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
2
1
< 40
41-50
71-80
Respiratory
Rate
<8
Temp °C
< 35
CNS
0
1
51-100 101-110 111-130
81-100 101-199
35.136.5
2
3
> 130
> 200
9 -14
15-20
36.637.4
> 37.5
A
V
21-29
> 30
P
U
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
Global Injury Solutions
Global Injury Solutions
FLS
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
The ABCDE approach to the
critically ill patient
A…
B…
C…
D…
E…
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
B
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
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
Treatment







Airway, Breathing
Oxygen
IV access, take blood sample
and lab investigations
Treat cause
Give fluids
Haemodynamic monitoring
MONA if acute coronary
syndrome
C
 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
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
