ABCDE algorithm Flashcards
ABCDE: Initial Approach
ABCDE: Initial Approach
The most important step is to stay safe!
- Scene safety
- Fire
- Motor vehicle crash
- Building collapse
- Chemical spill
- Violence
- Infections disease
Personal Protective equipment
- Gloves
- Gown
- Mask
- Goggles
- Hand washing
Safety Considerations
Scene safety
- Scene hazards
- Violence
- Infectious disease risk
Use personal protective equipment
- Consider appropriate PPE for situation
- Gloves, eye protection, gown and mask
Cleaning and decontamination
- Use PPE and wash your hands before and after every patient contact (or alcohol gel cleanser)
- Clean/disinfect surfaces
- Refer to local decontamination protocols for chemical exposures
Ask for help early
- Multiple patients
- Make arrangements if transfer is needed
- Know who to call for infectious outbreaks or hazardous exposures
ABCDE Approach: Elements [SUMMARY]
Airway with cervical spine immobilization:
- Check for obstruction
- If trauma-immobilize cervical spine
Breathing plus oxygen if needed:
- Ensure adequate movement of air into the lungs
Circulation with bleeding control and IV fluids
- Determine if there is adequate perfusion
- Check for life-threatening bleeding
Disability: AVPU/GCS, pupils and glucose
- Assess and protect brain and spinal functions
Exposure and keep warm
- Identify all injuries and environmental threats
- Avoid hypothermia
Airway Assessment
Airway Management
If the patient is unconscious and not breathing normally
If foreign body is suspected
If secretions are present
If the patient has swelling, hives, or stridor, consider a severe allergic reaction (anaphylaxis)
If the patient is unconscious and not breathing normally:
- If no concern for trauma: open airway using HEADTILT/CHIN-LIFT manoeuvre
- If trauma suspected: maintain c-spine immobilization and use JAW-THRUST manoeuvre
Consider placing an AIRWAY DEVICE to keep the airway open
- Oropharyngeal airway
- Nasopharyngeal airway
If foreign body is suspected:
- Visible foreign body: carefully REMOVE IT
- If the patient is able to cough or make noise, keep the patient calm
- ENCOURAGE to cough
- If the patient is choking (unable to cough/make sounds) use age-appropriate CHEST THRUSTS/ABDOMINAL THRUSTS/ BACK BLOWS
- If the patient becomes unconscious while choking: follow CPR PROTOCOLS
If secretions are present:
- SUCTION airway or wipe clean
- Consider RECOVERY POSITION if the rest of the ABCDE is normal and no trauma
If the patient has swelling, hives, or stridor, consider a severe allergic reaction (anaphylaxis)
- Give intramuscular ADRENALINE
Allow patient to stay in position of comfort
Prepare for HANDOVER/TRANSFER to a center capable of advanced airway management
Breathing Assessment
Look, listen and feel to see if the patient is breathing
Assess if the breathing is very fast, very slow or very shallow
Look for increased work of breathing
- Accessory muscle work
- Chest indrawing
- Nasal flaring
- Abnormal chest wall movement
Listen for abnormal breath sounds
REMEMBER with severe wheezes there may be no audible breath
sounds because of severe airway narrowing
Listen to see if breath sounds are equal
Check for the absence of breath sounds on one side
- If dull sound with percussion to the same side
- THINK large pleural effusion or haemothroax
- If also hypotension, distended neck veins or tracheal shift
- THINK tension pneumothorax
Check oxygen saturation
Breathing Management
If unconscious with abnormal breathing
If not breathing adequately (too slow or too shallow)
If breathing fast or hypoxia
If wheezing
If concern for anaphylaxis
If concern for tension pneumothorax
If concern for pleural effusion, haemothorax
If cause unknown
- If unconscious with abnormal breathing, perform BAG-VALVE-MASK-VENTILATION with OXYGEN and follow CPR PROTOCOLS
- If not breathing adequately (too slow or too shallow) begin BAG-VALVE-MASK-VENTILATION with OXYGEN
- If oxygen is not immediately available, do not delay ventilation
- Plan for immediate TRANSFER for airway management
- If breathing fast or hypoxia, give OXYGEN
- If wheezing, give SALBUTAMOL
- If concern for anaphylaxis, give intramuscular ADRENALINE
- If concern for tension pneumothorax, perform NEEDLE DECOMPRESSION, give OXYGEN, give IV FLUIDS
- Plan for immediate transfer for chest tube
- If concern for pleural effusion, haemothorax, give OXYGEN
- Plan for immediate transfer for chest tube
- If cause unknown, consider trauma
Circulation Assessment
Look, listen and feel for signs of poor perfusion
- Cool, moist extremities
- Delayed capillary refill
- Diaphoresis
- Low blood pressure
- Tachypnoea
- Tachycardia
- Absent pulses
Look for internal and external signs of bleeding
- Chest
- Abdomen
- From stomach or intestines
- Pelvic fracture
- Femur Fracture
- From wounds
Check for pericardial tamponade
- Hypotension
- Distended neck veins
- Muffled heart sounds
Check blood pressure
Circulation Management
Cardiopulmonary arrest
Poor perfusion
External bleeding
Internal bleeding
Unknown cause
For cardiopulmonary arrest follow relevant CPR PROTOCOLS
If poor perfusion: GIVE IV FLUIDS
- If external bleeding: APPLY DIRECT PRESSURE
- If internal bleeding or pericardial tamponade, REFER to centre with surgical capabilities
If unknown cause, remember trauma
- Apply BINDER for pelvic fracture or SPLINT for femur fracture with compromised blood flow
Disability Assessment
Assess level of consciousness
- AVPU or GCS in trauma
Check for low blood glucose (hypoglycaemia)
Check pupils (size, reactivity to light and if equal)
Check movement and sensation in all four limbs
Look for abnormal repetitive movements or shaking
- Seizures/convulsions
Disability Management
If altered mental status, no trauma, ABCDEs otherwise normal
If altered mental status, low glucose (<3.5mmol/L) or if unable to check glucose
If actively seizing
If pregnant and seizing
If small pupils and slow breathing, consider opioid overdose
If unequal pupils, consider increased pressure in the brain
If unknown cause of altered mental status, consider trauma
If altered mental status, no trauma, ABCDEs otherwise normal
- place in RECOVERY POSITION
If altered mental status, low glucose (<3.5mmol/L) or if unable to check glucose
- Give GLUCOSE
If actively seizing
- Give BENZODIAZEPINE
If pregnant and seizing
- Give MAGNESIUM SULPHATE
If small pupils and slow breathing, consider opioid overdose
- Give NALOXONE
If unequal pupils, consider increased pressure in the brain
- RAISE HEAD OF BED 30 DEGREES if no concern for spinal injury
- Plan for early TRANSFER/REFERRAL
If unknown cause of altered mental status, consider trauma
- IMMOBILIZE the cervical spine
Exposure Assessment
Examine the entire body for hidden injuries, rashes, bites or other lesions
- Rashes, such as hives, can indicate an allergic reaction
- Other rashes can indicate infection
Exposure Management
If snake bite is suspected
General exposure considerations
If cause unknown
If snake bite is suspected
- IMMOBILIZE the extremity
- Take a picture of the snake (if possible) to send to referral hospital
General exposure considerations
- REMOVE constricting clothing and jewelry
- COVER the patient to prevent hypothermia
- Acutely ill patients may be unable to regulate body temperature
- PREVENT hypothermia
- Remove wet clothing and dry patient thoroughly
- Respect the patient’s modesty
If cause unknown, remember trauma
- LOG ROLL for suspected spinal cord injury
