Hi guys, Jessica here, and welcome to CritIC!
In this video, we take a look at an acutely ill patient on the ward to practice our ABC
assessment skills.
This video is complementary to the previous ABCDE video, so be sure to check that one
out first.
Let’s go!
I’d like to start out by giving a few general words of advice that I talked about in my
previous video as well.
1.
You are not alone.
Assess the patient with at least one nurse present.
2.
Talk out loud!
It helps you to remember where you are and keeps everyone on the same page.
I’ll put this up in blue.
3.
Assess, address, advance.
Identify possible problems, address these, and only advance when you have done so.
4.
Look, listen, feel.
This helps you not to forget what to look for within each step.
5.
Now and then.
Ask yourself in each step: how is it now, and how will it be in a few minutes
6.
Do we have a problem?
Answer this question after each step.
7.
Again, you are not alone.
Ask for help from the more experienced.
So, it’s your first night shift and you’re having a coffee with the nurses, when all
of a sudden, one of the other nurses, Fiona, comes in and asks you to come see Mrs. Jensen
in room 16 immediately.
As you make your way to Mrs. Jensen, Fiona informs you that this 70 year old patient
is admitted with a urinary tract infection, and was found unresponsive in her bed.
Crap…
When you arrive at Mrs. Jensen, you ask nurse Fiona to stay with you at the bedside.
Is it ok for you to do the ABC’s with me?
Fiona nods and starts by checking vital signs on the patient.
Airway
We start with airway.
Mrs. Jensen looks like she’s sleeping.
You ask her to wake up, and shake her shoulder.
No response.
The patient is unresponsive.
You check if her mouth is empty – it is.
No accessory muscle use.
You listen for breath sound (present) and inspiratory stridor (also present).
I hear an inspiratory stridor.
We have a problem in A.
You perform the triple airway maneuver.
You feel for air coming out of the mouth (it is) and chest movement (present).
You administer oxygen through a non-rebreathing mask.
You check if the stridor disappears with the triple airway maneuver, it does, so it was
her tongue blocking the airway.
You ask someone to take over the triple airway maneuver.
We’ve addressed the stridor, let’s move on to B.
Breathing
We’ve moved on to B. Mrs. Jensen has an
oxygen saturation of 98%.
Fiona, would you please count her respiratory rate?
It’s 12.
Alright, a respiratory rate of 12 per minute.
She’s not in respiratory distress, no cyanosis.
I hear clear lung sounds and no abnormalities on percussion.
No problem in B for now.
When we revisit, remind me to get an arterial blood gas.
So, you already gave the patient oxygen.
Good.
In your mind you go back to A: is that still OK?
Alright, let’s move on.
Circulation
We’ve moved on to C. Mrs. Jensen has a blood
pressure of 120 over 80, with a heart rate of 60 per minute, regular in rhythm and force.
She feels warm, but a bit clammy.
Her capillary refill is normal.
Fiona, would you get iv access, and monitor blood pressure and heart rate every few minutes?
When we revisit, we may want to place a urinary catheter, but for now, there’s no problem in C
In your mind you go back to A and B: no changes in vitals?
OK.
Disability
We’re at D.
5 things, you remember: PEARL, EMV,
lateraliation, menigneal irritation, and don’t ever forget glucose.
Fiona, would you check her glucose?
You check her pupils
pupils equal and reactive to light.
E2 M5 V3, equals 10.
No left/right differences.
You pull her neck gently
No meningeal irritation.
Fiona, what’s her glucose?
It’s 1.2 mmol/l.
She’s hypoglycemic.
Fiona, please administer 50cc of 50% glucose solution intravenously.
Mrs. Jensen becomes responsive again.
Good work doctor.
We’ve resolved the problem in D. In your mind you go back to A, B and C: vitals OK?
Exposure
You tell Mrs. Jensen you’re glad she’s
feeling better, and ask her and Fiona to finish the ABC’s with you.
Temperature is 37 degrees Celcius.
You check her from top to bottom.
Nothing out of the ordinary.
So Mrs. Jensen was hypoglycemic.
Turns out she’s a type 2 diabetic on insulin.
Her insulin regimen had been adjusted during the day... probably a bit too much ey?
When you’ve made sure Mrs Jensen is feeling better, you ask Fiona to evaluate the situation
with you.
As stated in the previous video, these situations are stressful.
And you need to be able to evaluate them in order to feel better and to get better.
Is the nurse ok?
Are you ok?
How did we get into this situation and how did we handle it?
Any feedback?
And that’s about it.
Please give your honest feedback about this video!
Drop me a line in the comments below or send out a tweet.
Thanks for watching.