3) ABCDE APPROACH

ABCDE APPROACH

mnemonic that stands for Airway (A), Breathing (B), Circulation (C), Disability (D), & Exposure (E) and it is a structural approach to the assessment and reassessment of any of the signs & symptoms in order to prevent cases of incorrect diagnoses or misdiagnoses

ABCDE APPROACH

- applicable to all clinical emergencies for the immediate assessment and treatment of critically ill or injured patients (adults & children) during medical / surgical emergencies which includes both prehospital first-aid & in-hospital treatment

ABCDE APPROACH

- can be used in the street without any equipment or in a more advanced form such as: clinical settings, upon the arrival of emergency medical services, emergency rooms, general wards of hospitals, or intensive care units

ABCDE APPROACH

- widely accepted by experts in emergency medicine and aids in determining the seriousness of a condition in order to prioritize initial clinical intervention especially when critical illness or injury is suspected

ABCDE APPROACH

- this approach is NOT recommended in cardiac arrest cases: if the victim is in cardiac arrest, immediate treatment is cardiopulmonary resuscitation (CPR)

AIRWAY

- assess the patient's voice & breath sounds, then check for foreign bodies causing any airway obstruction that would need to be removed (Heimlich maneuver is utilized for choking victim)

AIRWAY

- with proper equipment: suctioning the airway to remove obstruction (blood/vomit) is advised

- treatment involves opening the airway & may be accomplished in various ways such as: tilting the head & lifting the chin, thrusting the jaw, etc.

HEIMLICH MANUEVER (ABDOMINAL THRUSTS)

- a 3-step emergency response technique that can save a life in seconds

- do NOT perform back blows before proceeding with this technique because it may further push the object down the trachea

HEIMLICH MANUEVER (ABDOMINAL THRUSTS)

- while standing behind the patient: reach around the patient, place a fist just above the patient's navel (thumb side up), grab the fist with your other hand, and then pull the fist inward & upwards towards your body (perform 5 abdominal thrusts and repeat if necessary)

BREATHING

- assess the respiratory rate, chest wall movement for symmetry, and chest percussions for unilateral dullness or resonance

- with proper equipment: lung auscultation must be done & a pulse oximeter may be applied

- treatment involves seating the patient comfortably & giving rescue breaths with or without a barrier device (if breathing is insufficient)

CIRCULATION

- assess the patient's skin color for any circulatory problems & check for the presence of sweating for signs of perfusion

- with proper equipment: electrocardiography monitoring & blood pressure measurements should be performed

- treatment involves stopping the bleeding of a wound & to elevate the patient's legs while in a supine position to counteract the effects of hypovolemia (decrease in the volume of circulating blood in the body)

DISABILITY

- assess the level of consciousness using either the AVPU METHOD where the patient is graded as Alert (A), Voice responsive (V), Pain responsive (P) ,or Unresponsive (U) or with the GLASGOW COMA SCALE or GCS (scoring system used to the describe a patient's level of consciousness after a traumatic brain injury)

DISABILITY

also check the pupillary light reflexes (PLR) or photopupillary reflex which tests the integrity of the eye (sensory & motor functions) and in gauging the brain stem function (high intensity light constricts the pupil & low intensity light dilates the pupils, but the pupils of both eyes must respond identically regardless of which eye is stimulated)

DISABILITY

- limb movements should be evaluated for potential signs of lateralization

- with proper equipment: blood glucose must be measured & intubation may be required

- treat airway, breathing, & circulatory problems then place the patient in the recovery position (lateral recumbent or three-quarters prone position of the body)

* GLASGOW COMA SCALE (GCS)

- summation of scores for eye, verbal, & motor responses

- uses a scoring system where the best response (fully awake) has a total of 15, a comatose patient will get a score ≤ 8, and a totally unresponsive patient has a score of 3 (brain-dead state)

Eye opening response

- characterized as spontaneous = score is 4

- only responds to speech = 3

- only responds to pain = 2

- no response = 1

Best verbal response

- oriented to time, place, & person = 5

- appears confused = 4

- uses inappropriate words = 3

- uses incomprehensible sounds = 2

- no response = 1

Best motor response

- obeys commands = 6

- moves in reaction to localized pain = 5

- flexion withdrawal from pain = 4

- abnormal flexion (decorticate) = 3

- abnormal extension (decerebrate) = 2

- no response = 1

EXPOSURE

- assess the patient for signs of trauma, bleeding, skin reactions (rashes), needle marks, etc.

EXPOSURE

- bearing the dignity of the patient in mind: some clothing should be loosened & removed to allow a thorough physical examination

EXPOSURE

- body temperature may be estimated by feeling the skin or by using a thermometer when available

- treat the suspected cause if present