ALS Notes

Remember “ABC”

Post Assessment notes:

– Mistakes:
– Not calling MET call right away when airway was threatened (patient
had stridor - couldn’t tell as it was mannequin)
– Bradycardia - not recognizing to give medication through bradycardia
algorithm
– Remember that just cause patient is hypotensive - doesn’t mean you
give fluids, there can be other causes of hypotension such as
cardiogenic shock

– Remember to practice more and fixing each step through A-E before
moving on to next letter - as reasonable as possible e.g. not waiting
for CXR or ECG before moving onto next stop

– Know medication dosages e.g. pain relief, asthma, opioids, seizures

– Know common conditions e.g. seizures, pneumonia, MI, opioid, asthma,
anaphylaxis, subdural haemtoma, afib, alcohol intoxication
– Know different team roles - iv, oxygen, airway, etc.
– Adrenaline dosage, opioid dosage
– MET criteria
– ECGs - arrhythmias, medications

– Remember to fix each component of A-H before moving onto next letter

Things to know:
– BLS to unconscious patient (“DRSABCD”)
– Bag valve mask/mouth to mask/airway adjunct technique with
supplemental oxygen
– Know the criteria/warning signs/physiological triggers of cardiac arrest
– e.g. pulseless, unresponsive, abnormal breathing
– 5 H’s (hypo/hyperkalemia, hypovolemia, hypoxia, hypothermia,
hydrogen (acidosis)) and 4 T’s (tamponade, tension pneumothorax,
thrombosis, toxins)
– Use cardiac monitor/defibrillator safely
– Recognize various ECG rhythms and treat appropriately
– Use pharmacological intervention and fluid therapy according to ARC
algorithms
– Know the correct dose of adrenalin (and route of administration) in
cardiac arrest and anaphylaxis
– Use the A-H approach to organize the patient assessment and
management

– Common short calls to know:

– What are the medications (dosages and duration)
– What are the procedures and specialities that may need to be
contacted?
– what are the next steps after resuscitation?:

– Anaphylaxis
– Adults: IM adrenaline 0.5mL (0.5mg/5 min 1:1000)
– Repeat in 5 mins
– Paeds: IM adrenaline 0.1mL to max 0.5mL

– Assess for? (3)

– IF CLINICAL SIGNS FOR ANAPHYLAXIS IN 2 OR MORE SYSTEMS
- ADMINISTER ADRENALINE!!!
– Call for help and do what? (2)
 – Remove trigger or causative agent e.g. cannula remove if
receiving medication, blood transfusion line
– Position patient flat or sitting (NOT standing or walking)

– Asthma/bronchospasm
– Salbumatol 12 puffs every 20 mins (100 mcg)
– REMEMBER 4x4x4 - (4 puffs, 4 breaths for each puff, repeat
after 4 minutes)
– Ipatropium 8 puffs every 20 mins (21 mcg)
– Prednisolone 37.5mg-50mg oral within 1 hour of presentation,
once daily for 5-10 days

– If asthma persists:
– Give 2 x 5mg salbutamol and 500mcg of ipatropium via
nebuliser

– IV MgSO4
– 0.2mmol/kg IV over 20 min, max 8 mmol
– 10 mmol diluted to 100 mL in fluid over 20mins
– Acute Pulmonary Oedema
– “POND”:
– Position
– Patient sitting up
– Oxygen or PPV
– Supplemental oxygen
– 4 L/min via nasal specs
– 5-10 L/min via Hudson mask
– 15 L/min via a non-rebreather mask
– If oxygen saturation is still <92% commence:
– CPAP (10 cm water pressure) or BiPAP (10/4 cm water
pressure)
– Nitroglycerin or sublingual tablet
– 400mcg sublingually every 5 mins upto three 3 doses or
400 mcg spray (2 puffs) repeat every 5 mins - max dose
1200mcg
– Repeat every 5 mins
– Diuretic
– frusemide 20mg to 80mg IV, repeat 20 minutes later if
needed

– Chest pain/STEMI

– “MONA”:
– Morphine
– 2 to 4 mg slow IV morphine push every 5 to 15 minutes
– Oxygen
– High flow oxygen 10-15L, non-rebreather mask
– Nitrates
– 400mcg sublingual tablet every 5 mins upto 3 doses,
400mcg spray (1 puffs) repeat every 5 mins
– Aspirin 300 mg to all patients ASAP

