ABCDE Assessment

If you have a patient who is in critical condition due to a life-threatening illness or injury, perform the ABCDE Assessment to help stabilize them to buy time for doctors to make a diagnosis and start treatment.

By Matt Olivares on Jun 03, 2024.

Fact Checked by Nate Lacson.

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What is the ABCDE Assessment?

The Airway, Breathing, Circulation, Disability, and Exposure Assessment, or for short, is a standard examination in any hospital or clinic with a resuscitation room. The purpose of this assessment is to examine patients who have been rushed into the resuscitation room due to a life-threatening illness or injury. It is a systematic method of identifying and addressing life-threatening problems to stabilize patients and buy doctors enough time to diagnose and treat patients so they can hopefully survive.

The assessment is divided into the following:

  1. Airway - Conductors of the assessment will check if there is anything obstructing the patient’s airways, like foreign bodies and swollen tissues. If there are obstructions, the medical team must clear them because obstructed airways can lead to brain damage, cardiac arrest, and even death.
  2. Breathing - After confirming that the airway is not obstructed, the medical team will check the patient’s breathing by gauging their respiratory rate, if they have any chest deformities and even their oxygen status. Depending on their findings, the medical team will provide assisted ventilation and supplementary oxygen.
  3. Circulation - For this part of the assessment, the medical team will gauge the patient’s heart rate, blood circulation, and blood pressure. They will also check if the patient has hypovolemia and hemorrhages.
  4. Disability - The penultimate part of this assessment will have the medical team gauge the patient for any neurological damage that their illness or injury has done to them by examining their motor responses, pupil reactions, and the level of their consciousness.
  5. Exposure - The final part of this assessment will have the team expose their patient (removing their clothes) while prioritizing their dignity and the maintenance of their body heat. This is so the medical team can check for bruises, rashes, bleeding, etc. The team will also check the patient’s temperature.

All of these will be done with utmost urgency to improve patient outcomes and give them a good chance of surviving.

Printable ABCDE Assessment

Download this ABCDE Assessment to assess patients in critical conditions.

How the ABCDE Assessment works:

Let’s take this one by one:

Airway

The medical team must check if the patient can talk or not. If they can, the team will move on to Breathing. If not, they need to check for signs of airway obstruction. These signs include the following:

  • See-saw respirations
  • Central cyanosis
  • Use of accessory muscles
  • Diminished breath sound

The team must also open the patient’s mouth to inspect if they have anything obstructing the airway. These can be foreign bodies, blood, vomit, etc.

If the patient has an airway obstruction, the conductor must ask for support from their team so that appropriate interventions can be provided. Examples of intervention are:

  • CPR
  • Head-tilt x Chin-lift Maneuver
  • Jaw thrust
  • Oropharyngeal airway
  • Nasopharyngeal airway

After enacting the necessary interventions, the medical team must re-assess the patient's airway before moving on to Breathing.

Breathing

For this part of the assessment, the medical team needs to assess the following:

  • The patient’s respiratory rate (normal rate should be 12 to 20 breaths per minute)
  • Oxygen saturation (normal rate should be 94 to 98%) for healthy patients, and 88 to 92% for patients with COPD

They must also conduct an inspection to check for the following:

  • Bradypnoea
  • Tachypnoea
  • Hypoxemia
  • Cyanosis
  • Stridor
  • Coughs
  • Shortness of breath
  • Kussmaul’s respiration
  • Cheyne-Stokes respiration

These can be assessed by doing the following:

  • Gently assessing the position of the trachea
  • Assessing the patient’s chest expansion when they breathe
  • Percussing the patient’s chest
  • Auscultating the patient’s chest
  • Taking arterial blood gas if the oxygen saturation is not normal
  • X-rays to check for pathologies

If interventions are required, these are some that the medical team can consider doing

  • CPR if the patient falls unconscious
  • Providing supplementary oxygen
  • Providing steroids and using a nebulizer for those with asthma
  • Antibiotics

Like with the first one, the patient must be reassessed after interventions have been implemented before moving to Circulation.

Circulation

For this part of the assessment, the medical team will check the following:

  • The patient’s heart rate (normal is 60-99 beats per minute)
  • The patient’s blood pressure (normal is 90/60mmHg and 140/99mmHg)
  • Calculate the patient’s current fluid balance

They must also conduct an inspection of the following:

  • Tachycardia
  • Bradycardia
  • Hypertension
  • Hypotension
  • Pallor
  • Oedema
  • Heart failure
  • Acute coronary syndrome
  • Jugular venous pressure

They can inspect the aforementioned problems and more by doing the following:

  • Blood tests
  • Intravenous cannulation
  • ECG monitoring
  • Bladder scan
  • Urine pregnancy tests for females
  • Collecting of culture/swabs
  • Catheterization

Possible interventions required depending on problems found are:

  • CPR if patients are unconscious or lose consciousness
  • Fluid resuscitation
  • Pain relief
  • Nitrates
  • Aspirin
  • Clopidogrel
  • Supplementary oxygen
  • Sepsis 6 Pathway
  • Diuretics
  • Replacing intravascular volume
  • Controlling the heart rate and rhythm

After implementing interventions, they must reassess the patient in terms of Circulation before moving to Disability.

Disability

For this part of the assessment, the medical team needs to check the patient for the following:

  • Their level of consciousness
  • The size and symmetry of their pupils
  • The responses of their pupils to light
  • Their drug chart
  • Capillary blood glucose (normal range is 4.0 to 5.8 mmol/l)

They should also check for:

  • Hypoglycemia
  • Diabetic ketoacidosis
  • Intracranial pathology (via CT head)
  • Opioid toxicity

Interventions that can be used for this part of the assessment are:

  • CPR for patients who lose consciousness
  • Naloxone
  • Glucose administration
  • Intravenous fluids
  • Insulin

After interventions have been implemented, they must reassess the patient before moving to Exposure.

