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FLS

ABCDE ,causes and


Prevention Cardiac
Arrest
By
Dr Noha
Elsharnouby
Associate
professor of
anesthesia and
ICU , Ain Shams
university

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Objectives
The

causes of cardiorespiratory
arrest
Identify and managing patients
at risk using the ABCDE
approach

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Early recognition of the critically ill
patient

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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

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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

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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

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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