ALS The Deteriorating patient (ABCDE approach) guidance - APR 21 V1

Learning Outcomes

  • Apply the ABCDE approach for assessing and treating deteriorating patients.

  • Identify and treat life-threatening problems as they arise.

  • Recognise when to call for help or escalate care to specialists.

  • Use a structured approach for patient handover.

Assessment Scenarios

  • Scenarios are designed for consistency in teaching and may be presented in any order.

  • Candidates should be asked for diagnoses before proceeding through the ABCDE assessment steps.

  • Discussion on further actions/treatments after each scenario is essential.

  • Prior experience with the ABCDE approach is assumed among candidates.

Teaching Delivery

  • Scenarios can be presented as:

    • Case-based discussions using visual aids.

    • Simulation-based workshops (+/- manikin).

  • Use an in-depth discussion for the first scenario; subsequent scenarios can be concise.

  • Background information should be provided using SBARD (Situation, Background, Assessment, Recommendation, Decisions) or RSVP (Reasons, Story, Vital signs, Plan) format before assessments.

  • Use the same format for handover after scenarios.

Instructor Requirements

  • At least one Resuscitation Council UK ALS Instructor must supervise the workshop.

  • Utilize structured handovers with the SBARD framework for all scenarios.

ABCDE Assessment Steps

1. Airway

  • Assess and ensure airway patency.

2. Breathing

  • Check respiratory rate, effort, and sounds (e.g., SpO2).

3. Circulation

  • Assess pulse, blood pressure, capillary refill, and urine output.

4. Disability

  • Evaluate consciousness level and pupils; measure blood glucose.

5. Exposure

  • Examine the patient for bleeding, rashes, and check temperature.

Case Examples

Case 1: Breathing Problem - Respiratory Failure

  • Patient History: 75-year-old Bernard, a lifelong smoker with COPD exacerbation.

  • Symptoms: Unresponsive, cyanosis, NIV mask on the floor.

  • Immediate Actions:

    • Airway support attempts (oral/nasopharyngeal airway).

    • High-flow oxygen administered.

    • Assisted ventilation and expert help called.

    • Assessment shows SpO2 improved to 89%.

Case 2: Airway and Circulation Problems - Septic Shock

  • Patient History: Mary with high NEWS score and abnormal vitals.

  • Decision: Urgent assessment and IV cannulation preparation.

  • Immediate Actions:

    • Airway management with NP airway and high-flow oxygen.

    • IV fluids for resuscitation; monitor blood cultures.

    • Recognition of sepsis with focus on treatment.

Case 3: Circulation Problem - ACS

  • Patient History: 55-year-old Jasvinder with central chest pain.

  • Immediate Actions:

    • Cardiac monitoring and oxygen therapy initiated.

    • Administered aspirin, sublingual nitrate, and IV morphine.

    • ECG shows ST-segment elevation; urgent cardiology review required.

Summary

  • Utilize a structured approach when giving handovers.

  • Effectively apply ABCDE in simulations.

  • Timely identification and treatment of life-threatening issues are critical.