Abcde Anaphylaxis - practical PDF

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Summary

practical...

Description

Semester 5 2019 CNA250: DR ABCDE scenario Anaphylaxis Student Name: Date: ABCDE Scenario: Anaphylaxis Assessor:

Student Number:

Clinical scenario: James Paulsen (33 years old) is day 1 post radical prostatectomy. You have just administered his prescribed IV ceftriaxone and he suddenly becomes distressed and short of breath. PMHx: allergy to penicillin, osteoarthritis. Please assess patient using the DRABCDE approach.

General Notes#

Step

Not Capable 0

Marks* Marginal 1

Capable 2

Danger

Washes Hands. Safe to Approach. Cease IV ceftriaxone

Response

Patient alert and very anxious.

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0

1

Swelling of lips, tongue

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Airway

Look Feel Listen Measure Treat

Stridor on inspiration & expiration Call for help. Administer IM adrenaline 0.5mg 1:1000 into outer midthigh

0 0

0 0

1 3

Breathing Look Feel Listen Measure Treat Circulation Look Feel Listen Measure Treat

Disability

Exposure

Lip cyanosis, pale, trachea central, rapid shallow symmetrical chest expansion, use of accessory muscles Trachea central, rapid shallow symmetrical chest expansion, nil tenderness, nil subcutaneous emphysema Decreased air entry bilaterally, generalised wheeze, percussion normal RR: 40. SpO2: 84% on room air O2 15 L via NRM. Request ABG. Request CXR. Position patient: lay patient down or very slightly head raised. Consider bronchodilators. Pale. JVP not visible. No peripheral oedema Peripheries warm to touch. Radial pulse weak, rapid and regular Heart sounds normal HR 120; BP 87/39; Temp 37.3 CR 2 secs; U/O 40 mL per hour Request 1 large bore cannula Bloods (FBC, U&E, CRP, clotting & Tryptase) Fluid bolus (500mL Normal Saline). Consider 200mg IV hydrocortisone. Take ECG. Position patient: lay patient down. GCS: 14 E=4, V=4, M=6 BGL: 6.6mmols/L PEARL; Nil limb weakness Skin: red raised rash on trunk and limbs. No other data collected on exposure. Help arrives. Clearly states impression and two appropriate recommendations Conducts all of the above fluently and systematically

Handover Fluency Total * Marking scheme is a guide only and may vary in the OSCE # Expect presentation cues to vary in the OSCE. This may require variations to treatment approaches

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