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CDHB

The ABCs

A - Airway Impairment

• Recognition
  • Altered level of consciousness (common association).
  • Noisy breathing.
  • Laboured breathing (especially a "see-saw" pattern of opposite chest and abdominal movement).
  • Not breathing.
• Management options (in order of invasiveness):
  • Supplemental oxygen.
  • Positioning:
    • Recovery position.
    • Chin lift.
    • Jaw thrust.
  • Suction and removal of foreign bodies.
  • Nasopharyngeal airway.
  • Oropharyngeal (Guedel) airway.
  • Laryngeal mask airway.
  • Orotracheal intubation.
  • Surgical airways:
    • Needle cricothyroidotomy.
    • Surgical cricothyroidotomy.
• Causes:
  • Altered level of consciousness (most common cause).
  • Mass (infective, neoplastic, inflammatory, foreign body).
  • Palsy (bulbar, pseudobulbar, vocal cord).

B - Breathing Impairment

• Recognition:
  • Altered level of consciousness (cause and effect).
  • Hypoxia:
    • Pulse oximetry/arterial blood gases
    • Cyanosis.
  • Hypercapnia - arterial blood gases.
  • Tachypnoea or bradypnoea.
  • Laboured breathing.
• Management options:
  • Supplemental oxygen (high flow with a mask and reservoir bag, will provide an FiO₂ approaching 80%).
  • Assisted ventilation:
    • Mouth to mouth/mouth to mask.
    • Bag to mask.
    • CPAP, BiPAP.
    • Bag to endotracheal tube.
• Causes:
  • Central respiratory depression.
  • Airways disease.
  • Lung disease.
  • Chest wall problem.
  • Pleural disease - pneumo/hydro/haemo thorax.

C - Circulatory Impairment

• Recognition:
  • Impaired brain perfusion (anxiety, confusion, lowered level of consciousness).
  • Impaired skin perfusion (coolness, pallor).
  • Impaired renal perfusion (decreased urine output).
  • Tachycardia, low pulse volume, decreased pulse pressure.
  • Hypotension (a late sign).
• Management options:
  • Supplemental oxygen.
  • Intravenous fluids.
  • Pressor agents.
  • Other specific treatment.
• Causes:
  • Hypovolaemia.
  • Cardiogenic (arrhythmias, myocardial damage).
  • Vasodilatation (sepsis, drugs, anaphylaxis).
  • Obstruction (tension pneumothorax, massive pulmonary embolism, cardiac tamponade).

Pitfalls in assessment of circulation:

Elderly patients, pregnant patients, athletes and patients on cardiac medications or with a pacemaker may have the normal signs of hypovolaemia masked, and caution should be used when assessing these groups.

Topic Code: 1267