1 Please mark your responses by filling in the appropriate boxes like this Name:
Clinical setting and history
S: 25-year-old patient who has become acutely short of breath B: Known asthmatic Course Centre: A: Now wheezy, unable to complete sentences R: Urgent assessment D: you agree to come urgently. Date: Clinical Course A: clear; B: RR 40 min-1, audible wheeze; accessory muscles ++; quiet breath sounds bilaterally, SpO2 – 86% (60% if not on O2); C: PR 120 min-1 (sinus tachycardia), BP 110/70 mmHg, CRT <2 s; D: verbal response; E: nil Assessor 1: Patient collapses Initial rhythm PEA (sinus tachycardia rate 120 min-1); continue for one further cycle if reversible causes not identified Assessor 2:
INTERVENTIONS – KEY TREATMENT POINTS IN BOLD
NOT Initial approach EXCELLENT ACCEPTABLE BORDERLINE ACHIEVED ST ABCDE approach Oxygen, IV access Recognise acute severe asthma Nebulised salbutamol IV steroids, nebulised anticholinergic, IV magnesium, IV bronchodilator Request CXR, ABG Cardiac arrest management PEA Confirm cardiac arrest / check rhythm Call resuscitation team / help 2 min CPR (30:2) Airway / ventilation / oxygen Attach ECG monitoring (if not already) Give adrenaline 1 mg IV Recognise relevant reversible causes (hypoxia – oxygenation; tension pneumothorax – needle decompression / thoracostomy) (further cycle as required)
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ALS Provider Course | CASTest | May/2020 | Version 1 1