment is undertaken. A sats probe gives you an important guide to the severity of her breathing difficulty. Appropriate to arrange a prescription & give a salbutamol nebuliser. However, as Sunita is acutely unwell, it is not appropriate to take a full Hx at this time.

Question 45

Although very short of breath, Sunita is able to answer your questions with short sentences. What is her conscious level using the ACVPU scale?

Answer 45

1. Alert

Question 46

You complete assessing disability and find that Sunita's blood sugar is 6.4 mmol L-1 and her pupils are equal and reactive to light. You move on to assess exposure. There is no evidence of rashes or blood loss and her temperature is 36.8oC. A colleague has now arrived to help you. You hand over the patient using SBARD. Which of the following make up the SBARD communication tool?

Answer 46

1. Situation 2. Background 3. Assessment 4. Recommendation 5. Decision ## Footnote S: Sunita is 22 years old and has attended the practice with shortness of breath and wheezing. B: She is known to be asthmatic and has had a recent cold. A: When I assessed her she had a RR of 35 min-1, was wheezy and unable to talk in full sentences. She has a tachycardia of 125 min-1. I have given her O2 and a salbutamol nebuliser. R: I recommend we call an ambulance and send her to hospital urgently. D: We have agreed that Sunita needs to be reviewed in hospital and I will call 999 for an ambulance.