ABCDE ,causes and Prevention Cardiac Arrest

1. FLS ABCDE ,causes and Prevention Cardiac Arrest

2. FLS • The causes of cardiorespiratoryarrest • Identify and managing patients at risk using the ABCDEapproach Objectives

3. FLS Early recognition of the critically ill patient

4. 3 2 1 0 1 2 3 Pulse < 40 41-50 51-100 101-110 111-130 > 130 Systolic BP mmHg < 70 71-80 81-100 101-199 > 200 Respiratory Rate < 8 9 -14 15-20 21-29 > 30 Temp °C < 35 35.1-36.5 36.6-37.4 > 37.5 CNS A V P U FLS Recognition of critically ill patients Track score - a score of > 4 triggers a review by doctor

5. FLS • Airway • Breathing • Circulation Causes of cardiorespiratory arrest

6. FLS Obstruction caused by: • CNS depression • Blood • Vomit • Foreign body • Trauma • Infection • Inflammation • Laryngospasm Causes of cardiorespiratory arrest Airway problems

7. FLS • 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 Causes of cardiorespiratory arrest Breathing problems

8. Global Injury Solutions

9. Global Injury Solutions

10. FLS Primary • Acute coronary syndromes • Dysrhythmias • Hypertensive heart disease • Valve disease • Drugs • Electrolyte / acid base abnormalities Secondary • Hypoxaemia • Blood loss • Hypothermia • Septic shock Causes of cardiorespiratory arrestCirculatory problems

11. FLS The ABCDE approach to the critically ill patient A… B… C… D… E…

12. FLS • Call for help early • Priority of treatment • Complete initial assessment • Reassessment • safety • Patient responsiveness to treatment ABCDE approachRules

13. FLS Recognition of airway obstruction • Talking • Difficulty breathing, distressed, choking • Shortness of breath • Noisy breathing • stridor, wheeze, gurgling • See-saw respiratory pattern, accessory muscles ABCDE approachAirway

14. FLS Treatment of airway obstruction • Oxygen • Airway opening - i.e. head tilt, chin lift, jaw thrust • Simple adjuncts • Advanced techniques - e.g. LMA, tracheal tube ABCDE ApproachAirway

15. FLS 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 ABCDE approachBreathing

16. FLS 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 ABCDE approachBreathing

17. FLS • Look at the patient • Pulse – central pulse (carotid) peripheral pulse • Peripheral perfusion capillary refill time ( normally <2 sec) • Blood pressure • Monitor ABCDE approachCirculation

18. FLS • Airway, Breathing • Oxygen • IV access, take blood sample and lab investigations • Treat cause • Give fluids • Haemodynamic monitoring • MONA if acute coronary syndrome Treatment ABCDE approachCirculation

19. ABCDE approachDisability AVPU or GCS?

20. Disability Glasgow Coma Score Global Injury Solutions

21. FLS • AVPU or GCS, and pupils • Treatment - ABC • Treat underlying cause • Blood glucose • if < 3 mmol l-1 give glucose ABCDE approachDisability

22. FLS • Remove clothes to enable examination - e.g. injuries, bleeding, rashes • Avoid heat loss • Maintain dignity ABCDE approachExposure

23. FLS Anyquestions

24. FLS • 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 Summary