The ABCDE approach ABCDE: Initial Approach

• Why the ABCDE approach? The most important step is to STAY SAFE.
• Approach every patient in a systematic way
Scene safety: Consider hazards, violence and
• Recognize life-threatening conditions early
infectious disease risk
• Do the most critical interventions first and fix
problems before moving on! Examples of hazards

• The ABCDE approach is very quick in a • Fire

stable patient. • Motor vehicle crash
• Building collapse

Goals: • Chemical spill

• Identify life-threatening conditions rapidly

• Ensure the airway stays open Ask for help early.

• Ensure breathing and circulation are adequate • Multiple patients

to deliver oxygen to the body • Make arrangements for transfer if needed
• The ABCDE approach is designed to quickly • Know who to call for infectious outbreaks or
identify reversible threatening conditions. hazardous exposures
• After finding and managing an ABCDE
problem, you need to go back to the
Consider appropriate PPE for situations
beginning and repeat your ABCDE
assessment again. In this way you can assess • Gloves
the effect of your intervention and identify • Gown
any new problems. • Mask
• A full set of vital signs should be checked at • Goggles
the end of the ABCDE approach, but do not • Hand washing
delay ABCDE interventions.
• The ABCDE approach should be repeated
Cleaning and decontamination
with any change in patient condition, and
• Use PPE and wash your hands before and
ideally every 15 minutes for critical cases.
after every patient contact (or alcohol gel
cleanser).
• Clean/disinfect surfaces
• Refer to local decontamination protocols for
chemical exposures.
ABCDE Approach: Elements REMEMBER!

Airway with cervical spine immobilization: Always check for signs of trauma in each of the
ABCDE sections and reference the trauma module as
• Check for obstruction.
needed.
• If trauma, immobilize cervical spine.

Breathing plus oxygen if needed:

ABCDE ASSESSMENT AND MANAGEMENTS
• Ensure adequate movement of air into the
lungs.

Circulation with bleeding control and IV fluids AIRWAY ASSESSMENT

• Determine if there is adequate perfusion. • Can the patient talk normally?

• Check for life-threatening bleeding. • Look for foreign body, swelling around the
airway
Disability
• Look for altered mental status
• Assess and protect brain and spinal functions. • Listen for abnormal sounds suggesting
• Check AVPU (Alert, Voice, Pain, obstruction • Look and listen for fluid in the
Unresponsive)/GCS, pupils and glucose. airway

Exposure and keep warm • Look to see if the chest wall is moving in or
out
• Identify all injuries and environmental
• Listen and feel for air movement from the
threats.
mouth and nose
• Avoid hypothermia.

This stepwise approach is designed to ensure that AIRWAY MANAGEMENT

life-threatening conditions are identified and treated If the patient is unconscious and not breathing
early, in order of priority. normally:

A problem discovered (A-B-C-D-E) must be • If no concern for trauma

addressed immediately before moving on to the next - Open airway using HEAD-TILT /
step. CHIN-LIFT maneuver.
• If trauma suspected
- Maintain C-SPINE
IMMOBILISATION and use
JAW-THRUST maneuver.
 • If secretions are present • If the patient becomes unconscious while
- SUCTION airway or wipe clean choking
- Consider recovery position if the - Follow CPR PROTOCOLS.
rest of the ABCDE is normal and
no trauma
BREATHING ASSESSMENT
• If the patient has swelling, hives, or stridor
- Consider a severe allergic • Look, listen and feel to see if the patient is

reaction (anaphylaxis) breathing

- Give intramuscular • Assess if the breathing is very fast, very slow

ADRENALINE or very shallow.

(EPINEPHRINE) • Look for increased work of breathing.

