The Concept of Emergency Care and Resuscitation

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Emergency care and Resuscitation involves rapid assessment and early intervention. Approach to  Emergency care and resuscitation needs to be systematic hence the use of the ABCs approach.  The ABCs approach provide the framework for evaluation and treatment of severely ill patients.

Primary survey

1. Airway

  • Assess the airway to establish patency of the airway. This includes:
    • Looking  for  signs  of  airway  obstruction  (signs  of  trauma,  swelling,  secretions, presence of foreign body).
    • Listen for abnormal sounds like stridor, snoring.
  • If there are signs of airway obstruction intervene by positioning, opening and clearing the airway.  Perform chin lift or jaw thrust manoeuvre to open the airway (If suspecting cervical spine injury use  the  jaw  thrust  manoeuvre).  Use  sunction  to  remove  the  secretions.  Airway  adjuncts  like  oropharyngeal or nasopharyngeal airway can be used. 

Note 

  • Remember to reassess the airway after performing interventions
  • Some patient may require use of advance airway devices like endotracheal intubation or surgical airway

2. Breathing

  • Upon completing airway assessment and intervention, assess for presence of breathing, signs of  respiratory  distress  such  as  tachypnea,  hypoxia,  cyanosis,  apnoea  and  abnormal  breath sounds.Provide  oxygen  when  oxygen  saturation  is  below  92%  or  the  patient  is  dyspnoeic. Oxygen can be administered using the nasal prong, simple face mask, non-rebreather mask or ambubag. Advance interventions include: mechanical ventilation.

3. Circulation

  • Check  for  pulse  (central  pulse)  for  not  more  than  10  seconds.  If  absent  start  CPR  (Refer cardiopulmonary resuscitation section below). Assess for signs of poor peripheral perfusion (shock)  such  as  cold  extremities,  prolonged  capillary  refill,  dry  mucous  membrane  and hypotension. If there are signs of shock, establish two (2) IV large bore cannula and give IV fluids (crystalloids) bolus (2lts in adults and 20mls/kg in pediatrics). Limit fluids to individuals whom you suspect to have heart failure, renal failure or malnourished children.

4. Disability

  • This  involves  rapid  assessment  of  the  neurological  status.  This  includes  assessment  for  the level of consciousness (use of AVPU or Glascow coma scale), signs of convulsions, random blood glucose level, examination of the pupils and presence of focal neurological deficit. Interventions that can be performed during the disability assessment include: correction of hypoglycemia, airway protection, stopping the convulsions by administering anticonvulsant

5. Exposure

  • This involves fully exposing the patient and rapid assessment of the body for signs of trauma, rashes or infection.

Secondary survey 

After  assessment  and  stabilization  of  ABCs  during  the  primary  survey,  focus  is  turned  into  secondary  survey.  The  secondary  survey  is  a  systematic  assessment  of  the  rest  of  the  body  to  identify injuries and illnesses. Common approaches include a head to toe or organ –system based  assessment.  It  is  important  to  note  that  the  secondary  survey  is  performed  after  the  primary  assessment  and  interventions.  When  performing  a  secondary  survey,  if  the  patient  condition  changes then you must stop immediately and redo the primary survey and necessary interventions. 

Note: 

All  patients  with  compromised  airway,  breathing,  circulation  or  disability  must  be  attended  in  the  resuscitation rooms. (Refer Triage overview section)