2.2 Primary survey: ABCDE approach

The Primary Survey: ABCDE approach is a critical first step in assessing and treating patients in emergency situations. It provides a systematic method for quickly identifying and addressing life-threatening conditions, ensuring that rescuers prioritize the most urgent needs first.

This approach covers Airway, Breathing, Circulation, Disability, and Exposure. By following these steps, first responders can quickly assess a patient's condition and provide immediate interventions to stabilize them before moving on to more detailed examinations and treatments.

Scene Assessment and Safety

Ensuring a Safe Environment

• Assess the scene for potential hazards before approaching the patient
• Identify and mitigate any risks to the rescuer, patient, or bystanders (traffic, fire, unstable structures)
• Call for additional help or resources if needed to ensure a safe working environment

Personal Protective Equipment (PPE)

• Wear appropriate PPE to protect against potential exposure to blood, body fluids, or other hazardous materials
• PPE includes gloves, eye protection, face masks, and gowns depending on the situation
• Properly remove and dispose of contaminated PPE after use to prevent cross-contamination

Assessing the Mechanism of Injury

• Determine the cause and severity of the patient's injury or illness based on the scene and available information
• Consider the forces involved in the incident (high-speed collision, fall from height, penetrating injury)
• Mechanism of injury helps anticipate potential injuries and guides the primary survey and treatment priorities

Airway and Breathing

Assessing Airway Patency

• Check if the patient's airway is open and unobstructed
• Look for signs of obstruction such as choking, gurgling, or stridor
• If the airway is compromised, open it using head-tilt/chin-lift or jaw-thrust maneuvers and remove any visible obstructions

Evaluating Breathing Effectiveness

• Assess the patient's breathing for rate, depth, and effort
• Look for signs of respiratory distress such as cyanosis, nasal flaring, or use of accessory muscles
• If breathing is inadequate, provide rescue breaths or assist with a bag-valve-mask device

Determining Level of Consciousness

• Assess the patient's responsiveness using the AVPU scale (Alert, Verbal, Pain, Unresponsive)
• Level of consciousness provides insight into the patient's overall condition and potential for airway compromise
• A decreased level of consciousness may require airway interventions to maintain patency

Measuring Respiratory Rate

• Count the number of breaths the patient takes in 15 seconds and multiply by 4 to calculate breaths per minute
• A normal respiratory rate for adults is 12-20 breaths per minute
• Abnormal respiratory rates (<12 or >20) may indicate underlying respiratory or cardiovascular problems

Circulation

Assessing Circulation and Perfusion

• Check for the presence and quality of the patient's pulse at the carotid, femoral, or radial arteries
• Assess skin color, temperature, and moisture for signs of poor perfusion (pale, cool, clammy skin)
• If no pulse is detected, begin chest compressions and follow CPR protocols

Performing a Pulse Check

• Locate the appropriate pulse point (carotid for adults, brachial for infants)
• Use two fingers to feel for the pulse, avoiding using your thumb as it has its own pulse
• A strong, regular pulse indicates adequate circulation, while a weak, irregular, or absent pulse suggests cardiovascular compromise

Evaluating Capillary Refill Time

• Press on the patient's nail bed or skin to blanch it and release
• Measure the time it takes for color to return, which should be less than 2 seconds in a well-perfused patient
• Delayed capillary refill (>2 seconds) may indicate shock or poor peripheral perfusion

Disability and Exposure

Assessing Neurological Disability

• Perform a brief neurological examination to assess the patient's mental status, motor function, and sensory function
• Look for signs of neurological deficits such as confusion, weakness, or abnormal pupil response
• A rapid neurological assessment helps identify potential brain injuries or other neurological emergencies

Using the Glasgow Coma Scale (GCS)

• The GCS is a standardized tool for assessing a patient's level of consciousness based on eye-opening, verbal response, and motor response
• Scores range from 3 (deep coma) to 15 (fully alert and oriented)
• A GCS score of 8 or less indicates a severe brain injury and requires immediate advanced care

Exposing the Patient for Examination

• Remove or cut away clothing as needed to fully examine the patient for injuries or abnormalities
• Protect the patient's privacy and dignity by draping exposed areas and only exposing necessary regions
• Prevent hypothermia by covering the patient with blankets or warm packs after the examination

Monitoring Body Temperature

• Measure the patient's body temperature using a thermometer or by feeling the skin
• Hyperthermia (high temperature) may indicate infection, heat illness, or drug reactions
• Hypothermia (low temperature) may result from prolonged exposure, shock, or certain medical conditions