– “BASH”: start within 24 hours and continue as outpatient

– Beta blockers
– ACEi or ARB
– Statins - high intensity - rosuvastatin or atorvastatin
– Heparin
 – Senior help - to assess need for CODE STEMI -> patient either
can have PCI if centre within 90 minutes or fibrinolysis (DAPT
(e.g. aspirin and clopidogrel) + anticoagulation e.g.
unfractionated heparin or LMWH)

– Cardiac arrest
– ALS
– Non-shockable rhythms
– Asystole
– Pulseless electrical activity
– Give IV 1mg adrenaline right away then every 2nd cycle of
CPR

– Shockable rhythms
– Ventricular fibrillation
– Pulseless ventricular tachycardia
– Give IV 1mg adrenaline after 2nd shock
– Every 2nd cycle
– Give IV 300mg amiodarone after 3rd shock
– 5 H’s:

– Hypothermia/hyperthermia

– Hypothermia:
– Temp less than 30 degrees celsius
– Measure core temp
– Apply warming
– Radiant heaters
– Air warming blankets
– Gastric/peritoneal/chest lavage
– Cardiopulmonary bypass may be used in some cases
– Continue resus until temp >34

– Hypoxia
– Ensure high FiO2

– Hypokalemia/hyperkalemia:

– Hypokalemia

– Treat if K+ <2.5 - confirm with blood gas

 – Tread lightly as the injection potassium chloride
can be lethal (2 to 5 mmol KCl slowly over 1 min)

– Hyperkalemia

– Confirm with VBG and ECG

– Give calcium chloride or calcium gluconate
– 10mL of 10% CaCl or CaGl as a bolus
– Reduces the effects of hyperkalemia on the
myocardium

– Administer insulin and glucose (dextrose)

– Give 10 units of insulin (act rapid)
– 50 mL of 50% dextrose = 25g (5g in 10mL)

– Increase blood pH if necessary

– Hyperventilation
– Sodium bicarbonate 1mL/kg of 8.4% solution

– Hypovolemia

– Hydrogen (acidosis)

– 4 T’s:

– Thrombus/embolus

Acute Coronary Syndrome (ACS) can progress to cardiac arrest and

may not respond to ALS interventions.
◆ Extra-Coporeal Membrane Oxygenation (ECMO) -
[Emergency cardiopulmonary bypass] may be considered
in cases that meet inclusion criteria

◆ Fibrinolytics may be considered if access to Primary PCI is not

available or there is suspicion of a large pulmonary embolus

A large clot in the pulmonary artery is one of the few single points
of failure in the circulation. A clot here can stop all circulation in the body.
Survival is unlikely unless some return of cardiac output
occurs.
 If PE is known to be present or extremely likely (and you have some
cardiac output) then call Cardiothoracic Surgeon to consider:

◆ Extra-Coporeal Membrane Oxygenation (ECMO) -

Emergency cardiopulmonary bypass
◆ Pulmonary embolectomy via Thoracotomy
◆ Fibrinolytic therapy (eg TPa) can be considered.

Anticoagulation with Heparin would be started after surviving an

arrest.

– Toxins
– Toxins info line (13 11 26)

– Cardiac Tamponade

– Clinical signs (e.g. Beck’s triad):

– Elevated JVP
– Muffled heart sounds
– Hypotension
– Pulsus paradoxus (a decrease in systolic pressure
 –
>10mmHg on inspiration)

– PEA in the absence of hypovolemia and tension

pneumothorax suggests cardiac tamponade

– Intervention:
– Echo to confirm
– Urgent Pericardiocentesis

– Tension pneumothorax

– Based on clinical signs:

– Hyper resonant over lung field
– Respiratory distress
– Tachycardia
– Unilateral absence of breath sounds
– Distended neck veins
– Cyanosis
– Hypotension
– Tracheal deviation

– Radiological signs:
– Tracheal deviation
– Diaphragm flattening

– Intervention:
– Immediate needle decompression with large bore
needle in 2nd intercostal space mid clavicular line
– Definitive treatment is a chest tube in the 5
intercostal space between the anterior mid
axillary line and mid axillary line, following
return of ROSC
– If tension re-develops a second needle can be
placed lateral to the first one

– Arrhythmia

– SVT
– Vagal manoeuvres + adenosine 6mg IV rapid bolus, then 12
mg if unsuccessful, then again 12 mg if unsuccessful
– VT

– Approach - check if patient has pulse?

