ABCDE Assessment for Critical Care

ABCDE Assessment

• The approach to critically ill patients is consistent
• Use the ABCDE approach for assessment and treatment
• Perform a thorough initial assessment
• Regularly reassess patients
• Prioritize life-threatening issues before moving to other aspects of the assessment
• Evaluate the effectiveness of treatments

Airway

• Airway obstruction is an emergency
• Untreated airway obstruction leads to hypoxia and potential damage to the brain, kidneys, and heart, ultimately risking cardiac arrest and death.
• Obstruction causes paradoxical chest and abdominal movements, and may lead to using accessory respiratory muscles
• Partial obstruction causes reduced air intake and noisy breathing sounds
• Complete obstruction results in a silent chest

Late Sign

• Central cyanosis is a late indicator of a problem

Additional Information

• Obtain expert help if needed
• Simple airway clearance methods may be required (e.g., head tilt, chin lift, jaw thrust)
• More advanced methods (e.g., oropharyngeal or nasopharyngeal airway insertion, laryngeal mask or tracheal intubation) may be necessary
• Provide high-concentration oxygen using a mask with an oxygen reservoir

Breathing

• Assess respiratory rate and chest expansion
• Check for chest deformities (e.g., flail chest)

Palpation

• Feel the chest wall for crepitus or surgical emphysema
• Note any tenderness

Percussion

• Hyperresonance may indicate pneumothorax
• Dullness may indicate pleural effusion

Auscultation

• Listen to the lungs for any abnormal sounds

O2 Saturation

• Track inspired oxygen concentration using pulse oximetry
• Pulse oximetry does not detect hypoxemia

Arterial Blood Gas (ABG)

• Obtain arterial blood gas samples as soon as possible

Circulation

• Assess the color of hands and digits
• Evaluate the state of the veins (collapsed or congested)
• Measure capillary refill time (normally less than 2 seconds)
• Prolonged capillary refill time indicates poor peripheral perfusion
• Assess limb temperature
• Palpate central and peripheral pulses
• Measure blood pressure bilaterally
• Low diastolic blood pressure suggests peripheral vasodilation
• Narrow pulse pressure signifies peripheral vasoconstriction
• Auscultate the heart for any abnormal sounds and murmurs
• Consider inserting two or more wide-bore intravenous cannulae

Blood Tests

• Take blood samples for cross-matching, biochemical analysis, hematological evaluation, and coagulation studies

Fluid Challenge

• Give a rapid fluid challenge, 500 cc over 5-10 minutes

• If the patient is hypotensive, give 1000 cc over 5-10 minutes

• Be cautious with smaller volumes if the patient has heart failure and auscultate the chest for crackles after each fluid bolus

• Regularly reassess patients

Chest Pain

• If a patient has primary chest pain and suspected acute coronary syndrome, obtain a 12-lead ECG early and treat initially with morphine, oxygen, nitroglycerin, and aspirin.

Disability

• Assess the patient's conscious level using the AVPU method
• Use the Glasgow Coma Scale (GCS) for detailed assessment of level of consciousness, in adults and children
• Look for pupils for size, equality, reaction to light, and other neurological deficits

Secondary Survey

• Gather detailed information about the patient's current complaints, medical history, chronic diseases, previous hospitalizations, medications and allergies, and family medical history.
• Conduct a structured examination of organ systems (respiratory, cardiovascular, abdomen and genitourinary tract, central nervous system, and musculoskeletal).
• Other investigations such as laboratory and radiological examinations may be needed
• Reassess the patient frequently

Exposure

• Fully expose the patient for proper examination but respect patient dignity and minimize heat loss

Additional Considerations

• Always reassess patients
• Consider other causes of decreased level of consciousness (e.g., medications, electrolyte or metabolic disturbances).
• Order blood glucose, electrolytes, renal function, liver function tests, and arterial blood gases.
• Ensure safe transfer to the intensive care unit (ICU) when appropriate

This quiz focuses on the ABCDE approach in assessing and treating critically ill patients. It covers essential aspects of the airway, including recognizing signs of obstruction and understanding the importance of timely interventions. Test your knowledge on evaluation techniques and the prioritization of life-threatening issues.