Transcript ABCDE ,causes and Prevention Cardiac Arrest
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ABCDE ,causes and Prevention Cardiac Arrest
By Dr Noha Elsharnouby Associate professor of anesthesia and ICU , Ain Shams university
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Objectives
The causes of cardiorespiratory arrest Identify and managing patients at risk using the
ABCDE
approach
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Recognition of critically ill patients
3 2 1 0 1 2 3 Pulse < 40 41-50 51-100 101-110 111-130 > 130 Systolic BP mmHg Respiratory Rate < 70 Temp ° C CNS 71-80 < 8 < 35 81-100 101-199 35.1 36.5
9 -14 36.6 37.4
A 15-20 > 37.5
V > 200 21-29 P > 30 U Track score - a score of > 4 triggers a review by doctor
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Causes of cardiorespiratory arrest
Airway
Breathing
Circulation
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Causes of cardiorespiratory arrest
Airway problems
Obstruction caused by:
CNS depression Blood Vomit Foreign body Trauma Infection Inflammation Laryngospasm
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Causes of cardiorespiratory arrest Breathing problems
Decreased respiratory drive
◦ CNS depression
Decreased respiratory effort
◦ muscle weakness ◦ nerve damage ◦ ◦ restrictive chest defect pain from fractured ribs ◦ ◦ ◦
Lung disorders
◦ pneumothorax ◦ haemothorax ◦ ◦ infection acute exacerbation COPD asthma pulmonary embolus ARDS
Global Injury Solutions
Global Injury Solutions
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Causes of cardiorespiratory arrest Circulatory problems
Primary
Acute coronary syndromes Dysrhythmias Hypertensive heart disease Valve disease Drugs Electrolyte / acid base abnormalities
Secondary
Hypoxaemia Blood loss Hypothermia Septic shock
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The ABCDE approach to the critically ill patient A… B… C… D… E…
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ABCDE approach
Rules
Call for help early Priority of treatment Complete initial assessment Reassessment safety Patient responsiveness to treatment
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ABCDE approach Airway
Recognition of airway obstruction Talking Difficulty breathing, distressed, choking Shortness of breath Noisy breathing ◦ stridor, wheeze, gurgling See-saw respiratory pattern, accessory muscles
A
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ABCDE Approach
Airway
Treatment of airway obstruction Oxygen Airway opening i.e. head tilt, chin lift, jaw thrust Simple adjuncts Advanced techniques - e.g. LMA, tracheal tube
A
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ABCDE approach
Breathing B
Recognition of breathing problems
Look
◦ Inspect respiratory distress, accessory muscles, cyanosis, respiratory rate, chest deformity, conscious level
Listen
◦ Auscultate breath sounds, noisy breathing
Feel
◦ palpat expansion, percussion, tracheal position Pulse oxymetry
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ABCDE approach
Breathing
Treatment of breathing problems Airway Oxygen Treat underlying cause - e.g. drain pneumothorax - e.g . Nebulizers Support breathing if inadequate - e.g. ventilate with bag valve mask
B
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ABCDE approach
Circulation
Look at the patient Pulse – central pulse (carotid) peripheral pulse Peripheral perfusion capillary refill time Blood pressure Monitor ( normally <2 sec)
C
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ABCDE approach Circulation
Treatment Airway, Breathing Oxygen IV access, take blood sample and lab investigations Treat cause Give fluids Haemodynamic monitoring MONA if acute coronary syndrome
C
ABCDE approach
Disability
AVPU or GCS?
Examination Eye opening
Spontaneous
To speech
To pain
None Best motor response
Obeys commands
Localizes
Withdraws
Abnormal flexion
Extends
None Best verbal response
Oriented
Confused
Inappropriate
Incomprehensible sounds
None Total Glasgow Coma Score 6 5 4 3 2 1 4 3 2 1 Points Disability Glasgow Coma Score 5 4 3 2 1 Best score =15 Worst score =3
Global Injury Solutions
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ABCDE approach Disability
AVPU or GCS, and pupils Treatment - ABC Treat underlying cause Blood glucose ◦ if < 3 mmol l -1 give glucose
D
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ABCDE approach Exposure
Remove clothes to enable examination - e.g. injuries, bleeding, rashes Avoid heat loss Maintain dignity
E
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Any questions
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Summary
Early recognition of patients at risk may prevent cardiorespiratory arrest Airway, breathing or circulation problems can cause cardiorespiratory arrest ABCDE approach to recognise and treat patients at risk of cardiorespiratory arrest