ABCDE Approach to Patient Care

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Now that we’ve looked at the basics of patient care and introduced the ABCD approach, we are now going to look at these in more detail, and also add E to the end, meaning it now becomes the ABCDE approach.

The “A" stands for Airway. Any airway obstruction is an emergency so you must get expert help immediately.

In most cases where airway obstruction occurs, the cause is the tongue falling to the back of the throat, and by checking the patient’s airway, you can see if it is blocked, and do your best to try and keep it clear. One way of checking the airway is to do the Head Tilt – Chin Lift movement, and this also removes the tongue from the back of the throat. However, should you suspect the casualty’s spine to be damaged, you should not do this. Instead you should perform the Jaw Thrust. Once the airway is open, the casualty will then be able to breathe.

The B stands for breathing.

During the primary assessment of breathing, it is vital to diagnose and treat immediately life-threatening conditions like a patient who is not breathing. To check for breathing, you must open the airway, place an ear next to their mouth so you are looking down their body. Then look, listen and feel for any signs of breathing. Be sure not to confuse regular breathing for agonal breathing. Should the casualty not be breathing, you should commence CPR immediately (after contacting the EMS?).

Something called bronchospasms causes a wheeze, which is common in anaphylaxis. All critically ill patients should be given oxygen.

The C stands for Circulation.

Checking for proper blood circulation can be done by capillary refill on an uninjured toe or finger, as well as feeling for a radial pulse. You can also feel for a Carotid pulse in the neck, however this tells us less about the casualty’s blood pressure than feeling for a radial pulse. Femoral pulses are not usually taken in a pre-hospital setting. It is also worth noting that the blood pressure in patients suffering anaphylactic shock will be quite low.

The D stands for Disability.

This doesn’t mean pre-existing conditions, but is more related to anything that hasn’t been covered already that isn’t normal. If the patient is conscious and is able to speak, you can ask them if they have any strange sensations in their body, any pain or anything that feels unusual. This can be very beneficial as you may have missed something in your primary assessment. There may also be things internally that are wrong such as chest pain or nausea; things that you may not be able to see without the casualty telling you.

Finally, the E stands for Exposure. To examine the patient properly, full exposure of the body is necessary. Skin and other changes may be difficult to see. Minimise heat loss where possible and always respect the patient’s dignity. Take a full clinical history from the patient, relatives or friends, and other staff and if you can, review the patient’s notes and charts to get a better picture of the situation you are dealing with.

With the ABCDE approach, it is important to always get help and ensure you stay within your training. Do not attempt any procedure unless you are qualified and allowed to do so.