ABCDE Protocol

Question 1

What does ABCDE stand for?

Answer 1

Airway
Breathing
Circulation
Disability
Exposure

Question 2

What is looked for in airways?

Answer 2

Signs of airway obstruction
Abdominal movements during respiration - usage of accessory muscles
Paradoxical chest

Question 3

What can be done to manage airways?

Answer 3

Head tilt and chin lift
Clear the airway ASAP
Keep airway open - using oropharyngeal or nasopharyngeal airway
Intubate (last resort)
Provide high concentration O2 - max given 15L/min
- Aim to maintain 94-98%

Question 4

When should lower O2 be aimed for?

Answer 4

In patients with type 2 respiratory failure, respiratory acidosis, COPD, hypercapnia

Question 5

What is initially assessed in breathing?

Answer 5

Any signs of respiratory distress
Count respiratory rate
Assess depth of breath, rhythm of respiration, chest expansion bilaterally
Presence of chest deformity or raised JVP

Question 6

What are further investigations for breathing?

Answer 6

SpO2
Palpate the chest wall - tracheal position
Percuss chest wall
Auscultate the chest

Question 7

What is the assumed cause of shock?

Answer 7

Hypovolaemia - until proven otherwise

Question 8

What is assessed in circulation in the periphery?

Answer 8

Hand and digit colour
Limb temperature
Capillary refill time
Heart rate
Blood pressure

Question 9

What pulses are looked for and what is assessed?

Answer 9

Peripheral and central pulses

Look for: presence, rate, quality, regularity and equality

Question 10

When auscultating the heart, what should you pay attention to?

Answer 10

Murmurs
Pericardial rub
Heart sounds

Question 11

What is treatment directed towards in cardiovascular collapse?

Answer 11

Fluid replacement
Haemorrhage control (can be external or internal)
Restoration of tissue perfusion (inotropes or vasopressors)

Question 12

How should fluids be given?

Answer 12

Use one or more large 14/16G cannulae
Give a bolus of 500ml of warmed crystalloid solution (e.g. Hartmann’s solution, 0.9% NaCl) over 15 mins if patient is hypotensive
- If patient does not improve, repeat the fluid challenge

Question 13

If patient has primary chest pain and suspected ACS, what should you do?

Answer 13

12-lead ECG
Aspirin 300mg PO
GTN sublingual spray
O2 if SpO2 <94%
Morphine IV

Question 14

What are common causes of unconsciousness?

Answer 14

Profound hypoxia
Hypotension
Hypercapnia
Cerebral hypo-perfusion 
Recent admission of sedatives or analgesics

Question 15

When looking at the eyes, what to assess?

Answer 15

Pupil size
Equality
Reaction to light

Question 16

How is consciousness initially assessed?

Answer 16

AVPU (alert, verbal, pain, unresponsive)

GCS (Glasgow Coma Scale)

Question 17

What does E (exposure) involve?

Answer 17

Examine the patient properly
Full exposure of the body may be needed
Environment temperature - minimise heat loss