assessment and resuscitation

Last reviewed 01/2018

Initial management should be observant of ABCDE:

• Airway - if the patient is unconscious, clear any dentures, vomit or blood, using a gloved finger. Insert an oropharyngeal airway and administer oxygen

• Breathing - if the patient is not breathing or has an absent gag reflex, pass a cuffed endotracheal tube. Listen for crackles - localised ones are suggestive of aspiration of vomit or other fluids; generalised, of pulmonary oedema. Note respiratory rate

• Circulation - record pulse and blood pressure. If systolic blood pressure is low - less than 90 mm Hg in patients over 50 years of age, or less than 80 mm Hg in younger patients - urgent intervention is necessary. Raising the foot of the bed may be adequate. Otherwise, provide haemaccel as a plasma expander, provided that the jugular venous pressure is not markedly elevated. If blood pressure remains low in spite of the correction of hypovolaemia, consider an infusion of dobutamine and dopamine

Pass a urinary catheter to assess renal function. Set up an ECG. Correct any hypoxia, acidosis or hypothermia

• Disability - use the Glasgow Coma Scale to provide rapid assessment of neurological function

• Exposure - in an unconscious patient, look for evidence of recreational i.v. drug use