FLS
ABCDE ,causes and
Prevention Cardiac
Arrest
By
Dr Noha
Elsharnouby
Associate
professor of
anesthesia and
ICU , Ain Shams
university
FLS
Objectives
The
causes of cardiorespiratory
arrest
Identify and managing patients
at risk using the ABCDE
approach
FLS
Early recognition of the critically ill
patient
FLS
Recognition of critically ill
patients
3
Pulse
Systolic BP
< 70
mmHg
< 40
41-50
71-80
Respiratory
Rate
<8
Temp C
< 35
CNS
51-100 101-110 111-130
81-100 101-199
35.136.5
> 130
> 200
9 -14
15-20
36.637.4
> 37.5
21-29
> 30
Track score - a score of > 4 triggers a review by doctor
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Causes of cardiorespiratory arrest
Airway
Breathing
Circulation
FLS
Causes of
cardiorespiratory arrest
Obstruction Airway
caused by: problems
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
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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
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ABCDE approach
Breathing
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
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ABCDE approach
Circulation
Look at the patient
Pulse central pulse (carotid)
Peripheral
peripheral pulse
perfusion
capillary refill time
( normally <2 sec)
Blood pressure
Monitor
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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
ABCDE
approach
Disability
AVPU or GCS?
Examination
Points
Eye opening
Spontaneous
To speech
To pain
None
4
3
2
1
Best motor response
Obeys commands
Localizes
Withdraws
Abnormal 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
Glasgow
Coma
Score
Global Injury Solutions
FLS
ABCDE approach
Disability
AVPU or GCS, and pupils
Treatment - ABC
Treat underlying cause
Blood glucose
if < 3 mmol l-1 give glucose
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ABCDE approach
Exposure
Remove
clothes to enable
examination
- e.g. injuries, bleeding, rashes
Avoid heat loss
Maintain dignity
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Any
questions
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Early
Summary
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
