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ABCDE ,causes andPrevention CardiacArrest
FLS
ByDr Noha
Elsharnouby
Associateprofessor ofanesthesia andICU , Ain Shams
university
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Objectives
The causes of cardiorespiratory
arrest Identify and managing patientsat risk using the ABCDE
approach
FLS
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FLSEarly recognition of the critically ill
patient
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Recognition of critically illpatients
UPVACNS
> 37.536.6-37.4
35.1-36.5
< 35Temp C
> 3021-2915-209 -14< 8Respiratory
Rate
> 200101-19981-10071-80< 70Systolic BP
mmHg
> 130111-130101-11051-10041-50< 40Pulse
3210123
Track score - a score of > 4 triggers a review by doctor
FLS
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Causes of cardiorespiratory arrest
Airway
Breathing
Circulation
FLS
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Causes of
cardiorespiratory arrestAirway problems
Obstruction caused by:
CNS depression Blood Vomit Foreign body Trauma Infection Inflammation Laryngospasm
FLS
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Causes of cardiorespiratory arrestBreathing problems
Decreased respiratory
drive CNS depression
Decreased respiratoryeffort muscle weakness nerve damage
restrictive chest defect
pain from fractured ribs
Lung disorders pneumothorax haemothorax
infection
acute exacerbationCOPD
asthma pulmonary embolus
ARDS
FLS
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Global InjurySolutions
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Global InjurySolutions
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Causes of cardiorespiratoryarrestCirculatory problems
Primary
Acute coronarysyndromes Dysrhythmias Hypertensive heart
disease Valve disease Drugs Electrolyte / acid base
abnormalities
Secondary Hypoxaemia Blood loss Hypothermia
Septic shock
FLS
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ABC
DE
The ABCDE approach to thecritically ill patient
FLS
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ABCDE approachRules
Call for help earlyPriority of treatmentComplete initial assessmentReassessment
safety
Patient responsiveness to
treatment
FLS
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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
AFLS
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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
AFLS
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ABCDE approach
Breathing
Recognition of breathing problems Look
Inspect respiratory distress, accessory muscles,cyanosis, respiratory rate, chest deformity, consciouslevel
Listen Auscultate breath sounds, noisy breathing
Feel palpat expansion, percussion, tracheal position
Pulse oxymetry
BFLS
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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
BFLS
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ABCDE approach
Circulation
Look at the patient Pulse central pulse (carotid)
peripheral pulse Peripheral perfusion
capillary refill time
( normally
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ABCDE approach
Circulation
Airway, Breathing Oxygen IV access, take blood sample
and lab investigations Treat cause
Give fluids Haemodynamic monitoring MONA if acute coronary
syndrome
Treatment
CFLS
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ABCDE approach
Disability
AVPU or GCS?
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Global InjurySolutions
Examination Points
Eye opening
Spontaneous
To speech
To pain
None
4
3
21
Best motor response
Obeys commands
Localizes
WithdrawsAbnormal flexion
Extends
None
6
5
4
3
2
1
Best verbal response
Oriented
Confused
Inappropriate
Incomprehensible sounds
None
5
4
3
2
1
Total Glasgow Coma Score Best score =15
Worst score =3
Disability
GlasgowComa
Score
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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
DFLS
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ABCDE approach
Exposure
Remove clothes to enableexamination
- e.g. injuries, bleeding, rashes Avoid heat loss Maintain dignity
EFLS
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Anyquestions
FLS
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Summary
Early recognition of patients at risk mayprevent cardiorespiratory arrest
Airway, breathing or circulation problemscan cause cardiorespiratory arrest
ABCDE approach to recognise and treatpatients at risk of cardiorespiratory arrest
FLS
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