ABCDE Medical Assessment

Summary

This video outlines a systematic approach to assessing and managing a deteriorating patient using the ABCDE method. Each step—Airway, Breathing, Circulation, Disability, and Exposure—is explained in detail, with interventions addressed immediately if critical issues are detected. The clip also demonstrates a nurse's real-time assessment of a simulated patient, covering clinical techniques such as auscultation, pulse checks, and fluid management. Effective communication strategies like SBAR are highlighted for ensuring thorough handovers. The assessment is completed by systematically addressing each step and appropriately escalating care when necessary.

Takeaways

• 🩺 Physical assessment of an unwell or deteriorating patient should follow the ABCDE approach: Airway, Breathing, Circulation, Disability, and Exposure.
• 🗣️ An open and clear airway is a priority. If the patient is talking, their airway is patent, but interventions may be necessary if the patient is unresponsive.
• 🫁 Breathing is assessed by checking respiratory rate, oxygen saturation, and the use of accessory muscles. Auscultation, percussion, and oxygen administration may be necessary.
• ❤️ Circulation assessment includes checking pulse rate, rhythm, and blood pressure, as well as evaluating skin condition and peripheral perfusion.
• 🧠 Disability refers to assessing the patient's level of consciousness, often using the AVPU (Alert, Voice, Pain, Unresponsive) scale and Glasgow Coma Scale (GCS) for detailed neurological evaluation.
• 🛏️ Exposure involves checking the patient for rashes, bruising, bleeding, and any other signs of illness or injury, while maintaining patient dignity and privacy.
• 🧑‍⚕️ Each step of the ABCDE assessment should be treated immediately, with constant reassessment to monitor interventions’ effects.
• 📈 Systematic reassessment from A to E is crucial, ensuring no life-threatening problems are missed during the evaluation process.
• 🩹 A structured handover to other healthcare professionals using SBAR (Situation, Background, Assessment, Recommendation) ensures clear and timely communication.
• ⚠️ Early recognition and treatment of sepsis, with interventions like oxygen therapy and fluid resuscitation, are critical when a patient shows signs of septic deterioration.

Q & A

What is the ABCDE approach in patient assessment?

The ABCDE approach stands for Airway, Breathing, Circulation, Disability, and Exposure. It is a systematic method used to assess and treat deteriorating or unwell patients, addressing life-threatening issues in order of priority.

Why is it important to follow the ABCDE sequence when assessing a patient?

Following the ABCDE sequence ensures that potentially life-threatening conditions are identified and treated in order of priority, preventing delays in care. It allows for systematic, thorough, and timely intervention during patient deterioration.

What initial actions are taken if the patient’s airway is compromised?

If the airway is compromised, the practitioner may lay the patient flat and use basic maneuvers like the head tilt-chin lift or jaw thrust. They may also use simple adjuncts like oropharyngeal or nasopharyngeal airways, or more advanced tools depending on skill level.

What are some of the signs of respiratory distress that the nurse identifies in the patient?

The nurse notices that the patient, John, is using accessory muscles to breathe and is struggling to maintain his oxygen saturation, which is a sign of respiratory distress.

How does the nurse assess circulation in the patient?

The nurse checks the patient's pulse, assessing its rate, regularity, and quality. The nurse also observes for signs such as cool or warm peripheries, dry or clammy skin, and capillary refill time to assess circulation and perfusion.

What does a capillary refill time longer than two seconds indicate?

A capillary refill time longer than two seconds indicates poor perfusion, which could be a sign of circulatory shock or dehydration.

What tools or methods are used to assess the patient’s breathing?

The nurse uses auscultation with a stethoscope to listen to breath sounds, percussion to detect any fluid or air abnormalities in the chest, and a pulse oximeter to monitor oxygen saturation levels.

What is the nurse's next step after identifying signs of a chest infection in the patient?

After identifying signs of a chest infection, including crackles in the lungs, the nurse plans to contact the doctor to review the patient and administer stronger antibiotics.

What does the term ‘disability’ refer to in the ABCDE approach?

In the ABCDE approach, ‘disability’ refers to the patient's level of consciousness. The nurse assesses this using tools like the AVPU scale (Alert, Voice, Pain, Unresponsive) or the Glasgow Coma Scale.

What key information does the nurse communicate to the doctor during the SBAR handover?

During the SBAR (Situation, Background, Assessment, Recommendation) handover, the nurse communicates the patient's current status, vital signs, suspected sepsis, treatment administered (oxygen, fluids), and the need for urgent review by the doctor.