• Allow patient to stay in position of comfort. - Accessory muscle work

• Prepare for HANDOVER/TRANSFER to a - Chest indrawing

center capable of advanced airway - Nasal flaring

management. - Abnormal chest wall movement

• Listen for abnormal breath sounds.
- With severe wheezes there may be
Consider placing an airway device to keep the airway
no audible breath sounds because
open
of severe airway narrowing.
• Oropharyngeal airway • Listen to see if breath sounds are equal
• Nasopharyngeal airway • Check for the absence of breath sounds on
one side.
- If dull sound with percussion to
Management or choking
the same side (THINK large
• If foreign body is suspected: pleural effusion or hemothorax.)
- Carefully REMOVE IT - If hyperresonance on percussion
• If the patient is able to cough or make noise on same side (THINK simple
- Keep the patient calm and pneumothorax.)
ENCOURAGE to cough. - If also hypotension, distended
• If the patient is choking (unable to neck veins or tracheal shift.
cough/make sounds) (THINK tension pneumothorax.)
- Use age-appropriate CHEST • Check oxygen saturation.
THRUSTS/ABDOMINAL
THRUSTS or BACK BLOWS.
BREATHING MANAGEMENT CIRCULATION ASSESSMENT

• If unconscious with abnormal breathing Look, listen and feel for signs of poor perfusion.
- Perform bag valve mask
• Cool, moist extremities
ventilation with oxygen and
• Delayed capillary refill
follow cpr protocols.
• Diaphoresis
• If not breathing adequately (too slow or too
• Low blood pressure
shallow)
• Tachypnoea
- Begin bag valve mask ventilation
• Tachycardia
with oxygen
• Absent pulses
• If oxygen is not immediately available, do
• Capillary refill check
not delay ventilation.
• Look for internal and external signs of
• Plan for immediate TRANSFER for airway
bleeding.
management.
- Chest
• If breathing fast or hypoxia
- Abdomen
- Give OXYGEN.
- From stomach or intestines
• If wheezing
- Pelvic fracture
- Give SALBUTAMOL
- Femur Fracture
• If concern for anaphylaxis
- From wounds
- Give intramuscular
• Check for pericardial tamponade
ADRENALINE.
- Hypotension
• If concern for tension pneumothorax
- Distended neck veins
- Perform NEEDLE
- Muffled heart sounds
DECOMPRESSION, give
• Check blood pressure.
OXYGEN, give IV FLUIDS.
- Plan for immediate transfer for
chest tube. CIRCULATION MANAGEMENT

• If concern for pleural effusion or hemothorax • Cardiopulmonary arrest

- Give OXYGEN. - Follow relevant CPR
- Plan for immediate transfer for PROTOCOLS.
chest tube. • If poor perfusion
- Give iv fluids.
• If cause unknown • If external bleeding
- consider trauma oxygen mask - Apply direct pressure
 • If internal bleeding or pericardial tamponade • If pregnant and seizing
- Plan handover / transfer to center - Give magnesium sulphate to stop
with surgical capabilities. seizures
• If unknown cause • If small pupils and slow breathing, consider
- Remember trauma. opioid overdose
• Apply BINDER for pelvic fracture or - Give NALOXONE.
SPLINT for femur fracture with • If unequal pupils, consider increased pressure
compromised blood flow. in the brain
- RAISE HEAD OF BED 30
DEGREES
DISABILITY ASSESSMENT • If no concern for spinal injury.

• Assess level of consciousness. - Plan for early transfer/referral.

- AVPU or GCS in trauma • If unknown cause of altered mental status,

• Check for low blood glucose consider trauma

(hypoglycemia). - IMMOBILIZE the cervical spine.

• Check pupils (size, reactivity to light and if

equal).
EXPOSURE ASSESSMENT
• Check movement and sensation in all four
limbs. • Examine the entire body for hidden injuries,
• Look for abnormal repetitive movements or rashes, bites or other lesions.
shaking. - Rashes, such as hives, can
- Seizures/convulsions indicate an allergic reaction
- Other rashes can indicate
infection
DISABILITY MANAGEMENT

• If altered mental status, no trauma, ABCDEs

EXPOSURE MANAGEMENT
otherwise normal
- Place in RECOVERY • If snake bite is suspected
POSITION. - Immobilize the extremity.
• If altered mental status, low glucose - Take a picture of the snake (if
(<3.5mmol/L) or if unable to check glucose possible and safe) to send to
- Give GLUCOSE. referral hospital.
• If actively seizing
- Give BENZODIAZEPINE.
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
• LOG ROLL for suspected spinal cord injury.