EXPOSE, EXAMINE, EVALUATE E Resp rate, pattern Aim SaO2 94-98% Arterial blood gas Consider imaging - XRAY / CT & depth +/- high flow O2 If breathing reduced or absent, SEEK EXPERT HELP MODIFIED ABCDEFG STREAMLINED ASSESSMENT OF THE CRITICALLY UNWELL/DETERIORATING PATIENT AIRWAY A BREATHING B CIRCULATION C DISABILITY D FAMILY F A D A P T E D B Y S I M O N M A R K D A L E Y ( 2 0 1 9 ) Breath sounds Airway opening Clear airway if obstructed & safe to do so diminished or absent? manoeuvres, suction +/- adjunct required If unresolved, SEEK EXPERT HELP GET SPECIALIST INPUT G DO WE RESUSCITATE? D RESUS TROLLEY R Blood pressure (manual) Pulse rate / pattern Capillary refill time & JVP IV / IO access + fluids if not overloaded Venous bloods +/- cultures 12-lead ECG Input vs output (hydration status) ACVPU & pupils Blood glucose level Drugs +/- reversal Expose & inspect - head to toe Physical exam as directed by A-D Check current & past medical history Is the patient getting better or worse? Is this a terminal event? HAS THE UNDERLYING CAUSE BEEN TREATED? Communicate with relatives early Obtain collateral history Consider escalation status DOCUMENT DECISIONS ON RESPECT FORM DR Does the patient have a ReSPECT from? What is their escalation plan? Have the resuscitation trolley easily accessible when there is concern re deterioration Utilise the knowledge & skills of others Don't be a hero - ask for help/ advice if YOU feel you need it