– If patient has pulse and is in VT

– CALL MET CALL RIGHT AWAY!
– Needs to be cardioverted at 200J for biphasic, 360 J
for monophasic
– Give amiodarone at 300mg IV for 20-60 minutes,
followed by IV 900mg over 24 hours

– If pulseless VT, then needs shock, and medications

– 1mg IV adrenaline after 2nd shock
– 300mg IV amiodarone after 3rd shock
– Atrial fibrillation
– Metoprolol 2.5 mg IV over 2 mins (Rate control)
– If onset <48 hours consider amiodarone 300mg IV over 30 to
60 minutes, followed by 900mg IV over 24 hours
– Long term use: sotalol for rhythm control, DOAC for
anticoagulation (e.g. apixaban) based on CHA2DS2VASC
score
– Atrial flutter
– Control rate - IV metoprolol 2mg over 2 mins
Bradycardia/heartblock

– Bradycardia - atrophine 500mcg IV (0.5mg), then repeat at

IV 1mg every 3-5 minutes, max 3 mg
– contraindications to atropine (if they are on PDE-5 (e.g.
sildafenil))

– If atropine ineffective, consider transcutaneous cardiac

pacing

– Or

– Isoprenaline 500-600 micrograms IV

– Or

– Adrenaline 2 to 10 micrograms IV/min

– If adrenaline ineffective, consider patient for transvenous

pacing
– Causes:
– Drugs (e.g. beta-blockers)
– Electrolyte abnormalities

– Haemorrhage (trauma or post-surgical)

– Fluid resus (0.9% saline 500mL over 10 mins)

– If SBP <80, ALARMING AND SHOULD HAVE IV FLUIDS +
BLOOD PRODUCTS ASAP!!!

– Massive transfusion protocol: O negative blood, 4 units of blood

(CBE, ROTEM, ABG, coags, cross match)

– Consider 1 g IV tranexamic acid over 10 mins if uncontrolled

– Consider having patient going to theatre, call gen surgery team

– Low oxygen sats

 – Giving supplementary oxygen if SpO2 <94% (special exemption
in COPD patients where you aim 88-92%)
– Nasal specs (1-4L/min)
– Hudson mask (5-8L/min)
– Non-rebreather mask (10-15L/min)

– Ventilation:
– Bag-valve mask (15L/min)
– In scenario where patient has respiratory distress (RR
<12)

– Hypotension

– Management:
– Fluids - 500ml 0.9% saline IV over 10 mins
– If due to sepsis, give fluids and check lactate
– If due to dehydration, give fluids 0.9% saline IV
– If due to cardiac failure, don’t give more fluids

– Approach:
– Always treat the patient and not the number; vitals are
sensitive but not specific

– Check if:

– Hypotensive bad:
– Number is low and patient is dying (e.g. altered
level of consciousness, decreased urine output,
trend of blood pressure getting progressively
lower)

– Hypotensive good:
– Number is low but patient is fine, should we hold
anti-hypertensives?

– Easy to stop - antihypertensives:

– CCB’s (amlodipine)
– ACE inhibitors
– ARBs
– Hydrochlorothiazides
 – Harder to stop
– Beta blockers (generally do not cause that
much hypotension and may be important
in preventing tachyarrhythmias such as AF
which may worsen heart failure)
– Furosemide (may be needed in ongoing
treatment of heart failure)

– Hypertension
– More gradual = amlodipine 5mg oral, single dose
– More rapid = ramipril 2.5mg oral, single dose

– Check if it asymptomatic or symptomatic hypertension?

– If symptomatic - may need to treat urgently (Headache, visual

changes, chest pain, etc.)
– e.g. hypertensive urgency vs hypertensive emergency
(e.g. end organ damage (CNS - LOC, asterixis), cardiac,
renal, papilledema
– BP >180/120

– If asymptomatic - may have more time (e.g. 24 hours) to treat

and not suggested to treat urgently
 – Approach:

– Review current medications

– Can give an extra dose, titrate up current regimen
or give AM dose early depending on clinical
situation

– Adding agents
– These agents will not act immediately but again
unless it’s an emergency there is no need to lower
urgently
– Beta blockers are NOT good antihypertensives
– Calcium channel blockers: amlodipine (5mg and
go up in 2.5 to 5 mg increments)
– Thiazide diuretics: hydrochlorothiazide (12.5 mg
and go up in 12.5 mg increments)
– ACE inhibitors: ramipril (2.5 mg BID and go up by
2.5 mg increments, stop at 10 mg)
– Vascular smooth muscle dilators: hydralazine
(5mg-10mg TID and go up in 5mg increments),
good in renal failure. More rapid acting, can give
extra dose if needed.

