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DRS ABCD
WASH HANDS
DANGER
RESPONSIVENESS
AIRWAY
Open AIRWAY with head tilt (NOT NECK) chin lift if NO SPINE
injury
Jaw Thrust if risk of spine injury
o Place fingers behind mandible and pull the jaw upwards
and use thumbs to open the mouth slightly
DONT OPEN AIRWAY FIRST IF BLOCKS ARE FOUND WILL
MOVE BACK AND OBSTRUCT TRACHEA FURTHER
BREATHING
CPR
Begun if no breaths/not breathing normally!
30 compression before 2 Breaths take turns with trained helper (switch
every 2 min) or continue till you tire
30 Chest Compressions:
100-120/min to depth of 5-6cm
extend elbows, wrists and fingers
hands are palm down with fingers interlocked
carpal area over mid-sternum (not above/below)
allow for proper recoil
heel of hand in child, 2 fingers in infant but same Rate/Ratio
(30:2)
2 Rescue Breaths
Defibrillator
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Hand Hygeine: total time = 40 60 with soap and 20-30 with gel
Remove Jewelry
Wet hands and wrist thoroughly and apply soap
Rub palm to palm
Rub back of hand and repeat with the other
Rub palm to palm with fingers interlaced
Rub back of fingers with hands clasped
Rub thumb
Rub Finger tips
Rub around the wrists
Rinse hands under water with fingers first and let water drain
towards the wrist
Pat hands with paper towel moving from fingers to wrist
Use paper towel to turn off taps
Vital Signs
Temp
PR
RR
BP
Others: O2 sat, Neuro obs, BSL, Urine
Changes with Age, RF, body position, smoking, exercise, food
1. Temperature
a. Normal is 36.6 to 37.2 in adults, 38 in child/infant
b. Temp changes 0.-1 during 24 hour period
c. Highes at 6PM
d. Core> Surface
e. Site: beneath tongue, tympanic, Axillary, Rectal
i. Age/Condition determines site
ii. Rectal + Tympanic = core but rectal more accurate
1. Avoid Tympanic: Hearing aid, newborns, ear
wax, ear trauma
2. Avoid Rectal: Diarrhea, Rectal Surgery, ICD
iii. Oral underestimates by 0.5 and Axillary by 1 =>
Surface Temp
1. Avoid Oral in: Face trauma, unccoperative,
epilepsy, shaking, infant
2. Avoid Axillary in uncooperative + takes a long
time
2. Pulse
a. Note the baseline
b. Strongest in arties closes to heart, palpable if close to surface
c. Adults use Radial (Located on lateral, flexor aspect of wrist
over the distal radius) /Carotid
d. Infants/Small children: Brachial (Located on the anteromedial
aspect of the cubital fossa medial to the biceps tendon)/Apex
(on MCL)
e. Neonate: Apex(before 4yo between MCL and Ant Axillary line
ie more lateral)
i. Apex gives you Rate and Rhythm on Auscultation
f. Done for 30 seconds (x2 for BPM), Full Minute if
Abnormal
g. Rate (BPM)
h. Volume (Amp/Strength thread/weak or strong/bounding)
i. Not heard when auscultating Apical Pulse
i. Rhythm
i. Regular intervals
ii. Pulses & Pauses at unequal intervals (Regularly
irregular)
iii. No pattern (Irregularly Irregular)
j. (ADULT)60-100 -110 -160 (NEONATE)
k. Tachy is >100 and Brady <60 in Adults
l. Brady can be normal in adults
3. Resp Rate
a. Note the baseline
b. Assessed over 30s, if irregular done for 60s
c. Do it during pulse measure position look at 1 cycle of breath
in breath out
d. Adults:16-25 -Neonate:30-40
e. Rate + use of accessory muscles or just diaphragmatic
f. Depth ~ Degree of Chest Wall Movement deep? Normal?
Shallow?
g. Rhythm: Irregular/Regular
h. Stridor on inspiration. Wheezing on expiration
i. Brady<8, tachy>25
j. Cheyne Stokes: shallow breaths increasing in depth and
rate then decrease and stop for 15- 30 seconds
release
Remove clothing from the arm
Sizes
Newborn to adult thigh, if too small, high reading, too
large low reading
When wrapping, make sure the INDEX line on the
Blood Pressure
Cuff size
o Choose cuff appropriate for Pxs arm Size
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