A-E Assessment

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  • A-E Assessment
    • Rationale
      • Systamatic
      • Reduces the risk of miscommunication
      • Standardisedapproach across multi-professional teams
    • Infants and children
      • Look well for a long time before the body ‘gives up’ and they deteriorate rapidly. If treatment is started before deterioration it is far more successful
    • The News2 and Pews are tools used to document and monitor trends
      • The condition of an unwell patient can change rapidly which is why it is important to perform a baseline assessment
      • Frequency of assessment must be decided - based on the score
      • Should be regularly monitored, can recognise changes, assess intervention and respond rapidly to deterioration
    • Airway
      • What is the positioning and basic manoeuvres?
      • Anything visible in the mouth?
      • Listen and feel for air movement
      • Is the patient conscious and vocalising? This is indication of a patent (clear) airway
      • Open the airway
        • Mucous membranes should look pink and moist
        • Blush tinge is a sign of reduced oxygen in the blood
      • Obstruction can happen at any level of respiratory tract
      • Differences in a child
        • Proportionately  larger head
          • So can block airway by the position of their heads
        • Infants are obligate nose breather
        • Larger more flaccid tongue
        • Larynx more superior and anterior
        • Proportionately larger occiput
        • Loosely attached mucous membrane
        • Infants and young children rely on the diaphragm to breathe more than adults do
        • Cricoid cartilage narrowest part of the funnel shape airway
      • Airway Assessment
        • Feel for inspiration
        • Listen for noise breathing
          • Stridor - inspiratory noise; airway obstruction above the thoracic inlet
          • Wheeze - expiratory noise; airway obstruction below the thoracic inlet
          • Grunting - expiratory noise; attempt to maintain the end-expiratory lung volume (infants and children)
          • Snoring - the tongue is partially obstructing the pharynx
        • If completely obstructed then there will be no breath sounds or noise
        • Partial obstruction - air entry is diminished and often noisy as air pass through narrowed airway or past foreign onbject
        • Other causes
          • Secretions
          • Blood
          • Vomit
          • Food
          • Loose teeth/dentures
          • Foreign objects
          • Facial burns
          • Inhalation injury
          • Oedma
          • Anaphylaxis
    • Visual assessment - split second by looking at them
      • Skin tone
      • Engaging with the enviroment
      • Obviously breathing?
      • Using all limbs?
      • Screaming/crying?
      • Interaction between parent and child
      • Age?
    • Breathing
      • Visual Inspection
        • Look, listen and feel, what is their position
      • Advanced Skills
        • Auscultation-is using a stethoscope to listen to sounds of breathing
        • Palpatation - using your hands, check for equal chest movements and that the trachea is midline
        • Perfusion - tapping on a surface to determine the underlying structures eg consolidation, collapse or fluid
      • Respiratory rate is the most useful indicator to assess if the airway is compromised
      • Adults increased respiratory rate of >20 bpm is a warning that they could suddenly deteriorate
      • Under 16 bpm
        • 0-1 40-60bpm
        • 1-5 20-40bpm
        • 5-12 20-40 bpm
        • Over 12 15-25bpm
      • Persistently high respiratory rates may lead to respiratory fatigue and failure
      • Low respiratory rates can be a pre-morbid sign
      • Breathing Assessment
        • Is respiratory rates within parameters?
        • Rhythm altered
        • Tripod position
        • Use of accessory muscles
        • Pursed lip breathing
        • Mouth breathing/nasal flaring
        • Unequal lung expansion
      • Child Assessment
        • Tachypnoea
        • Nasal flaring
        • Head bobbing
        • Intercostal recession
        • Subcostal recession
        • Trachea tug
        • Additional sounds
        • Exhaustion
    • Circulation
      • Heart Rate
        • Tachycardia is faster than age parameters
        • Bradycardia is slower than age parameters
        • Irregular rhythm suggest cardiac arrhythmia
        • Inaqualitieto certain areas could suggest localisted circulatory impairment eg clots
      • Blood Pressure
      • Pulse Pressure
        • Weak and thread pulse indicates reduce cardiac output and shock
        • Bounding indicates increased cardiac output for example sepsis
      • Perfusion
        • Assesses skin colour and tempreture
        • Pale skin (pallor) and mottling can be due to shock
          • Blood is diverted from peripheries to preserve blood supply to vital organs
        • Cyanosis is a blush tinge to the skin which indicates lack of oxygenation
        • Red, pink, flushed skin +/- rashes may indicate sepsis
        • Pale or ashen skin can be due to anaemia
          • A reduction of the amount of haemoglobin in the blood
      • Capillary Refill Time

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