A-E Assesment

Question 1

Pre A-E

Answer 1

Check area is safe
Equipment- oxygen, bag valve mask, suction, airways e.g igels
Hand hygiene, get gloves

Handover
Hello my name is
Get consent

Question 2

A

Answer 2

AIRWAY
Look, listen, feel

Question 3

B

Answer 3

BREATHING
Count breaths for 1min (12-20) should see equal rise and fall, no use of accessory muscles, no noise
Check oxygen saturation (>96% for normal, 88-92 in COPD patients)
Discolouration e.g cyanosis, blue or grey around the mouth

Question 4

C

Answer 4

CIRCULATION
Count pulse for 1min (50-90) feel for strength, pace, rhythms/patterns
Check blood pressure (systolic should be 110-220)
Cap refill- either centrally or peripherally, should come back within 2 seconds
Temperature (36.1-38)
Urine output (0.5ml/kg/hour) if worried do ECG

Question 5

D

Answer 5

DISABILITY
AVCPU
Pupil reaction
Blood glucose (either 4-6 or 5-7)
Ask if they are comfortable
Ask if they are feeling sick or nauseous

Question 6

E

Answer 6

EXPOSURE
Ask for consent
Gradually expose patient whilst keeping them as covered as possible. Try to do top to bottom, front then back
Look for redness, swelling, hotness especially in calves for DVT
Look at wound site

Question 7

Post A-E

Answer 7

Handover using SBAR