CHECK

(NOW)

SEE
Patient not talking Unresponsive Patient has noisy breathing Patient responsive and talking Not breathing Abnormal Breathing Noisy breathing or low SpO2

DO
(NOW)
Get help, head tilt/chin lift, oxygen 15 l/min Airway clear? Suction. Head tilt, chin lift and oxygen 15 l/min by non-rebreath mask Regular re-assessment Get Help, call 2222 and start the cardiac arrest algorithm, get cardiac arrest trolley Reassess A Oxygen 15 l/min Get help Regular re-assessment

PLAN
(CONSIDER)
Get cardiac arrest trolley Airway adjuncts Outreach, Anaesthetic or ICU review Further respiratory assessment Consider post resuscitation care Assisted ventilation (bag, valve, mask) Do you need an anaesthetist? CXR, ABG, sputum and blood cultures. Specific therapies e.g. bronchodilators, steroids and antibiotics Oxygen 15 l/min

A AIRWAY

Talk to the patient Look, Listen and Feel

DO YOU NEED HELP NOW? IF YOU DO, GET HELP IMMEDIATELY

B BREATHING

Breathing Yes or No? If Yes: Look, Listen and Feel Respiratory rate Colour (cyanosis) Listen to chest Feel chest Monitor SpO2

OXYGEN TOOLKIT:

Normal Breathing

If your patient has chronic respiratory failure OR becomes less responsive OR their respiratory rate decreases to less than 9, in response to administered oxygen, SEEK SENIOR HELP

DO YOU NEED HELP NOW? IF YOU DO, GET HELP IMMEDIATELY

C CIRCULATION

Circulation / signs of life yes or no? If yes: pulse and BP Capillary refill Limb temp and colour Urine output (ml/kg/hr) Fluid balance

No circulation or signs of life Circulation abnormal

Get Help, call 2222 and start the cardiac arrest algorithm Gain IV access; the cannula you can insert Fluid challenge: 500ml* 0.9% sodium chloride as rapidly as possible. Reassess ABC and get help * 250 ml if patient is known to have heart failure

Consider post resuscitation care FBC, coagulation screen, U&E, LFT, blood cultures, group and save, x-match, colloid fluid bolus and reassess result of fluids given.

Circulation Normal Regular re-assessment Continue to re-assess ABCDE and document FLUIDS TOOLKIT: If your patient has heart failure OR their BP decreases and/or heart rate increases and/or saturation decreases and/or patient develops crackles on chest auscultation, STOP the fluids and SEEK SENIOR HELP

DO YOU NEED HELP NOW? IF YOU DO, GET HELP IMMEDIATELY

D DISABILITY E EXAMINATION

AVPU

A and V P and U

Check glucose, pupils and observe Reassess ABC, check glucose and pupils Seek expert help (anaesthetist) immediately and put patient into recovery position if safe to do so Reassess ABCD Stop bleeding if possible Seek expert, appropriate help

Continue to reassess ABC Investigate cause, check prescriptions, consider CT scan, lumbar puncture etc.

DO YOU NEED HELP NOW? IF YOU DO, GET HELP IMMEDIATELY

Brief examination including: Drips and drains Catheters and wounds Reasons for excess fluid loss. Where does it hurt and is it normal (inc abdomen and limbs) Pain relief Specific investigation e.g. radiology

DO YOU NEED HELP NOW? IF YOU DO, GET HELP IMMEDIATELY PLAN YOUR COMMUNICATION USE SBAR Commence MEWS