1. What are the three main components of the ABCDE assessment in acute care? How would you perform each component and what are the expected findings? - The ABCDE assessment stands for Airway, Breathing, Circulation, Disability and Exposure. It is a systematic approach to assess and manage critically ill patients. - To perform the airway component, you would check if the patient has a patent airway, look for signs of airway obstruction such as stridor, snoring, gurgling or use of accessory muscles, and intervene as needed with suctioning, positioning or advanced airway management. - To perform the breathing component, you would assess the patient's respiratory rate, rhythm, depth and effort, auscultate the lung sounds, measure the oxygen saturation and blood gas values, and intervene as needed with oxygen therapy, ventilation support or bronchodilators. - To perform the circulation component, you would assess the patient's heart rate, blood pressure, capillary refill time, skin temperature and color, peripheral pulses and urine output, and intervene as needed with fluid resuscitation, vasopressors or inotropes. - To perform the disability component, you would assess the patient's level of consciousness using the AVPU or GCS scale, check for pupil size and reaction to light, assess the motor and sensory function of the limbs, and intervene as needed with seizure precautions, sedation or analgesia. - To perform the exposure component, you would remove the patient's clothing to inspect for any injuries, wounds or sources of infection, maintain the patient's privacy and dignity, and intervene as needed with wound care, antibiotics or antipyretics. - The expected findings for each component depend on the patient's condition and baseline status, but generally they should indicate adequate oxygenation, perfusion and neurological function. 2. What are the indications and contraindications for non-invasive ventilation (NIV) in acute care? What are the advantages and disadvantages of NIV compared to invasive ventilation? - NIV is a form of respiratory support that delivers positive pressure to the airways via a mask or interface without requiring an artificial airway. It is indicated for patients with acute respiratory failure due to conditions such as COPD exacerbation, acute cardiogenic pulmonary edema, asthma attack or pneumonia. - NIV is contraindicated for patients with severe respiratory failure that requires high levels of oxygen or pressure support, patients with impaired consciousness or airway protection, patients with facial trauma or deformity that prevents a good seal of the mask or interface, patients with hemodynamic instability or shock, patients with excessive secretions or vomiting that may cause aspiration, and patients who do not tolerate or cooperate with NIV. - The advantages of NIV compared to invasive ventilation include preserving the patient's natural airway and cough reflex, reducing the risk of ventilator-associated pneumonia and other complications of intubation, improving patient comfort and communication, and facilitating weaning from respiratory support. - The disadvantages of NIV compared to invasive ventilation include potential air leaks and pressure loss due to poor mask fit or interface tolerance, difficulty in delivering adequate oxygen or pressure support in some cases of severe respiratory failure, increased work of breathing due to increased dead space and resistance of the mask or interface, and possible complications such as skin breakdown, eye irritation or gastric distension.