Frans JV Pangalila
UNTAR
A
Exposure
&
examinati
on
B
D
Disability due
to neurological
deterioration
Breathing &
ventilation
C
Circulation &
shock
management
The principles
Perform primary ABCDE survey (5
min)
Instigate treatment for life
threatening conditions as you find
them
Reassess when any treatment is
completed
Perform more detailed secondary
ABCDE survey including
investigations
Initial assessment
Key components of initial assessment are :
- assessment of airways patency , breathing
and circulation
Clinical features suggestive of imminent
severe deterioration
or warning sign of severe illness are :
Once again :
Key Points in Approaching The
Critically Ill Patient :
Management of the airway, breathing and
circulation (ABC)
Assessment and treatment should occur
simultaneously
Do not move on until the previous system is
stable or being
stabilized
Continual reassessment of the ABC is vital
LOOK
LISTEN
FEEL
Airway interventions
(basic)
Jaw Thrust
Airway assessment
-Keeping the airway open, look, listen and feel for
normal
Look breathing
for chest movement
(tachypnea,
use of accessory muscle/tracheal
tug,
paradox thoraco-abdomino
respiration)
sweating
Listen for gurgling, snoring,
stridor
(note : stridor
maybe
absent
in severe
-Hypercapnea
and
tend to
decrease
in
case
and
conscious level
the presence
of a normal oxygenation
indicate
: the compensatory
mechanisms are
does
not
ex
haus
exclude a compromised airway)
ted
Feel for air
-Bradycardia
indicates
on your
impending
cheek
cardiorespiratory
Key point : a patient with signs of airway
arrest
should never be left alone
obstruction
Airway interventions
(basic)
Oropharyngeal airway
Manfaat :
- mencegah pangkal
lidah jatuh
kebelakang
- fasilitas suction
- mencegah tergigitnya
lidah
- Airway patency untuk
penderita
Airway interventions
(basic)
Nasopharyngeal Airway
Indikasi : pasien setengah sadar dengan napas
spontan
Airway interventions
(advanced)
GET HELP!!!
Nebulised
adrenaline for
stridor
LMA
Intubation
Cricothyroidoto
my
Needle or
surgical
Breathing assessment
B
Note : that marked tachypnoea is a useful marker of a
severely ill patient regardless of whether the patient has respiratory failure
percusion-expansion
tachypnoea > 25 bpm
bradypnoea < 10 bpm
accessory muscles of respiration
unable to complete sentences
confusion
cyanosis
PaO2 < 8 kPa , PaCO2 > 6kPa
Breathing - interventions B
Circulation - assessment
Skin
mottling
Circulation assessment
Look :
- sweating
- pallor
- tachypnoea / kussmaul
Feel :
2s
-
cold peripheries
capillary refill time >
tachycardia
narrow pulse pressure
hypotension
Circulation - shock
Inadequate tissue
perfusion
Loss of volume
Hypovolaemia
Pump failure
Myocardial & nonmyocardial causes
Vasodilatation
Sepsis, anaphylaxis,
neurogenic
BP = HR x SV
x SVR
Circulation-interventions
Position supine with legs raised
Left lateral tilt in pregnancy
IV access - 16G or larger x2
+/- bloods if new cannula
Fluid challenge
colloid or crystalloid?
ECG Monitoring
Specific treatment
-- Inotrope/vasopresor, vasodilator,
antibiotik,steroid
surgical
Disability - causes
a marked reduction in conscious level
indicates either that :
compensatory hemostatic mechanisms have been
overhelmed or severe
neurological disease
common causes :
Disability - assessment
AVPU
-
A lert
responds to V oice
responds to P ain
U nresponsive
Assessment of the pupils
- equal, size and do they responds to
light?
- un equal : alert intracranial SOL
- pinpoint : opiate abuse or brain stem
stroke
Treatment of altered of
conscious level
Recovery position
Disability - interventions
Exposure - Assessment
Secondary survey
Repeat ABCDE in more detail
History
Order investigations
ABG, CXR, 12 lead ECG, Specific bloods
Management plan
Referral
Summary
at all times
Recognize the severity of ilnness and call for
apprppriate per
sonnel and equipment
Reassess ABC informally or formally
Monitor the patient
Do not leave the patient alone
Ensure ECG, pulse oxymetry, and non-invasive blood
pressure
as a minimum standard of monitoring
Do not get out of your depth : ask for the help !!