![]() If the patient is unconscious or unresponsive, start the basic life support (BLS) algorithm as per resuscitation guidelines.Īirway Clinical assessment Can the patient talk? If the patient is an inpatient, check if they have been receiving thromboprophylaxis. Make sure the patient’s notes, observation chart and prescription chart are easily accessible.Īsk for another clinical member of staff to assist you if possible. Introduce yourself to the patient including your name and role.Īsk how the patient is feeling as this may provide some useful information about their current symptoms. Introduce yourself to whoever has requested a review of the patient and listen carefully to their handover. You may be asked to review a patient with a PE due to chest pain or shortness of breath. Your assessment and management should be documented clearly in the notes, however, this should not delay initial clinical assessment, investigations and interventions.Īcute scenarios typically begin with a brief handover from a member of the nursing staff including the patient’s name, age, background and the reason the review has been requested.Any medications or fluids will need to be prescribed at the time (in some cases you may be able to delegate this to another member of staff).Make use of your local guidelines and algorithms in managing specific scenarios (e.g.Review results as they become available (e.g.If you require senior input, call for help early using an appropriate SBARR handoverstructure.Clearly communicate how often would you like the patient’s observations relayed to you by other staff members.All critically unwell patients should have continuous monitoring equipment attached for accurate observations.Make use of the team around you by delegating tasks where appropriate.Re-assess regularly and after every intervention to monitor a patient’s response to treatment.Treat all problems as you discover them.General tips for applying an ABCDE approach in an emergency setting include: You might also be interested in our medical flashcard collection which contains over 1000 flashcards that cover key medical topics. Cyanosis: a late sign that indicates a significant drop in blood oxygen levels (SpO 2).Pleural rub: a squeaking or grating sound caused by ischaemic lung tissue coming in contact with the pleura.Evidence of deep vein thrombosis (DVT) such as a red, swollen calf.Hypotension: suggestive of right ventricular strain.Tachycardia: a heart rate of more than 100 beats per minute.Tachypnoea: a respiratory rate of more than 20 breaths per minute.Dizziness or syncope: due to haemodynamic instability (i.e.Haemoptysis: secondary to infarcted lung tissue.Pleuritic chest pain: with each breath, the pleura comes into contact with an ischaemic area of the lung.Medications such as the combined oral contraceptive pill or hormone replacement therapyĪ provoked PE refers to a PE developing in an individual who has recognised risk factors for PE.Īn unprovoked PE refers to a PE developing in an individual with no known underlying risk factors.Personal or family history of a clotting disorder or PE/DVT. ![]() ![]() Risk factors for developing a deep vein thrombosis (DVT) or PE include: In fact, clinical examination is often unremarkable and unless you consider PE as the cause of a patient’s chest pain or shortness of breath, you may miss the diagnosis. The diagnosis of a PE cannot be made on examination alone. You may also be interested in our overview of the ABCDE approach and other emergency management guides.Ī study in 2009 reported that in 1 in 4 patients with a PE, the first manifestation will be sudden-unexpected death.¹ PE is an important cause of out-of-hospital and in-hospital cardiac arrest and as such is part of the 4 H’s and 4T’s of reversible causes of cardiac arrest.
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