– When to be worried about high blood pressure (end organ

damage)?
– Headache, visual changes, chest pain

– Hypoglycaemia
– Immediate treatment is to ask nurses to give juice/sugars
– Asking nurses to administer the hypoglycemias kit ONLY IF
PATIENT CONSCIOUS AND ABLE TO SWALLOW- usually on
the wards - this is what was mentioned in the endocrine
lecture during intensives
– IF UNCONSCIOUS AND UNABLE TO SWALLOW -
ADMINISTER IV DEXTROSE !!!!
– Stop all sulfonylureas
– Reassess the patient’s insulin orders
 – 50mL 50% dextrose IV over 10-15 minutes
– Risk of seizures, LOC, and cardiac events, palpitations, sweating,
tachycardia

– AFTER IV DEXTROSE GIVEN (AS IT WILL WEAR OFF SOON E.G.

SUGAR HIGH)
– GIVE THEM SOMETHING ORAL TO EAT IF THEY CAN
TOLERATE, PATIENT WILL MOST LIKELY BE HUNGRY!!

– GLUCAGON 1mg IM can be given in outpatient setting

– Normal BSL range 4-10

– What are the causes of hypoglycaemia?

– In hospital, usually due to excess insulin administration, so

you should come down on any insulin they are on, BUT
remember that Type 1 diabetics cannot have their basal
insulin completely stopped (NEED TO CONTINUE LONG
ACTING INSULIN)
– Other causes include sulfonylureas, liver failure, renal failure,
adrenal insufficiency, sepsis
– Very rarely due to an insulinoma (all other causes should be
considered first) but if this is a patient with ongoing refractory
hypoglycaemia (e.g. unlikely to be a new problem overnight),
this can be considered and ICU should be involved in
monitoring at the least.

– Hyperkalemia - approach?
– Check bloods (VBG)
– Check ECG
– If evidence then treat:
– IV calcium gluconate 1g in 10mLs slow push over 2 to 3 mins
– IV insulin - short acting insulin 10 units IV bolus + glucose 50% of
50mL IV over 5 mins (give the glucose first to prevent
hypoglycaemic event)
 – SABA - salbutamol 5mg to 20mg via nebulizer or 20 puffs
(100mcg per puff) via MDI with spacer if required

– Check guidelines
– Large vein (2.2mol)

– Pain

– Analgesia (oral)

– Mild:
– Paracetamol - 500mg to 1000mg orally every 4 to 6
hours, max 4000mg in 24 hours
– Ibuprofen - 200mg to 400mg orally every 6 to 8 hours,
max 1200mg in 24 hours

– Severe:
– Oral oxycodone: 5 to 10 mg orally every 3 to 4 hours, max
15mg per dose
– Oral morphine: 10mg every 3 to 4 hours

– Psych - code black

– Call MET
– Call security
– IM droperidol/risperidone?
– Oral benzos if mild to moderate, IM benzos if severe

– e.g. 10+2 rule = 10mg oral olanzapine and 2mg oral lorazepam

– Opioid overdose
– Will have respiratory depression - remember to bag valve mask!!!
– 40mcg (0.04 mg) of IV naloxone, repeat every 2-3 mins if needed
(max 10mg)
– Put 1 mL naloxone in 9 mL of saline because it’s 400mcg in
package, then give 1 mL of new solution

– IM 0.4 mg to 2mg, repeat after 2-3 mins if needed

– Intranasal: 1.8mL (1 spray) into 1 nostril

– Aim is to improve respiratory drive and LOC for patient to

maintain their airway
 – REMEMBER TO BAG VALVE MASK THESE PATIENTS TO HELP
WITH VENTILATION AND IMPROVE RR

– Seizures

– Most seizures don’t require treatment (usually last 1-3 minutes)

– Protect airway
– Remove any dangers from surroundings
– Put patient on left side
– Maintain oxygenation

– In hospital
– Check glucose
– IV access
– VBE
– CBE, antiepileptic drug concentration

