WHO Basic Emergency Care
WHO Basic Emergency Care
WHO Basic Emergency Care
Approach
Basic Emergency Care Course
Objectives
• List the hazards that must be considered when approaching an ill or injured person
• List the elements to approaching an ill or injured person safely
• List the components of the systematic ABCDE approach to emergency patients
• Assess an airway
• Explain when to use airway devices
• Explain when advanced airway management is needed
• Assess breathing
• Explain when to assist breathing
• Assess fluid status (circulation)
• Provide appropriate fluid resuscitation
• Describe the critical ABCDE actions
• List the elements of a SAMPLE history
• Perform a relevant SAMPLE history.
Essential skills
• Assessing ABCDE • Needle-decompression for tension
• Cervical spine immobilization pneumothorax
• Full spine immobilization • Three-sided dressing for chest wound
Goals:
• Identify life-threatening conditions rapidly
• Ensure the airway stays open
• Ensure breathing and circulation are adequate to deliver oxygen to
the body
What is a SAMPLE history?
• Categories of questions to obtain a patient’s history
• Signs and Symptoms
• Allergies
• Medications
• Past medical history
• Last oral intake
• Events
• Immediately follows the ABCDE approach
• Allows providers to easily communicate
Goal:
• Rapidly gather history critical to the management of the acutely ill patient
ABCDE: Initial Approach
• The most important step is to stay safe!
• Scene safety
• Fire
• Motor vehicle crash
• Building collapse
• Chemical spill
• Violence
• Infections disease
• Personal Protective equipment
• Gloves
• Gown
• Mask Personal protective equipment
• Goggles
• Hand washing
Safety considerations
• Scene safety
• Scene hazards
• Violence
• Infectious disease risk
A person walks into your health post vomiting, bleeding from the
mouth and complaining of abdominal pain
!
This stepwise approach is designed to ensure that life-threatening conditions are
identified and treated early, in order of priority.
QUESTIONS?
?
Breathing: Assessment
• Look, listen and feel to see if the patient is breathing
• Assess if the breathing is very fast, very slow or very shallow
• Look for increased work of breathing
• Accessory muscle work
• Chest indrawing
• Nasal flaring
• Abnormal chest wall movement
• Listen for abnormal breath sounds
!
• REMEMBER with severe wheezes there may be no audible breath
sounds because of severe airway narrowing
Breathing: Assessment
• Listen to see if breath sounds are equal
• Check for the absence of breath sounds on one side
• If dull sound with percussion to the same side
• THINK large pleural effusion or haemothroax
• If also hypotension, distended neck veins or tracheal shift
• THINK tension pneumothorax
• Check oxygen saturation
Breathing: Management
• If unconscious with abnormal breathing, perform BAG-VALVE-MASK-VENTILATION with OXYGEN and
follow CPR PROTOCOLS
• If not breathing adequately (too slow or too shallow) begin BAG-VALVE-MASK-VENTILATION with OXYGEN
! •• IfPlan
oxygen is not immediately available, do not delay ventilation
for immediate TRANSFER for airway management
• If breathing fast or hypoxia, give OXYGEN
• If wheezing, give SALBUTAMOL
• If concern for anaphylaxis, give intramuscular ADRENALINE
• If concern for tension pneumothorax, perform NEEDLE DECOMPRESSION, give OXYGEN, give IV FLUIDS
• Plan for immediate transfer for chest tube
• If concern for pleural effusion, haemothorax, give OXYGEN
• Plan for immediate transfer for chest tube
• If cause unknown, consider trauma
Breathing
QUESTIONS?
?
Circulation: Assessment
• Look, listen and feel for signs of poor perfusion
• Cool, moist extremities
• Delayed capillary refill
• Diaphoresis
• Low blood pressure
• Tachypnoea
• Tachycardia
• Absent pulses
Circulation: Assessment
• Look for internal and external signs of bleeding
• Chest
• Abdomen
• From stomach or intestines
• Pelvic fracture
• Femur Fracture
• From wounds
• Check for pericardial tamponade
• Hypotension
• Distended neck veins
• Muffled heart sounds
• Check blood pressure
Circulation: Management
• For cardiopulmonary arrest follow relevant CPR PROTOCOLS
• If poor perfusion: GIVE IV FLUIDS
• If external bleeding: APPLY DIRECT PRESSURE
• If internal bleeding or pericardial tamponade, REFER to centre with
surgical capabilities
• If unknown cause, remember trauma
• Apply BINDER for pelvic fracture or SPLINT for femur fracture with
compromised blood flow
Circulation
QUESTIONS?
?
Disability: Assessment
• Assess level of consciousness
• AVPU or GCS in trauma
• Check for low blood glucose (hypoglycaemia)
• Check pupils (size, reactivity to light and if equal)
• Check movement and sensation in all four limbs
• Look for abnormal repetitive movements or shaking
• Seizures/convulsions
Disability: Management
• If altered mental status, no trauma, ABCDEs otherwise normal
• place in RECOVERY POSITION
• If altered mental status, low glucose (<3.5mmol/L) or if unable to check
glucose
• Give GLUCOSE
• If actively seizing
• Give BENZODIAZEPINE
• If pregnant and seizing
• Give MAGNESIUM SULPHATE
Disability: Management
• If small pupils and slow breathing, consider opioid overdose
• Give NALOXONE
• If unequal pupils, consider increased pressure in the brain
• RAISE HEAD OF BED 30 DEGREES if no concern for spinal injury
• Plan for early TRANSFER/REFERRAL
• If unknown cause of altered mental status, consider trauma
• IMMOBILIZE the cervical spine
Disability
QUESTIONS?
