Clinical Prioritization in First Aid Situations

Introduction

• Prioritization of care in clinical and first-aid situations uses the ABCDE principles.
• These are based on the first five letters of the alphabet: Airway, Breathing, Circulation, Disability, and Exposure.

A - Airway

• Vital for airway to be open (patent):
  • Assess if a patient can talk; if so, the airway is clear.
  • If unsure, use "look, listen, and feel" method:
    • Look: Monitor chest and abdomen movements.
    • Listen: Place ear near nose to hear breathing.
    • Feel: Check for breath on your hand.
• Consequences of blocked airway:
  • Leads to hypoxia, unconsciousness, brain and myocardial damage, and death.
  • Hypoxic brain injury can result from prolonged oxygen deprivation.
• Cyanosis:
  • Indicates hypoxemia (low oxygen levels in blood), causing a blue tint to skin and mucous membranes.
• Managing airway:
  • Common obstruction is the patient's tongue in unconscious patients.
  • Use neck extension or jaw thrust (if cervical spine injury is suspected) to open airway.
  • In hospitals, administer high concentrations of oxygen.

B - Breathing

• Assessment:
  • Monitor respiratory rate (normal: 12-20 breaths per minute).
  • Assess rhythm and oxygen saturations (target >94%).
  • Listen for obstruction sounds like stridor or wheezing.
  • Check trachea for deviation (indicates pressure issues).
• Interventions:
  • Sit patient up to improve breathing.
  • Use positive pressure ventilation (e.g., bag valve mask, airway adjuncts) if patient cannot breathe independently.
  • In first-aid, mouth-to-mouth may be necessary.

C - Circulation

• Assessment:
  • Check heart rate, pulse, blood pressure, and capillary refill time.
  • Palpate peripheral and central pulses, especially if blood pressure is low.
• Interventions:
  • Perform chest compressions if circulation is absent.
  • Monitor and reassess the effects of any interventions.

D - Disability

• Assessment:
  • Check nervous system function using the "GAP" principles:
    • G: Glucose levels (hypoglycemia causes unconsciousness).
    • A: Alertness (use AVPU - Alert, Voice, Pain, Unresponsive).
    • P: Pupils reaction to light.
  • Look for lateralizing signs (unequal power in limbs).

E - Exposure

• Inspection:
  • Examine entire body surface, especially in trauma situations.
  • Maintain patient dignity and privacy; consider chaperones.
• Environmental considerations:
  • Monitor and maintain patient’s body temperature and comfort.
  • Ensure therapeutic environment to prevent hypothermia and maintain coagulation.

Additional Points

• Secondary Survey:
  • Conduct thorough head-to-toe examination after primary survey.
• Catastrophic Hemorrhage in Trauma:
  • In some situations, stop hemorrhage before addressing airway (military protocol).
• Ongoing Reassessment:
  • Constantly reassess ABCDE and interventions in response to changes.
• Teamwork and Communication:
  • Effective communication and early help are crucial.
  • Use SBAR (Situation, Background, Assessment, Recommendation) for clear communication.

Conclusion

• ABCDE is a primary survey in clinical assessments, treat life-threatening issues before moving on.
• Continuous reassessment and intervention are critical.
• Call for help early when uncertain; teamwork is essential in emergencies.