APPROACH TO THE EMERGENCY PATIENT

Emergency conditions often require urgent intervention long before a diagnosis is established, and a presentation- based approach is key to managing patients effectively.

1. The ABCDE Approach allows rapid assessments and intervention for life threats using     the following categories:

A: Airway – ensure airway is clear by manually removing things that could block the airway Such as blood, food, dentures and some times the tongue may fall back and block the airway when the Casualty has lost their consciousness. Clearing or managing the airway by removing foreign body from the mouth with the hands or by suctioning. To clear the airway – open the mouth, head tilt, jawthrast/ chin lift. The three manoeuvre constitutes Triple Safar manoeuvre- open the mouth, Head tilt and Jaw thust

B:  Breathing – check if the casualty is breathing at all if so is rate life sustaining. Put your left ear near patient’s mouth and nose with the ear will feel warm air, you hear if there are any abnormal breath sounds and the left eye will look at the chest and abdominal movement hence the  LOOK, LISTEN, and FEEL

C: Circulation- check peripheral pulse on the Radial Artery, then central carotid pulse in the neck or femoral artery  or check the apical heart beat. If the Heart stops

Adult basic life supportalgorithm    

UNRESPONSIVE

↓

SHOULT FOR HELP

↓

OPEN AIRWAY

↓

NOT BREATHING

↓

CALL  911 or SENIOR MEDICAL OFFICER

↓

30 CHEST COMPRESSION

↓

2 RESCUE BREATHS THEN 30 CHEST COMPRESSIONS (press 4 to5 cm)

After a compression release all the pressure and repeat at the rate of 100/ minute.

Note: in trauma avoid head tilt

 

D:  DISABILITY -Assess and protect brain and spine functions

E: EXPOSURE- Expose patient and look for injuries and environmental threats and avoid hypothermia.

 

2. ANOTHER APPROACH

A – Alert

V- Verbal Response

P-  Pain Response

U-   Unresponsive

 

LEVEL OF UNCONSCIOUSNESS

LEVEL 1.  The person is conscious – alert and able to answer to questions normally

LEVEL 2. Is known as drowsiness where by  the person answers questions vaguely (not to the point )

LEVEL 3. (stupor ) in this level the person obeys to command and can only respond to pain

LEVEL 4.  The person do not react at all

 

3. The SAMPLE History  is a method of rapidly gathering history critical to the management of the acutely ill patient. The sample categories are:

S: Signs and symptoms

A: Allergies

M: Medications

P: Past Medical History

L: Last oral intake

E: Events surrounding illness

FOR REFERENCES: NORMAL VITAL SIGNS

NORMAL ADULT VITAL SIGNS  

Ø  Pulse Rate: 60- 100 Beats Per Minute

Ø  Respiratory rate: 10 – 20 breaths per min

Ø  A respiratory rate of less than 8 breaths per minute is a danger sign and may require intervention.

Ø  Systolic blood pressure < 90

Ø  Oxygen saturation  > 90%

 

 

 

NORMAL PEADIATRIC VITAL SIGNS

In children vital signs are age dependant,  normal heart rate is higher in younger children

AGE  (Years)	NORMAL PULSE RATE RANGE	NORMAL SYSTOLIC BLOOD PRESSURE
0-1	100- 160	> 60mmHg
1-3	90- 150	> 70mmHG
3-6	80- 140	> 75mmhg

RESPIRATORY RATE

AGE	RESPIRATORY RATE
< 2 Months	40- 60 breaths per min
2- 12 months	25 50 breaths per minute
1-5 years	20 40 breaths per min

To estimate a child’s weight  (from 1- 10 years old ) use the formula [ Age in years + 4 ]x 2