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Tuesday, November 10, 2020

Rapid Emergency Assessment of Patient: ABCDE

 ABCDE  Assessment 

This consists of assessment of Airway, Breathing, Circulation, Disability, and Exposure. This assessment strategy is commonly used in a critical care context, and is particularly suited to the rapid or emergency assessment of a patient. 


Indicators of an airway compromise 

  • Airway obstruction 
    • In complete airway obstruction, there is no air entry, with absent breath sounds and paradoxical chest and abdominal movements. 
    • In partial airway obstruction, there is decreased air entry, with abnormal breath sounds and altered or increased respiratory effort. 
  • Look for altered or increased respiratory effort, use of accessory muscle (sternocleidomastoid, trapezius, and internal intercostals).  Paradoxical chest and abdominal movements 'see-saw respiration; drooling (inability of the patient to swallow their own saliva ),  and bleeding from the nose, mouth or tracheotomy. 
  • Listen for hoarseness, stridor, snoring, gurgling, and inability to speak. 
  • Feel for movement of expired air from the mouth or nose, and for sweaty or clammy skin. 

Indicators  of respiratory compromise 
  • Look for altered or increased respiratory effort, use of accessory muscle ( sternocleidomastoid, trapezius, and internal intercostals), nasal flaring, pursed-lip breathing, unilateral chest expansion, chest and/ or spinal deformity, presence and patency of chest drains, chest surgery, trauma, bruising, bleeding, and flail chest.
  • Listen for inability to complete full sentence, audible breath sounds, and abnormal breath sounds via auscultation of the anterior, lateral, and posterior surface of the chest(unilateral, inspiratory and/or expiratory wheeze, crackles, pleural rub, and bronchial, decreased, or absent breath sounds)
  • Feel for tracheal deviation, subcutaneous emphysema, crepitus, thoracic tenderness, and abnormal resonance via percussion. 
  • Record the respiratory rate ( normal range 12-20 breaths/min) and oxygen saturation (normal range 97-100%)

Indicators of circulatory compromise 
  • Look for pallor, cyanosis (peripheral and central), chest deformity, jugular venous distension, cardiac devices (pacemaker or implantable defibrillator ) bruising and haemorrhage. 
  • Listen for reduced level of consciousness due to poor cardiac output ( confusion, drowsiness ) complaints of chest pain, and abnormal heart sound via auscultation (S3, S4, murmurs, pericardial rub).
  • Feel for pulse rhythm and strength, capillary refill time (normal value <3s ), limb temperature, and sweaty, clammy, warm or cool skin.
  • Record heart rate (normal range, 60-100 beats/min) blood pressure, central venous pressure, urine output and core temperature. 

Indicators of neurological compromise 
  • Look the pupil size, equality, and reaction to light, as well as head trauma and cerebrospinal fluid leakage 
  • Listen for reduced level of consciousness due to poor neurological function ( confusion, drowsiness ), and complaints of pain.
  • Record the blood glucose concentration, Alert Verbal Pain Unresponsive and Glasgow coma scale (GCS). 

Indicators of physiological compromise 
  • Look for bleeding, bruising, burns, rashes, swelling, inflammation, infection, and wounds on the body.
  • Listen for complaints of pain, pruritus, heat, and cold.
  • Feel for venous thromboembolism and oedema. 

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