A to E Assessment for Deteriorating and Acutely Unwell Patients

"...the 80 assessment is a fundamental tool used to provide a quick assessment for a patient who is critically ill it follows an order going through the potentially life-threatening problems giving priority to the most severe issues all right so the stands for Airway and what we're doing here is basically checking that there's no obstruction but also evaluating the likelihood that the patient will be able to maintain the airway if they deteriorate further there are several things you can do to assess the airway you can watch the patient and look for signs of an obstruction such as paradoxical chest or abdomen movements cyanosis which is a blue discoloration of the skin or use of accessory muscles you can also listen for sounds for example if the patient is talking that a fairly conclusive sign that the airway is obstructed however if you hear sounds extruder which is a high pitch sound mostly in inspiration or even a wheeze these sounds are indicative of a partial obstruction so what happens if you hear nothing you're either have to try and hear the breath sounds using a stethoscope or you'll have to try and feel for it the way you do this is by putting your hand or your ear next to the patient's nose or mouth and feeling for the air flow causes of an airway obstruction include the patient's tongue a foreign body swelling and even fluid it's such as vomiting or blood so what do we do about it well if it's obstructed the patient can rapidly deteriorating die or suffer hypoxic damage to organs such as the brain and heart so the first thing you do is you get help depending on the cause the patient may be moved into the recovery position so on this side you may perform movers like back slaps or the abdominal thrusts in order to help dislodge a foreign body it's patient ventilating and normal respiratory rate is between 12 and 20 breaths per minute hide and 25 is a marker that the patient may deteriorate quickly we would also look at the depth and the effort of the breathing are they using the accessory muscles is the chest expansion symmetrical is the trachea displaced or is the hyper resonance investigations include the use of a pulse oximeter so measuring the oxygen saturation generally we aim at for to 95% with a minimum of eighty eight percent however you need to be careful in COPD patients not to overdo the oxygen therapy because you can end up suppressing their breathing life-threatening causes of breathing issues include acute severe asthma pulmonary edema and tension pneumothorax the treatment again depends on the cause oxygen is given in most cases if no obstruction is present then non-invasive ventilation..."

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