Exposure

The medical team will have to undress the patient while prioritizing the patient’s dignity and body heat.

They must check the patient for the following:

  • Rashes
  • Bruises
  • Infections
  • Erythema
  • Discharge
  • Swelling
  • Tenderness
  • Bleeding/hemorrhages 
  • Body temperature (normal is 36C toto 37.9C)

The interventions that can be used for this part of the assessment are:

  • CPR (if the patient loses consciousness)
  • Blood products
  • 2 large-bore intravenous access
  • Antibiotics

Once interventions have been implemented, they must reassess the patient.

___________________________________________________________________

After all the procedures are done, and the patient has been stabilized, here are the next steps:

  • Take a full clinical history, whether from the patient, their relatives, friends, from the staff, or from all of them
  • Review the patient’s notes, charts, recent investigation results, current medications, and prescribed medications
  • Document the ABCDE Assessment
  • Discuss the patient’s current condition with a senior member of the team and prepare for handover (the latter is for procedures beyond your capabilities or for the people attending the next shift)

ABCDE Assessment Example

The ABCDE Assessment is a standard procedure for anyone working in resuscitation rooms, emergency rooms, etc. We’re assuming that you are already aware of what this assessment is and what should be done for each part of the assessment, so we created a printable ABCDE Assessment template where you can record all the procedures and findings your team got for each part of the assessment. It is important to record all of them for medical history purposes and for handover to others handling them in different shifts or for specific tests that need to be conducted.

If you like what you see and you think this will help you properly record all your findings, then feel free to download our ABCDE Assessment PDF! It’s free! You can print it and fill it out with a pen, or you can engage with the editable portions of the PDF!

Download this ABCDE Assessment Example (Sample) here:

ABCDE Assessment Example

When is it best to conduct the ABCDE Assessment?

The ABCDE Assessment is always conducted whenever a patient is on the verge of death due to a life-threatening disease or injury. This assessment is done with utmost urgency and will work to stabilize the patient. It gives them a shot at surviving by giving medical teams enough time to diagnose and treat them.

More often than not, this assessment is conducted whenever a patient is sent to an emergency department or a critical care setting so that medical staff can determine how severe their condition is and prioritize their treatment.

If you downloaded our ABCDE Assessment template, it is best used while conducting the necessary inspections and interventions per part of the assessment. The examiners and the persons conducting interventions don’t need to be the ones writing on the sheet. Since you’re likely (and you’re supposed to be) working with a team, your team can delegate someone else who can document everything.

Documentation is an important part of the ABCDE process because it is necessary for the patient’s medical history. It can also be used to provide all the necessary information that other medical staff needs to know, especially for those conducting certain tests or those taking your duties after the end of your shift.

What are the benefits of the ABCDE Assessment?

It can help healthcare professionals quickly identify life-threatening issues.

Since those using this are likely to be medical staff working in emergency, critical care, and resuscitation departments, the ABCDE Assessment gives the staff a structured procedure for assessing patients that will help them identify and intervene with life-threatening issues their patients are dealing with. By providing immediate intervention, medical teams can prevent the patient’s health and vitals from deteriorating further, as well as stabilize them to the point that the patient has a fighting chance to survive. Stabilizing a patient on the verge of death will also give medical teams a chance to do their part and treat their patient with the best care possible so they can recover.

It will help healthcare professionals be thorough when stabilizing the patient.

One of the great things about the ABCDE Assessment is that it has a set structure that frames how medical teams will stabilize a patient. By following the procedure of Airway → Breathing → Circulation → Disability → Exposure, medical teams can cover all bases possible. By being thorough through this assessment, medical teams have less of a chance of overlooking anything critical that may turn things for the worse. So, not only does this assessment set a standardized procedure, but it can protect the patient from further deterioration and even death if things are done correctly.

The template that we have can help with handing over information.

Just as the assessment provides a structure for inspecting and treating patients, it also provides a structure for how things should be documented. If you download our template, you can jot down all the procedures done, the findings, and what interventions were implemented for each assessment stage. By detailing everything that has taken place, you can ensure that you will be providing all the necessary information needed during handovers. By having all the necessary information, other members of your team can determine what to do and what to look out for.

For example, if you noted that the patient loses consciousness every now and then, your teammates can prepare for that to make sure that they don’t lose consciousness. Or, if they do, they can prepare to do CPR at any moment.

How long does it take to complete an ABCDE Assessment?
How long does it take to complete an ABCDE Assessment?

Commonly asked questions

How long does it take to complete an ABCDE Assessment?

That depends on the condition of the patient. It may take tens of minutes to hours. What you need to keep in mind is that all the procedures are done rapidly in order to stabilize the patient as soon as possible and to maintain them in a stabilized state.

When do medical staff perform the ABCDE Assessment?

Whenever a patient is rushed to an emergency department, critical care, intensive care, or resuscitation room. If they are on the verge of death because of a life-threatening illness or injury, this assessment will be used immediately in order to get more favorable patient outcomes.

What happens if medical staff identifies life-threatening problems while conducting the assessment?

They will address the problem. The procedure will be different depending on what the problem is. For example, the medical staff detects airway obstruction during the Airway stage of the assessment. What they need to do is to clear the obstruction. They must do this and then reassess the patient. If there are no more problems concerning the airway, they can move on to the next stage of the ABCDE Assessment.

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