Emergency Medicine Is a Dynamic Specialty
Emergency medicine is a dynamic specialty which mainly focuses on the rapid assessment and intervention of life-threatening conditions. It is well known that emergency patients are undifferentiated and mostly they come for unscheduled care. This is usually a new environment for a medical student in clinical years. Facing many undifferentiated patients and understanding the situation requires an initial standardized approach. There is an “ABCDE” approach which is universally accepted and applicable in all clinical emergencies for immediate assessment and intervention (1).
The Summary of ABCDE Approach for Medical Students
ABCDE assessment, which is also called primary survey is all about looking for immediately life-threatening conditions while at the same time doing lifesaving interventions. Rapid intervention usually includes O2 Support, IV access, the fluid challenge with or without specific treatment. The approach should take no longer than 5 min. It can be repeated as many times as necessary, depending on patient condition. During the ABCDE phase, you may recognize that the situation needs much more experience than critical but straightforward life-saving maneuvers. So, get experienced help as soon as you need it. Because resuscitation efforts need a team approach, If you have one, delegating jobs can help to move steps faster and smoother.
A - Airway
Acute Problems
- Decreased GCS
- Excessive secretions
- Foreign body
- Inflammation
- Infection
- Trauma, and so on.
Assessment
- Unresponsive patient
- Added sounds
- Snoring, wheeze, stridor
- Accessory muscles use
- Irregular respiratory pattern
Interventions
- Head tilt chin lift
- Jaw thrust
- Suction
- Oral airway application
- Nasal airway application
- Advanced airway interventions (endotracheal intubation, surgical airway, etc.)
B - Breathing
Acute Problems
- Decreased GCS
- Respiratory depressions
- Muscle weakness
- Exhaustion
- Asthma/COPD
- Sepsis
- Cardiac event
- Pulmonary edema
- Pulmonary embolus
- ARDS
- Pneumothorax
- Haemothorax
- Flail chest
Assessment
Look
- Respiratory rate (Apnea/Bradypnea/Tachypnea), symmetry, effort, SpO2, color
Listen
- Talking: sentences, phrases, words
- Air entry, wheeze, silent chest other added sounds
Feel
- Central trachea, percussion, expansion
Interventions
- Consider ventilation with BVM (Bag-Valve-Mask Ventilation)
- Consider ventilation with BVM
- Position upright if struggling to breath (be careful in trauma patient)
- Specific treatment like β agonist for wheeze, chest drain for pneumothorax
C - Circulation
Acute Problems
- Loss of volume/Hypovolaemia
- Pump failure (Myocardial & non-myocardial causes)
- Vasodilatation (Sepsis, anaphylaxis, neurogenic)
Assessment
- Look at color
- Examine peripheries
- Pulse, BP & CRT
- Hypotension (late sign)
- Decreased urine output
Interventions
- Position supine with legs raised (shock position)
- Left lateral tilt in pregnancy
- IV access – 16G or larger x2 (+/- bloods if new cannula
- Fluid challenge
- ECG Monitoring
- Specific treatment
D - Disability
Acute Problems
- Inadequate perfusion of the brain
- Sedative side effects of drugs
- Toxins and poisons
- Cerebrovascular accident (CVA)
- Increased ICP
Assessment
- AVPU (Alert, responds to Voice, responds to Pain, Unresponsive) or GCS
- Pupil size/response
- Posture
- Pain relief
Interventions
- Optimize airway, breathing & circulation
- Treat underlying cause (i.e., naloxone for opiate toxicity)
- Control seizures
- Seek expert help for CVA or high ICP
E - Exposure
- Remove clothes and examine head to toe, including patients front and back.
- Look for hemorrhage, rashes, swelling, sores, syringe drivers, catheter, etc.
- Keep the patient warm.
- Maintain dignity
Reference
- Thim T, Krarup NH, Grove EL, Rohde CV, Løfgren B. Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. Int J Gen Med. 2012;5:117–121. doi:10.2147/IJGM.S28478
