ABCDE assessment

When is the ABCDE assessment approach used?

For Health Professionals when working with acutely unwell, critically ill and deteriorating patients

Why is the ABCDE assessment used? (5)

. Systematic approach

. Quick to complete

. Covers all body systems

. Essential for recognising and assessing deteriorating patients

The ABCDE assessment approach is based on which two management frameworks?

It is based on Advanced Trauma Life Support (ATLS) and Acute Illness Management (AIM).

What does ABCDE stand for?

• A - Airway

• B - Breathing

• C - Circulation

• D - Disability

• E - Exposure/everything else

What are you looking for during the assement?

Identify possible problems which can be adressed by chest physio

What are the core physio problems for CVR?(5)

• Increased WOB

• Sputum retention

• Reduced lung volume

• Reduced exercise tolerance/skeletal muscle dysfunction/Reduced mobility

• Impaired gas exchange (Hypoxaemia:Type 1 respiratory failure, Hypercapnia: Type 2 Reps failure)

What is the key question when assessing a patients airway?

• Is it patent and protected

What is a crucial action to remember if a patient's condition changes during an ABCDE assessment?

You may need to go back to the beginning and start to reassess at any point.

What is a key indicator of a patent airway in a conscious patient?

The patient is speaking.

Define the term patent in relation to CVR physio?

Airway is open and unobstructed

Define the term protected in relation to CVR physio?

The airway is secure and prevents the lung from filling up with foreignn substances

What are the signs of airway obstruction?(6)

• Gurgling/audible secretions

• Inability to speak

• Cyanosis

• Decreased saturations

• Increased WOB

• Patient distress

What does Stridor show?

Upper airway obstruction

What does snoring show?

• nasopharyngeal obstruction

What are the causes of airway obstruction?(6)

• Secretions

• Inflammation, Anaphylaxis

• Decreased conscious level

• Direct Trauma

• Laryngospasm

• Tongue displacement (Trauma, Fitting, Arrest)

What are the different types of airway used?

• Patients own

• Nasopharyngeal (NP)

• Oral (Guedes)

• Endotracheal tube (ETT)

• Tracheostomy (Trachy)

• Laryngectomy (Larry)

What are physios looking for when assessing Breathing?(6)

• Self-ventilating? (Nose/mouth breathing, supplemental oxygen, non-invasive ventilator support)

• Mechanically ventilated? (Note the ventilator settings)

• Oxygen saturations (SpO2)? (Hypoxia, SpO2 target range, ABGs)

• Oxygen therapy? (Interface?, Humidifcation?, FiO2 or L/min)

• Respiratory Rate? (Tachypnea, Bradypnoea)

• Pattern (Apical, hyperventilation)

What is the typical target range for oxygen saturations (SpO2​) in a healthy patient?

Greater than 96%.

What is the target SpO2​ range for certain patient groups, such as those with COPD at risk of hypercapnic respiratory failure?

88-92%.

What term describes an abnormally fast respiratory rate?

Tachypnoea.

What term describes an abnormally slow respiratory rate?

Bradypnoea.

What are physios looking for when assessing Circulation?

• Heart rate and rhythm (tachycardic?, Bradycardic?, Sinus rhythm?, Atrial fibrilation?

• Blood pressure (Hypotensive, Hypertensive)

• Colour/pallor (Flushed, pale, clammy)

• Capillary refill (<2 seconds is normal)

• Temperature (Pyrexial, Hypothermic)

• Any medical support (Inotropes, Beta-blockers, Diuretics)

• Renal function considerations

• Urine output

• 24hr fluid balance

• Any haemodialysis/haemofiltration in situ?

What are physios assessing when looking at Disability?(8)

• ACPVU scale

• Glasgow Coma Scale 1-15 (Specialists will perform, just be aware of this)

• Sedation (Any sedative medication)

• Pupils (equal and reactive or unequal and unreactive)

• Seizures (Has there been any seizure activity)

• Pain (present, under control, triggers, analgesia)

• Muscle tone (Spasticity, increased tone, low tone, paralysis)

• posture and positioning

What does the ACPVU scale stand for?

• Alert

• Confused

• Voice

• Pain

• Unresponsive.

What are physios doing and looking for when assessing exposure/everything else?(10)

Expose the patient’s body with dignity and respect, and look for:

• Rashes

• signs of bleeding

• swelling, including peripheral oedema

• peripheral cyanosis

• mottling to the skin

• pressure areas

• bruising

• Trauma (Fractures, injuries, wounds, burns)

• Surgical wounds (Location, size, drain in situ, clean and dry)

• Attachments (Intravenous lines- fluids and antibiotics, urinary catheter, chest drain, feeding tubes)

What order do physios assess Exposure?

1. hands and feet

2. pressure areas (potential sources of infection)

3. limb exposures (rashes, swelling, bruising, deformities)

4. Abdominal distention

5. Equipment and monitering in the bed space

6. Drains and lines in situ

7. Blood tests (FBC, UandEs, LFTs, clotting)

8. Microbiological cultures (Blood, sputum, urine, wounds, lines)

What is the purpose of the National Early Warning Score 2 (NEWS2)?

It is a scoring system based on physiological observations to recognise and respond to deteriorating patients.

What is observed while looking at the NEWS2? (6)

• Respiratory rate

• Oxygen saturation and oxygen therapy

• Systolic blood pressure

• Pulse rate

• level of consciousness

• temperature

What does the NEWS2 scoring system trigger in a hospital setting?

An appropriate and timely clinical response, including escalation to the correct personnel.

What are the five main symptoms of respiratory disease that should be asked about in a subjective assessment?

Breathlessness (Dyspnoea), cough, sputum and haemoptysis, wheeze, and chest pain.

When taking a subjective history, it is important to establish the patient's _____ versus ____.

NORMAL versus NOW

What does the term 'collateral history' mean?

Obtaining information from family or carers, not just the patient.