Radiologists must be aware of this to intervene appropriately when sub-optimal imaging indications are presented. In this respect, knowing the content and the language of the ATLS can be helpful. Instances of disagreement with the evidence in the literature and daily practice are highlighted [ 1 ]. In The Netherlands, 22 out of , people die each year because of accidental injury.
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The approach is widely accepted by experts in emergency medicine and likely improves outcomes by helping health care professionals focusing on the most life-threatening clinical problems.
In an acute setting, high-quality ABCDE skills among all treating team members can save valuable time and improve team performance. The approach is applicable in all clinical emergencies.
It can be used in the street without any equipment Figure 1 or, in a more advanced form, upon arrival of emergency medical services, in emergency rooms, in general wards of hospitals, or in intensive care units. The evidence supporting the systematic ABCDE approach to critically ill or injured patients is expert consensus.
The approach is widely accepted and used by emergency technicians, critical care specialists, and traumatologists. In analogy, algorithms for resuscitation are applied to improve the speed and quality of treatment. The authors believe that a generally accepted algorithm for the ABCDE approach taught to health care professionals may improve treatment of the critically ill and injured, whereas differences in the interpretation of the algorithm may lead to confusion.
Training health care professionals for recognition and management of critically ill patients increases confidence and reduces concerns about being responsible for the severely ill. The clinical signs of critical conditions are similar regardless of the underlying cause. This makes exact knowledge of the underlying cause unnecessary when performing the initial assessment and treatment. It is a valuable tool for identifying or ruling out critical conditions in daily practice.
Cardiac arrest is often preceded by adverse clinical signs and these can be recognized and treated with the ABCDE approach to potentially prevent cardiac arrest. When confronted with a collapsed patient, first ensure the safety of yourself, bystanders, and the victim.
Then check for cardiac arrest unresponsive, abnormal or absent breathing, and, if trained, pulse-check lack of carotid artery pulse. If the victim is in cardiac arrest, call for help and start cardiopulmonary resuscitation according to guidelines. All health care professionals can encounter critically ill or injured persons, either at work or in private life, and may therefore benefit from knowing the ABCDE approach.
The lay public expects health care professionals to act when confronted with illness or injury, whether it occurs in the street with no equipment at hand or in the hospital. Assessment and treatment can be initiated without equipment and more advanced interventions can be applied on arrival of emergency medical services, in a clinic, or at the hospital.
Medical emergencies, including pediatric emergencies, occur in the general practitioners office more often than expected.
With the ABCDE approach, the initial assessment and treatment are performed simultaneously and continuously. Even when a critical condition is evident, the cause may be elusive; in such situations, life-saving treatment must be instituted before a definitive diagnosis has been obtained.
Early recognition and effective initial treatment prevents deterioration and buys time for a definitive diagnosis to be made. Causally focused treatment can then be instituted. First, life-threatening airway problems are assessed and treated; second, life-threatening breathing problems are assessed and treated; and so on.
Using this structured approach, the aim is to quickly identify life-threatening problems and institute treatment to correct them. Often, assistance will be required from emergency medical services, a specialist, or a hospital response team eg, medical emergency team or cardiac arrest team. Responders should call for help as soon as possible and exploit the resources of all persons present to increase the speed of both assessment and treatment.
Improved outcome is most often based on a team effort. On completion of the initial ABCDE assessment, assessments should be repeated until the patient is stable. It must be remembered that it may take a few minutes before the effect of an intervention is evident. In case of deterioration, reassessment should be performed. Then, a general impression is obtained by simply looking at the patient skin color, sweating, surroundings, and so on.
Although this is valuable, the critical clinical situation is frequently complex and the systematic approach described below helps break it down into manageable parts Table 2. Notes: Normal adult ranges are given in parentheses.
Importantly, a patient with values within the given ranges may still be critically ill. Assessment and treatment points in italics require equipment. The approach described in this table is primarily aimed at the nonspecialist and is not exhaustive.
If the patient responds in a normal voice, then the airway is patent. Airway obstruction can be partial or complete. Signs of a partially obstructed airway include a changed voice, noisy breathing eg, stridor , and an increased breathing effort.
A reduced level of consciousness is a common cause of airway obstruction, partial or complete. A common sign of partial airway obstruction in the unconscious state is snoring. Untreated airway obstruction can rapidly lead to cardiac arrest. All health care professionals, regardless of the setting, can assess the airway as described and use a head-tilt and chin-lift maneuver to open the airway Figure 2.
With the proper equipment, suction of the airways to remove obstructions, for example, blood or vomit, is recommended. If possible, foreign bodies causing airway obstruction should be removed. In the event of a complete airway obstruction, treatment should be given according to current guidelines.
If the victim becomes unconscious, call for help and start cardiopulmonary resuscitation according to guidelines. Importantly, high-flow oxygen should be provided to all critically ill persons as soon as possible.
In all settings, it is possible to determine the respiratory rate, inspect movements of the thoracic wall for symmetry and use of auxiliary respiratory muscles, and percuss the chest for unilateral dullness or resonance. Cyanosis, distended neck veins, and lateralization of the trachea can be identified. If a stethoscope is available, lung auscultation should be performed and, if possible, a pulse oximeter should be applied.
