The ABCDE Approach
The ABCDE approach stands for Airway, Breathing, Circulation, Disability and Exposure. It is an approach to assess and treat deteriorating or critically ill patients before help arrivals. For a deterioration patient, the initial assessment would be completed and regularly re-assessing. This would ensure that life-threatening problems are treated first, and its effect assessed. If not effective call for appropriate help early and ask members of the teams to help with assessment attaching monitors and intravenous access. Communicate effectively by using the SBAR (situation, background, assessment, and recommendation) or RSVP (reason, story, vital signs, and plan) approach.
The first steps to follow in this approach are personal safety and the use of personal protective equipment such as gloves and aprons. Generally, look at the patient to check whether they appear unwell. If the patient is awake ask, How are you if responds normally then the airway is patent, is breathing and has brain perfusion. Call for help or ask someone to do so. If the patient is unconscious, unresponsive, and not breathing normally start CPR (cardiopulmonary resuscitation) if trained to do so. Vital signs should be monitored and blood (when inserting intravenous cannula) for investigation.
Airway obstruction is an emergency and requires immediate expert help because if left untreated can cause hypoxia, damage to the brain, kidneys, heart, cardiac arrest, and death. Therefore, look for the signs of airway obstruction such as the use of accessory muscles for respiration, late central cyanosis, abdominal movement, and paradoxical chest. Airway obstruction can be cleared by airway opening manoeuvres, suction, and insertion of an oropharyngeal or nasopharyngeal airway if failed tracheal intubation may be required. Oxygen should be given with a mask at a high concentration usually 15L min-1 to prevent collapse of the reservoir during inspiration. In an acute failure oxygen saturation of 94-98% should be maintained and with the patient at risk of hypercapnic respiration failure oxygen saturation 88-92%.
During the initial assessment of breathing, life-threatening conditions such as acute severe asthma, pulmonary oedema, tension pneumothorax and massive haemothorax should be treated first. First, look, listen and feel (for 30 s) for general signs of respiratory distress such as sweating. The normal respiratory rate is 12-20 breaths per minute and anything high (25 min-1) is a sign of illness and that the patient is deteriorating.
Hypovolaemia is the primary cause of shock in medical and surgical emergencies and requires immediate intravenous fluid to a patient when present with cool peripheries and a fast heart rate. Breathing problems can compromise the patient’s circulation state, therefore check the colour (blue, pink, pale or mottled) of the patient hands, and digits. Also, check the limb temperature for cool or warm and measure the capillary refill time (CRT). Assess the state of the veins, count the pulse rate, palpate peripheral and central pulses, measure blood pressure auscultate the heart and call for expert help.
Profound hypoxia, hypercapnia or cerebral hypoperfusion are common causes of unconsciousness. ABCs should be reviewed and treated for hypoxia and hypotension. Drug chart check for causes of depressed consciousness and antagonist given if required. The patient’s pupils are to be examined and take initial assessment of their conscious level using the AVPU (alert, voice, pain and unresponsive). Measure the blood glucose to exclude hypoglycaemia and follow local protocol for the management of hypoglycaemia. Lateral position unconscious patient if their airway is not protected.
To fully examine a patient, full exposure of their body may be necessary, therefore respect their dignity and reduce heart loss. Ensure to have taken a full clinical history from the patient, if possible, their relative or friend and staff, and review patient notes and chart for any change in medication or vital signs. Also, check the results from the laboratory and consider which level of support to give. All the findings should be recorded in the patient’s note and handed over to the next staff.
The ABCDE approach is relevant to the topic I am studying because it helps to identify deteriorating or critically ill patients. It has been broken down into sub-headings such as airway, breathing, circulation, disability, and exposure to help me understand the critical signs and symptoms to check and look out for. The main concepts being discussed are the steps to take to preserve life and prevent health conditions from worsening and early diagnosis. The ABCDE approach has helped me understand the action to take when there are obvious signs that a patient is deteriorating. A lot of terminology has been used such as antagonist, pneumothorax, massive haemothorax and tachyarrhythmia. They sound familiar such as haemothorax, (haem- (blood loss) thorax) blood entering the pleural cavity.
Reference
Resuscitation Council UK (2021) The ABCDE approach. [online] Resuscitation Council UK. Available at: https://www.resus.org.uk/library/abcde-approach.