1. ABCDE

2. What has happened?

3. . Assessment

4. ABC CAB Response Responsive Non Responsive

5. . Make rapid initial assessment AVPU method

6. . A lert responds appropriately / aware of place / time respond to V ocal stimuli respond to P ainfull stimuli U nresponsive AVPU

7.  Verbal response  Orientated5  Confused4  Inappropriate words3  Incomprehensible sounds 2  None 1  Eye opening  Spontaneously 4  To Speach 3  To Pain 2  None 1  Motor response  Obeys verbal commands6  Localising pain 5  Withdrawsfrom pain stimuli 4  Flexing to pain 3  Extension to pain 2  No response 1 GCS

8. Flexion of the upper limb with extension of the lower limb (decorticate response) and extension of the upper and lower limb (decerebrate response) indicate a more severe disturbance and prognosis.

9. . Interpretation Individual elements as well as the sum of the score are important. Hence, the score is expressed in the form "GCS 9 = E2 V4 M3 at 07:35". Severe, with GCS ≤ 8 Moderate, GCS 9 - 12 Minor, GCS ≥ 13.

10. . The ABCDE approach to prevent CA A irway B reathing In responsive C irculation D isability E xposure

11. . A irway Look for signs air way obstruction Complete(no breath sounds and often cyanosed) Incomplete(Often noisy or stridor) Depressed level of consciousness (often leads to airway obstruction)

12. . Treatment Obtain expert help immediately Airway opening manoeuvres Airway suction Insertion of an oro- or nasopharyngeal airwayET intubation may be required when these fails A irway

13. . Give O2 at high concentration 15 L/ min (100%) To reach SaO2 94% - 98% except In COPD 88% - 92%

14. . B reathing Look, listen and feel for signs of respiratory distress Sweating Central cyanosis Use of accessory muscle of respiration Abdominal respiration RR&depth Normal (12 – 20/min ) High (> 25 / min ) Equal expansion on both sides

15. . B reathing Note any chest deformity Look for raised jugular venous pulse( Asthma & tension pneumothorax) Look for abdominal distension (Limit diaphragmatic movement) Treatment Obtain expert help immediately Give O2 Treatment depends upon the cause

16. . C irculation Consider hypovolemia to be a cause of shock,until proven otherwise.

17. - Unless there are obvious signs of a cardiac cause, give IV fluid to any patient with cool extremities and a faster HR - In sugrical patient, rapidly exclude Hge ( overt or hidden) - Remember that breathing problems, such as tension Pneumothorax, can also compromise a patient "s circulatory state C irculation

18. . Signs of hypovolemia -Cool cold extremities. -prolonged CRT(cap, refilling time). -Collapsed veins - Tachycardia. -Low Bp( Bp may be normal). C irculation

19. . Fluid challenge test In normotensive ( 500 cc NS IV over 5 -10 min) In Hypotensive ( 1000 cc NS over 5 – 10 min) In HF (250 cc NS over 5 – 10 min) The specific treatment depends on the cause. But should be directed at Fluid replacement He control And restoration of tissue perfusion C irculation

20. . D isability Common causes of unconsciousness 1)hypoxia 2)hypercapnia 3)Hypoperfusion 4)hypoglycemia 5)Drug (Intoxication, recent administration of sedative drugs, Withdrawal

21. . H Hge

22. .