A-G Assessment

Question 1

Airway

Answer 1

LOOK
For any signs of airway obstruction
For evidence of mouth/neck/swelling/haematoma
For security of artificial airway
Are they coughing up sputum? What colour is it? Do they require suctioning?
Swelling of the tongue

LISTEN
For noisy breathing (e.g. gurgling or snoring)
Is your patient talking clearly

FEEL
For the presence of air movement
For the security of the artificial airway

Question 2

Breathing

Answer 2

LOOK
At the chest wall movement, to see if it’s normal and symmetrical
To see if the patient is using their neck and shoulders muscles to breathe
At the patient to measure their respiratory rate and effort
Look at the rise and fall of chest
Are they using neck muscles
Position of patient
Oxygen therapy

LISTEN
To the patient talking to see if there can complete full sentences
For noisy breathing (e.g. wheezing)

FEEL
For the position of the trachea to see if its central
For surgical emphysema or crepitus
If the patient is diaphoretic (sweaty)

Question 3

Circulation

Answer 3

LOOK
At the skin color for pallor and peripheral cyanosis; Pink, pale, mottled, red, rah noted
At the capillary refill time
At the patient’s central venous pressure and jugular venous pressure

LISTEN
To the patient for complaints of dizziness and headaches
For patients blood pressure and heart sounds

FEEL
Your patient’s hands and feet to see if they are warm or cold
Your patients peripheral pulses for presence, rate, quality, regularity and equality

Question 4

Disability

Answer 4

LOOK
At the level of consciousness
For facial symmetry, abnormal movements, seizure activity or absent limb movements
At pupil size, equality and reaction to light
Record the Glasgow Coma Scale (GCS)- orientation to person, place and time

LISTEN
To patient’s response to external stimuli and pain
For slurred speech
For patients orientation to person, place and time

FEEL
For patients response to external stimuli
For muscle power and strength

Question 5

Exposure

Answer 5

LOOK
For any bleeding, (e.g. investigate wounds and drains that may be hidden by bed clothes)

LISTEN
For air leaks in drains
For bowel sounds

FEEL
The patient’s abdomen

Question 6

Fluids

Answer 6

LOOK
At the observation and fluid charts, noting the fluid input and output
All losses from drains and tubes
At the amount and colour of the patients urine and urinalysis results

LISTEN
For patients complaints of thirst

FEEL
The skin turgor

Question 7

Glucose

Answer 7

LOOK
At the blood glucose levels
For signs of low glucose, including confusion and decreased conscious state
At medication chart for insulin and oral hypoglycaemics

LISTEN
For patients complaints of thirst
For patients orientation to person, place and time

FEEL
If the patient is diaphoretic (sweaty, cold or clammy)

Question 8

A-G ASSESSMENT RECOMMENDATIONS

Answer 8

Give Oxygen
Based on your assessment decide on appropriate oxygen flow or percentage. If in doubt, commence on 4L/min on a Hudson mask and increase as indicated by oxygen saturation or patient condition

Position your patient
Position to optimize their breathing- usually this is as upright position as possible and as tolerated by the patient
Place the patient in the left lateral position if they are unconscious but have adequate breathing and circulation and where there is no evidence of spinal injury

Call for help if you can’t manage
Establish IV if not present +/- fluids

Never leave a deteriorating patient without a priority management and review plan
Document and communicate clearly:
All treatment provided
Outcomes of treatment implemented
What care is still required
The plan should include expected outcomes and when the patient will be reviewed again