2. ABCDE approach

Question 1

What does ABCDE stand for

Answer 1

Airway 
Breathing 
Circulation
Disability 
Exposure

Question 2

Before you start the ABCDE what kind of things are you thinking

Answer 2

What are your initial impressions of the patient
Can you take a quick focuses history
Ask for a set of vital signs and monitoring if available

Question 3

Airway

When assessing the airway what kind of things are you asking yourself

Answer 3

is the patient talking
is the patient responsive
are there an added sounds to breathing (snoring, gurgling, stridor)

Question 4

Airway

when assessing the airway what thing would make you move on to breathing

Answer 4

if the patient is talking

Question 5

Airway

what potential interventions could you give

Answer 5

open airway (only responding to pain or unresponsive)
Suction (gurgling)
nebulised adrenaline (stridor)
simple airway adjunct- oral nasal (if having to do airway manoeuvres)

Question 6

Airway

Under what circumstances would you open their airway

Answer 6

if the are only responding to pain or if they are unresponsive

Question 7

Breathing

what are you thinking when assessing breathing (think PIPPA)

Answer 7

Inspection
• Respiratory rate?
• Respiratory effort?
• O2 saturations?
 Palpation
• Trachea central?
• Expansion equal? 
Percussion
• Areas of dullness or hyper-resonance?
 Auscultation
• Breath sounds?
• Added sounds?
• Inequality to the sides?

Question 8

Breathing

what investigations would you want to consider in regards to breathing

Answer 8

ABG

CXR

Question 9

Breathing

What potential interventions could you do

Answer 9

• Sitting up (struggling to breath)
• Oxygen (SpO2 less than their expected normal)
• Ventilation (drowsy patient, resp rate <8, open airway)
• Specific treatment (see below)

Question 10

Circulation

when assessing circulation what questions are you asking yourself

Answer 10

1. what is the heart rate, rhythm and character of the pulse
2. are the peripheries warm and what is cap refill
3. what is the blood pressure
4. is there any signs of haemorrhage
5. what is the temperature
6. Are there any heart sounds or murmurs
7. what does the ECG show

Question 11

Circulation

what are the potential interventions when assessing circulation

Answer 11

IV access
Bloods (VBG, FBC, U&Es, X-match, LFTs clotting)
fluid challenge - 250ml 0.9% NaCl stat (tachycardia, cap refill time > 2 secs +/- hypotension)
specific treatment (see below)

Question 12

Disability

What kind of things would you be assessing in this section

Answer 12

Assess responsivenss (AVPU) ie  are they alert +/- confusion
is there any reduction in alertness or new onset confusion (ie check blood glucose, check pulls and posturing and check drug chart)

Question 13

Disability

if there is any reduction in alertness or new onset of confusion what things would you want to be checking

Answer 13

blood glucose
pupils and posturing
drug char

Question 14

Disability

What potential interventions would you consider when assessing disability

Answer 14

optimise airway, breathing and circulation to ensure the brain is well oxygenated

give glucose if they are hypoglycaemic

Acute brain injury (unequal, unresponsive pupils, abnormal posturing) - CT scan and expert help

Drugs/medication overdose (recreational or iatrogenic) - support ABCDE, reversal agent where possible

Question 15

Exposure and everything else

What would you want to do in this section

Answer 15

examine the patient more closely if appropriate (rashes, swelling and bleeds)
take a more detailed history if possible
review notes, blood results, ECGs, X rays

Question 16

If there is a global wheeze then what could the potential diagnosis be and therefore what would be the most appropriate treatment

Answer 16

Asthma

Peak flow to asses severity
nebulised salbutamol
Nebulised ipratropium
oral or IV cortiocosteriods

Question 17

If there are bibasal crackles with peripheral odema and bat wings on CXR what would be the potential diagnosis and most appropriate treatment

Answer 17

Pulmonary oedema

Furosemide
nitrates
if very severe CPAP

Question 18

If the patient has a temperature, localised crackles, bronchial breathing and opacity on CXR what would be the potential diagnosis and most appropriate treatment

Answer 18

Pneumonia

Is the patient septic ?
IV antibiotics

Question 19

if the patient examination shown;
quietness to the lung bases
dull to percuss
loss of costophrenic & cardiophrenic angles on CXR

what would be the potential diagnosis and most appropriate treatment

Answer 19

pleural effusion

important to treat the cause and consider draining

Question 20

If the patient examination shows 
globally quiet breath sounds 
global wheeze
acidosis 
retaining CO2

what would be the potential diagnosis and most appropriate treatment

Answer 20

exacerbation of COPD

O2 guided by SpO2
treat the exacerbating cause
nebulised salbutamol & ipratropium

Question 21

if the patient examination shows
in extreme hyperresonant
decreased breath sounds
mediastinnal shift

what would be the potential diagnosis and most appropriate treatment

Answer 21

Tension pneumothorax

needle decompression
chest drain

Question 22

If the patient is in shock what main things will you notice about the circulation

Answer 22

increased HR
increased Capillary refill time (CRT)
decreased BP

Question 23

Name some main types of shock

Answer 23

Hypovolemic shock (too little blood volume)

cariogenic shock (due to heart problems)

septic or anaphylactic shock (due to some kind of distribution weather that be an infection or allergen)

neurogenic shock (caused by damage to the nervous system)