ABCDE

This checklist is indicated during the initial management of a potentially critical patient. The purposes of the checklist are:

• to identify and initially manage problems such as an occluded upper airway, hypoxia, hypoglycemia

• to gather information from the physical examination that allows for the recognition of syndromes such as hemorrhagic chock, raised intracranial pressure, opoid toxidrome

This generic ABCDE consists of assessments coupled to potential measures.

1. Airway & C-spine

• Inspect head & neck: Manual immobilisation of the cervical spine?

• Assess airway sounds // EtCO₂¹: Airway opening maneuvers?² Adrenalin 1 mg Neb?

• Inspect oral cavity // ET tube¹: Lateral decubitus, suction, use of MaGill forceps?

2. Breathing

• Measure SpO2: Oxygen 10 L/min via mask?

• Measure respiratory rate: Ventilate?

• Inspect chest wall: Ventilate (low tidal volume)? Seal (open chest)?

• Auscultate lungs: Salbutamol 5 mg (2.5 mg if < 5 years) Neb?

3. Circulation

• Assess pulse/blood pressure/CRT³: Hemostasis, IV/IO access x 2?

• Measure heart rate: Crystalloid 500 ml bolus (10 ml/kg)?

• Connect 3 lead EKG: Atropine 0.5 mg IV, external pacing?

4. Disability

• Assess level of consciousness⁴: Bensodiazepine if agitated?

• Inspect eyes (opening, gaze, pupils)

• Assess distal sensation & movement

• Measure glucose: Glucose 30% 30 ml (Glucose 10% 2 ml/kg) ⁵

5. Exposure

• Inspect front side of body: Stabilisation measures (pelvis, femur)?

• Inspect back side of body: Log-roll, stabilisation of the spine?

• Measure temperature: Prevent hypothermia? Treat hyperthermia?

Footnotes

1-If the patient is intubated

2-Airway opening maneuvers include the following (from least to most invasive):

• Head-tilt & Chin-lift or Jaw-Thrust

• Oral or nasal pharyngeal tube

• Extra glottic airway device, e.g. laryngeal mask airway

• Endotracheal intubation

• Cricothyrotomy

If Foreign Body Airway Obstruction, other specific measures are indicated (see under Checklists/Procedures)

3-CRT (Capillary Refill Time) is mainly of value in children

4-According to AVPU: Alert, response to Voice, response to Pain, Unresponsive

5-In the absence of IV/IO access, administer Glucagon 1 mg (0.5 mg < 6 years) IM or SC