?
Exposure: Assessment
• Examine the entire body for hidden injuries, rashes, bites or
other lesions
QUESTIONS?
?
In-Depth, Acute, Life-Threatening Conditions
In head/neck injuries obstruction can be from blood or due to the trauma itself
Opioid medications (such as morphine, pethidine and heroin) can decrease the body’s
drive to breathe
Breathing Conditions: Asthma/ COPD
Signs and Symptoms Management
• Wheezing • Give SALBUTAMOL as soon as possible
• Cough • Give OXYGEN if indicated
• Accessory muscle use
• May have history of asthma/COPD,
allergies or smoking
Asthma and COPD are conditions causing spasm in the lower airway
Breathing Conditions: Large Pleural
Effusion/ Haemothorax
Signs and Symptoms Management
• Difficulty in breathing • Give OXYGEN
• Decreased breath sounds on affected • Plan for HANDOVER/TRANSFER
side • Patient may need chest tube
• Dull sounds with percussion on affected
side
• With large amount of fluid could have
tracheal shift
Pleural effusion occurs when fluid builds up in the space between the lung and the
chest wall or diaphragm limiting the expansion of the lungs
Circulation Conditions: Pulselessness
Signs and Symptoms Management
• No pulse • Follow relevant CPR PROTOCOLS
• Unconscious
• Not breathing
Circulation Conditions: Shock
Signs and Symptoms Management
• Rapid heart rate (tachycardia) • LAY FLAT if tolerated
• Rapid breathing (tachypnoea) • Give OXYGEN
• Pale and cool skin • STOP and CONTROL any bleeding
• Capillary refill >3 seconds • Give IV FLUIDS
• Sweating (diaphoresis) If sign of infection give ANTIBIOTICS
May have: •
• Plan for HANDOVER/TRANSFER
• Dizziness •
• Confusion
• Altered mental status
• Hypotension
Pericardial tamponade occurs when there is a fluid build-up in the sac around the heart
Pressure build-up keeps the heart from filling properly
Disability Conditions: Hypoglycaemia
Signs and Symptoms Management
• Sweating (diaphoresis) • Give GLUCOSE immediately
• Altered mental status • If they can speak/swallow, give oral
• Seizures/convulsions GLUCOSE
• Blood glucose <3.5mmol/L • If they cannot speak or is unconscious,
• History of diabetes, malaria or severe give IV GLUCOSE
infection • If unavailable give buccal (inside of
• Responds quickly to glucose cheek)
Disability Conditions: Increased Intracranial
Pressure
Signs and Symptoms Management
• Headache • RAISE the head of the bed 30 degrees
• Seizure/convulsions • If trauma, MAINTAIN CERVICAL SPINE
• Nausea, vomiting IMMOBILIZATION
• Altered mental status • Check glucose
• Unequal pupils • If seizures, give BENZODIAZEPINE
• Weakness on one side of the body • Plan for HANDOVER/TRANSFER
• Pressure must be reduced as soon as
possible which requires surgery
Once you find an ABCDE problem and manage it, you have to GO BACK
and repeat the ABCDE again to identify any new problems that have
developed and make sure that the management you gave worked
Using the workbook section above, list the management for airway
blocked by a foreign body
Special Paediatric Considerations
Paediatric Airway Considerations
Compared to adults, children have:
• Bigger tongues
• Use “sniffing” position
• Shorter necks, softer airway
• Easier to block off
• Avoid over-extending or flexing the neck
• A larger head compared to body
• Watch closely for airway obstruction
• Use jaw thrust
• Correct head position with padding to open airway
• Excessive drooling, stridor, airway swelling, unwillingness to move neck are high-risk signs
! in children
Paediatric Breathing Considerations
then
M Medications Obtain a full list and note recent medication or dose changes
P Past Medical History May help in understanding current illness and change management
choices
L Last Oral intake Note whether solid or liquid; vomiting/choking risk for sedation;
intubation or surgical procedures
E Events surrounding
the injury/illness
Helpful clues to the cause, progression and severity of current illness
Workbook Question 4
Using the workbook section above, list what the letters in SAMPLE stand for:
S
A
M
P
L
E
Disposition Considerations
• After ABCDE approach -> SAMPLE history -> Secondary exam-> Consider
disposition
• If you have to intervene in any of the ABCDE categories, immediately
consider HANDOVER/TRANSFER to a higher level of care
• A good handover includes:
• Brief identification of the patient
• Relevant elements of the SAMPLE history
• Physical exam findings
• Record of interventions given
• Plans for future care
• Things you may be concerned about
Questions
?
Quick Cards