– If seizure persist >5 mins use IV or IM midazolam 5mg to 10 mg

over 2-5 minutes , repeat in 5 mins if needed

– If seizure persist >10 mins use phenytoin 20mg/kg IV (max rate

50mg/min) over 20 mins

– Follow up after seizure

– Transfer to to ICU
– Continuous EEG monitoring
– If ongoing seizure or respiratory compromise then intubate
– Seizures >15 mins - give propofol
– Future prophylaxis/follow up

– Complications of seizures
– Aspiration
– Trauma - posterior shoulder dislocation
– CNS injury
– Pulmonary oedema
– Rhabdomyolysis, acidosis, kidney failure
– Hyperthermia

– Sepsis

– Criteria:
– Hypoxemia or RR >22
 – Impaired consciousness
– Systolic BP <90
– Lactate >2

– “Sepsis 6”, “FABULOS” - S = do all components within 60 minutes

– 3 in
– Fluids - resus
– Antibiotics - IV 4g pipercillin 0.5g tazobactam, 6 hourly
ONLY if hospital acquired and unknown
– For known causes of sepsis e.g. chest, abdominal -
follow the guidelines
– Oxygen - high flow oxygen

– 3 out
– Urine output
– Lactate
– Blood cultures, bloods

– Alcohol withdrawal
– Benzo - diazepam 10mg orally, every 4-6 hourly as required
– Thiamine - IV or IM 300mg, TDS for 3-5 days

– 4 Types of Shock:

Assessment on Tuesday at 11:40

 – ISBAR
– A = assessment remember to mention (cover A-E
assessment)

ALS Workshop
– Intro
– Drugs
– Scenarios
– BLS assessment

Allowed to bring cheat sheet

– Drug dosages
– Sequences of treatment

ECGs
– Review 6 and treatment for each

Drugs

– Adrenaline - 300mcg - epipen

– Other device - anapen?
– IM - 1:1000, 1mg in 1mL = 0.5 mL (500mcg) - anaphylaxis
– 1 in 10,000 = 5mL
– Cardiac arrest
– Self-flushing for 1 in 10,000 - quicker, more expensive

– Amiodarone
– Ampulle = 150mcg
– Need 300mcg - need 2 packages
– Need IV 300mg - over 20-60 mins
– Can cause profound hypotension

– Atropine
– Bradycardia
– 500-600mcg

– Adenosine
– SVT
– Chemical cardioversion
– Blocks AV node 1-2 secs
– 6mg, 2nd dose 12mg, 3rd dose 12mg
 – Give IV rapid bolus - flush fast afterwards
– Sense of impending doom - patient told about

– Naloxone
– 400mcg ampule - dilute
– 40mcg at a time - small increments
– Paeds still give 400mcg

– Glucose
– 50mL - 50% (25g)

To Do:
– REVIEW ECGs and treatment for each
– e.g. heart block, pbc
– 6 ECGs shown during workshop
– Sinus bradycardia
– Ventricular fibrillation
– Ventricular tachycardia
– Atrial fibrillation
– Myocardial infarction
– Inferior STEMI DO NOT GIVE GTN -
– PVC? (Premature ventricular contractions), Arrhythmias, couplet
PBC
– PBC Causes: anemia, hypoxia, drugs, electrolytes

ECG Notes:

– Normal ECG

– Bundle branch blocks

– Complete bundle branch block present if QRS duration > 0.12
seconds

– Right bundle branch block (RBBB)

– The right ventricle depolarizes after the left with a second R
wave in V1
– Cardiac axis normal
– Second R wave in V1 and a deep wide S wave in V6
– V1 = “M” shape
 – V6 = deep S wave, “W” in V6

– Left bundle branch block (LBBB)

– Small Q wave in V1 and R wave in V6
– “M” shape in V6
– “W” shape in V1
– Bradyarrhythmias
– Sick Sinus Syndrome
– Failure of the sinus node to generate a depolarization wave leads
to sinus bradycardia, sinus pauses or sinus arrest, when no sinus
activity occurs
– Sinus pauses of more than 5 seconds in patients with pre
syncope or syncope usually result in pacemaker implantation
for the patient

– Atrioventricular (AV block) types:

– First degree, second degree, and third degree (complete) heart block

– First degree heart block

– PR interval >0.2 seconds
– Second degree heart block
– Two types
– Mobitz 1
– Progressive lengthening of PR interval in sinus
rhythm, culminating in one impulse not traversing
the AV node and a “dropped beat”
– Occasionally, in fit young people and does not
require pacemaker

