ABCDE ,causes and

Prevention Cardiac
Arrest
FLS
By
Dr Noha
Elsharnouby
Associate
professor of
anesthesia and
ICU , Ain Shams
university
Objectives
The causes of cardiorespiratory
arrest
Identify and managing patients
at risk using the ABCDE
approach
FLS


FLS
Early recognition of the critically ill
patient
Recognition of critically ill
patients

U P V A CNS
> 37.5
36.6-
37.4
35.1-
36.5
< 35 Temp C
> 30 21-29 15-20 9 -14 < 8
Respiratory
Rate
> 200 101-199 81-100 71-80 < 70
Systolic BP
mmHg
> 130 111-130 101-110 51-100 41-50 < 40 Pulse
3 2 1 0 1 2 3
Track score - a score of > 4 triggers a review by doctor
FLS
Causes of cardiorespiratory arrest
Airway
Breathing
Circulation

FLS
Causes of
cardiorespiratory arrest
Airway problems
Obstruction caused by:
CNS depression
Blood
Vomit
Foreign body
Trauma
Infection
Inflammation
Laryngospasm
FLS
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
FLS
Global Injury Solutions
Global Injury Solutions
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
FLS
A
B
C
D
E
The ABCDE approach to the
critically ill patient
FLS

ABCDE approach
Rules
Call for help early
Priority of treatment
Complete initial assessment
Reassessment
safety
Patient responsiveness to
treatment



FLS
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
A
FLS
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

A
FLS
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
B
FLS
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


B
FLS
ABCDE approach
Circulation

Look at the patient
Pulse central pulse (carotid)
peripheral pulse
Peripheral perfusion
capillary refill time
( normally <2 sec)
Blood pressure
Monitor
C
FLS
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
C
FLS
ABCDE approach
Disability


AVPU or GCS?
Global Injury Solutions
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
ABCDE approach
Disability

AVPU or GCS, and pupils
Treatment - ABC
Treat underlying cause
Blood glucose
if < 3 mmol l
-1
give glucose

D
FLS
ABCDE approach
Exposure
Remove clothes to enable
examination
- e.g. injuries, bleeding, rashes
Avoid heat loss
Maintain dignity
E
FLS
Any
questions
FLS
Summary
Early 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
FLS