Tension pneumothorax must be relieved immediately by inserting a cannula where the second intercostal space crosses the midclavicular line needle thoracocentesis. Bronchospasm should be treated with inhalations. If breathing is insufficient, assisted ventilation must be performed by giving rescue breaths with or without a barrier device.
Trained personnel should use a bag mask if available. The capillary refill time and pulse rate can be assessed in any setting. Inspection of the skin gives clues to circulatory problems. Color changes, sweating, and a decreased level of consciousness are signs of decreased perfusion. If a stethoscope is available, heart auscultation should be performed. Electrocardiography monitoring and blood pressure measurements should also be performed as soon as possible.
Hypotension is an important adverse clinical sign. An intravenous access should be obtained as soon as possible and saline should be infused. The level of consciousness can be rapidly assessed using the AVPU method, where the patient is graded as alert A , voice responsive V , pain responsive P , or unresponsive U. Alternatively, the Glasgow Coma Score can be used. The best immediate treatment for patients with a primary cerebral condition is stabilization of the airway, breathing, and circulation.
In particular, when the patient is only pain responsive or unresponsive, airway patency must be ensured, by placing the patient in the recovery position, and summoning personnel qualified to secure the airway. Ultimately, intubation may be required. Pupillary light reflexes should be evaluated and blood glucose measured. A decreased level of consciousness due to low blood glucose can be corrected quickly with oral or infused glucose.
Signs of trauma, bleeding, skin reactions rashes , needle marks, etc, must be observed. Bearing the dignity of the patient in mind, clothing should be removed to allow a thorough physical examination to be performed. Body temperature can be estimated by feeling the skin or using a thermometer when available. The formulation of the mnemonic ABC has its roots in the s. Safar described methods to safe-guard the airway and deliver rescue breaths, thereby giving rise to the first two letters of the mnemonic, A and B.
In , Styner crashed in a small aircraft with his family, and they were admitted to the local hospital. Here, he observed an inadequacy of the emergency care provided. Emphasizing the systematic approach to the critically injured patient, he formed the basis of the Advanced Trauma Life Support courses.
Accordingly, the ABCDE approach is an extension of the initially described ABC approach for patients in cardiac arrest to patients experiencing all medical and surgical emergencies. The ABCDE approach is a strong clinical tool for the initial assessment and treatment of patients in acute medical and surgical emergencies, including both prehospital first-aid and in-hospital treatment.
It aids in determining the seriousness of a condition and to prioritize initial clinical interventions. Widespread knowledge of and skills in the ABCDE approach are likely to enhance team efforts and thereby improve patient outcome. National Center for Biotechnology Information , U. Int J Gen Med. Published online Jan Author information Copyright and License information Disclaimer. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.
This article has been cited by other articles in PMC. Keywords: emergency medicine, general medicine, internal medicine, multiple trauma, multiple injury.
Open in a separate window. Figure 1. Airway, Breathing, Circulation, Disability, Exposure Universal principles for all patients Apply when critical illness or injury is suspected or evident Assess and treat continuously and simultaneously Treat life-threatening signs immediately Life-saving treatment does not require a definitive diagnosis Reassess regularly and at any sign of deterioration. A — Airway: is the airway patent?
Figure 2. B — Breathing: is the breathing sufficient? C — Circulation: is the circulation sufficient? D — Disability: what is the level of consciousness? Conclusion The ABCDE approach is a strong clinical tool for the initial assessment and treatment of patients in acute medical and surgical emergencies, including both prehospital first-aid and in-hospital treatment.
ABCDE Approach to Emergency Management
The approach to all deteriorating or critically ill patients is the same. The underlying principles are:. Airway obstruction is an emergency. Get expert help immediately. Untreated, airway obstruction causes hypoxia and risks damage to the brain, kidneys and heart, cardiac arrest, and death. During the immediate assessment of breathing, it is vital to diagnose and treat immediately life-threatening conditions e.
Advanced trauma life support
The approach is widely accepted by experts in emergency medicine and likely improves outcomes by helping health care professionals focusing on the most life-threatening clinical problems. In an acute setting, high-quality ABCDE skills among all treating team members can save valuable time and improve team performance. The approach is applicable in all clinical emergencies. It can be used in the street without any equipment Figure 1 or, in a more advanced form, upon arrival of emergency medical services, in emergency rooms, in general wards of hospitals, or in intensive care units. The evidence supporting the systematic ABCDE approach to critically ill or injured patients is expert consensus. The approach is widely accepted and used by emergency technicians, critical care specialists, and traumatologists.
Guidelines and guidance
A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations.
Advanced trauma life support ATLS is a training program for medical providers in the management of acute trauma cases, developed by the American College of Surgeons. Similar programs exist for immediate care providers such as paramedics. The program has been adopted worldwide in over 60 countries,  sometimes under the name of Early Management of Severe Trauma , especially outside North America. Its goal is to teach a simplified and standardized approach to trauma patients.