– Mobitz 2
– No lengthening of PR interval but a sudden non-
conduction of one impulse and the absence of a
QRS complex after a P wave
– Pacing is required in these patients because of
the unpredictable risk of sudden ventricular
standstill
 – Third degree heart block
– Characterized by slow ventricular response, usually 30 to
40 bpm with no sinus beats being conducted to the
ventricles
– There is no connection between the P waves and QRS
complexes often termed a complete “dissociation”
– Patients with complete heart block require a pacemaker

– Tachyarrhythmias
– Supraventricular Tachyarrhythmias
– Supraventricular Tachycardia (SVT)

– General term describing any rapid heart beat that originates

above the ventricles
– Atrial tachycardia
– Circuit-driven “re-entrant” tachycardia
– AV nodal re-entrant tachycardia (AVNRT) - the circuit
within the AV node
– Atrioventricular re-entrant tachycardia (AVRT) - the
circuit includes a pathway outside of the AV node
 – Wolf-Parkinson-White (WPW) is the name given
to this condition with an associated
tachyarrhythmia
– ECG with a predominantly positive delta wave
and QRS complex in lead V1 indicates left
ventricular pathway = type A WPW syndrome
– ECG with a predominantly negative delta wave
and QRS complex in lead V1 indicates a right
ventricular pathway = type B WPW syndrome \

– VT
– VF
– SVT
– Atrial flutter
– Typical sawtooth pattern
 – Atrial fibrillation
– Irregularly irregular QRS complexes
– These result in a rapid or slow rhythm

Rate = 60-100
Rhythm = P wave present after QRS and QRS present
PR interval = 0.12-0.20 seconds
QRS = <0.12 secs
Axis
– LAD = greater than -30
– RAD = greater than +90
CANVAS ALS Refresher quiz notes:
– In STEMI, if patient is hypotensive (systolic BP <90) or if its a inferior
STEMI (leads II, III, avF), DO NOT GIVE GTN because of risk of
hypotension, or if patient has taken sildenafil (Viagra), or if HR <50

ALS Revision Notes:

Goals for next assessment:

. Focus on important components during A-E

– Especially in airway and breathing, make sure each of these are
fixed before moving onto next letter in A-E
– e.g. make sure to check if intervention has helped improve
patient’s status
– e.g. if patient was given oxygen via non-rebreather mask
check at high flow (15L), check if any changes to RR and
SpO2, if not bag-valve mask may be needed

. Communication - clear with nursing staff and clinicians

. Toolkit
– Know how to use each of the equipment in SLE and around patient
– Know dosages of medications and how to administe

– Go to cover shifts and be involved don’t be hesitant, ask to start and then
step aside if not able to handle

– Know GCS
A-E Assessment:

What are the assessments and interventions?

- REMEMBER THAT AIRWAY AND BREATHING ARE MOST IMPORTANT FIRST

– REMEMBER TO REASSESS AFTER EACH INTERVENTION
– e.g. airway - if not patent (e.g. noisy breathing) make sure
intervention has improved this before moving on
– e.g. breathing - if RR low e.g. 8 make sure that patient has
highest level of ventilation support e.g. bag-valve mask (and give
additional breaths)

– A - airway
– Check if airway is patent, obstructed - e.g. foreign body, vomiting -
requiring suction, may need to perform jaw thrust to open airway,
 –

may need to insert airway adjunct

– Airway assessment:
– Look for swelling, trauma, burns, obstruction
– Listen: for stridor, snoring, silence, voice

– Airway Interventions:
– Remove obstruction e.g. vomit - with suction tube
– Airway maneuver e.g. jaw thrust
– Airway adjunct e.g. oropharyngeal, nasopharyngeal, iGEL

– B - breathing
– Assessment
– Are they breathing?
– RR?
– Effort
– Auscultation
– SpO2?

– Breathing interventions:
– Apply oxygen e.g. nasal specs, Hudson mask, non-rebreather
– Ventilate - e.g. bag valve mask, seniors may escalate to CPAP or
BiPAP

– C - circulation - pulse, bleeding?, HR, BP, cap refill, HSD, ECG, bloods,
fluid status? (e.g. JVP, mucous membranes, peripheral oedema)
– IV access, fluids, drugs

– D - drugs, documentation, disability (AVPU/GCS, pupils, neuro test -

“squeeze my fingers”), drains, DON’T FORGET glucose

– E - exposure - bruises, bleeding, rashes, surgical dressings, abdomen

SNT, calves SNT, peripheral oedema