How the ABCDE Assessment works
The ABCDE Assessment is a straightforward procedure that must be done in order to ensure that the patient is well taken care of during emergencies. To help you out, here's a rundown of what to do during every step of the assessment:
Step 1: Assess airway
The medical team must check if the patient can talk or not, especially if the patient appears unconscious. If they can, the team will move on to Breathing. If not, they need to check for signs of airway obstruction, such as:
- See-saw respirations
- Central cyanosis
- Use of accessory muscles
- Diminished breath sound
The team must also open the patient's mouth to inspect for foreign bodies, blood, vomit, etc., that may obstruct the airway and cause brain damage, cardiac arrest, 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, and nasopharyngeal airway.
After enacting the necessary interventions, the medical team must reassess the patient's airway before Breathing.
Step 2: Check 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 chronic obstructive pulmonary disease (COPD).
They must also inspect to check for bradypnoea, tachypnoea, hypoxemia, cyanosis, stridor, coughs, shortness of breath, Kussmaul's respiration, and Cheyne-Stokes's 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, the medical team can consider CPR if the patient falls unconscious, Providing supplementary oxygen, 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.
Step 3: Check 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 to check if they have tachycardia, bradycardia, hypertension, hypotension, pallor, edema, heart failure, acute coronary syndrome, or 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's response in terms of Circulation before moving to Disability.
Step 4: Assess 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
- Review the patient's drug chart to identify medications that might lead to neurological issues
- 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 implementing interventions, they must reassess the patient before moving to Exposure.
Step 5: Check for 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 to 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.
Step 6: Review, document, and proceed to next steps
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 relevant parties
- Review the patient's notes, charts, recent investigation results, current medications, and prescribed medications
- Document the ABCDE Assessment on the ABCDE assessment template
- Discuss the patient's current condition with a senior member of the team and prepare for handover. if needed
