ABCDE assessment

Question 1

What does ABCDE stand for?

Answer 1

A = airways
B = breathing
C = circulation
D = disability
E = exposure

Question 2

What should you do to check airways?

Answer 2

• Check if they can talk

- Head tilt chin lift manoeuvre (check for blockages)

Question 3

What should you do if a patient is breathing but is unconscious?

Answer 3

Insert oropharyngeal airway

Question 4

What should you do if a patient is breathing and is partly or fully conscious?

Answer 4

Insert nasopharyngeal airway

Question 5

What should you do to check breathing?

Answer 5

• Respiratory rate
• Oxygen saturation
• Auscultate chest
• Percuss chest
• Look for:
  Sweating
  Cyanosis
  Use of accessory muscles
  Abdominal breathing

Question 6

What should you do if oxygen saturation is low?

Answer 6

ABG

Question 7

What should you do if you suspect pneumonia?

Answer 7

ABG and CXR

Question 8

What are the interventions conscious but is short of breath?

Answer 8

Sit them upright

Question 9

What should you offer to critically unwell patients who have a low O2 sat?

Answer 9

Administer oxygen through a 15L non-rebreathe mask

Question 10

What should you do to check circulation?

Answer 10

• Heart rate
• Blood pressure and pulse
• Capillary refill time
• Temperature
• Colour of digits/hands
• Check for collapsed veins
• Chest auscultation
• Check fo oedema
• JVP

Question 11

What investigations and procedures should you do for circulation?

Answer 11

• Insert an IV cannula
• Bloods
  FBC
  U&Es
  LFTs
• ECG
• Bladder scan

Question 12

What would you give to a hypovolaemic patient?

Answer 12

• 500ml bolus of Hartmann’s solution or 0.9% sodium chloride over 15 mins
• 250ml boluses if risk of fluid overload -> HF

Question 13

What would you give to a patient suspected with sepsis?

Answer 13

Sepsis 6 pathway:

1. Oxygen
2. Blood cultures
3. IV antibiotics
4. IV fluids
5. Serial lactases
6. Ongoing monitoring of urine output

Question 14

What would you give to a patient with a haemorrhage?

Answer 14

Replacement of intravascular volume with fluid and blood products

Question 15

What would you give to a patient with fluid overload?

Answer 15

• Diuretics

- Strict fluid balance monitoring

Question 16

How would you assess disability?

Answer 16

AVPU scale:
1. A = alert
The patient is fully alert, but no necessarily orientated
2. V = verbal
The patient makes some kind of response when you talk to them
3. P = pain
The patient responds to a painful stimulus
4. U = unresponsive
The patient doesn’t show evidence of any eye, voice or motor responses to pain

If a more detailed assessment is needed, use the Glasgow Coma Scale

Look at their pupils

• Size
• Pupillary responses

Question 17

What could cause an acute deterioration in a patient’s level of consciousness?

Answer 17

• Hypovolaemia
• Hypoxia
• Hypercapnia
• Metabolic disturbance (hypoglycaemia)
• Seizure
• Raised intracranial pressure or other neurological insults (stroke)
• Drug overdose
• Iatrogenic causes (administration of opiates)

Question 18

What investigations and procedures should you do for disability?

Answer 18

• Blood glucose
• Ketone levels (if blood glucose is elevated)
• CT head

Question 19

What do you give for opioid toxicity?

Answer 19

Naloxone (Blocks opiate receptors)

- Or something similar

Question 20

What do you give for hypoglycaemia?

Answer 20

• Glucose (oral or IV)

Question 21

What do you give for diabetic ketoacidosis (DKA)

Answer 21

• IV fluids

- Insulin

Question 22

How would you assess exposure?

Answer 22

1. Inspection:
      Rashes
      Bruising
      Signs of infection
      IV lines 
      Calves - erythema, swelling, tenderness
      Surgical wounds - haematoma, active bleeding, infection 
      Catheters
2. Bleeding
3. Temperature

Question 23

What investigations and procedures should you do for exposure?

Answer 23

Cultures/swabs