In my previous post I wrote about safe administration of drugs. Today, I’ll write about the ABCDE clinical assessment that is used in emergency situations.
Before you rush to help the patient always check if it’s safe and there is no danger for your own safety, such as vehicles if on the road, slippery floor, etc. Here we go:
Airway – is the airway open? are there any obstructions/vomit/blood? proceed with the ‘head-tilt, chin-lift’ if no risk of neck trauma or ‘jaw trust’ if neck trauma is suspected, in order to see if the patient is breathing. CALL FOR HELP; within 10 seconds you have to assesses if there is breathing or not, and if not proceed with CPR algorithm, however, if there is breathing proceed with the ABCDE assessment.
Breathing – look if the chest is raising, listen (for breathing sounds, wheezing, stridor etc.) and feel (place your hands on the chest if necessary to feel if the chest if raising evenly on both sides, is the breathing abnormal, for example, shallow or rapid, is the patient using accessory muscles?) Count the respirations for 1 minute, check the oxygen saturation in the blood (SO2) and administer oxygen if necessary
Circulation – check the pulse for 1 min and feel if it’s regular and strong or abnormal, use ECG machine if available to check the sinus rhythm, check the capillary refill (apply pressure on one of the finger nails for 5 sec and see if there is refill within 2 sec), check the colour & temperature of the skin (pale, rashes, does it feel hot/cold etc.), check the body temperature with a thermometer, check the blood pressure, check the urine output if possible and look for signs of haemorrhage.
Disability – check the AVPU score (alert/voice/pain/unconscious), , check the blood sugar levels, check the pupils with a light torch and if they react to light, are they even, do a head to toe assessment, try to gather some past medical history regarding medications, allergies, chronic conditions, (eg. asthma, diabetes, heart problems, etc.), pain they might be feeling
Environment/Exposure – protect the patient’s dignity and avoid exposing them, prevent body heat loss by placing a blanket on the patient, put them in the recovery position if the patient is unconscious but is breathing, continue checking the vital signs until help arrives. Ask the patient if you’d like to contact their family or friend.