UNIVERSITY OF RIJEKA

FACULTY OF MEDICINE

MEDICAL ENGLISH 1

MAY 12, 2015

PATIENT EVALUATION

NIKOLA COLOVIC

1ST YEAR

doc. dr. sc. ARIJANA KRISKOVIC, prof.

CONTENTS

INTRODUCTION 3

1. WHEN INJURY OCCURS 4

2. ABCDE APPROACH 5

2.1. A - AIRWAY 5

2.2. B - BREATHING 6

2.3. C - CIRCULATION 6

2.4. D - DISABILITY 8

2.5. E - EXPOSURE 8

3. SAMPLE 10

CONCLUSION 11

SUMMARY 12

REFERENCES 13

INTRODUCTION

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In my paper work I will be writing about evaluating an injured or ill

person following the ABCDE approach in order to properly help her. First, I

will be writing about correct approach at the scene then step by step explain

ABCDE approach - what to do; what to check; what to expect; what to look

for. After thoroughly explaining ABCDE approach I will be writing about

SAMPLE which helps you gather more information about the victim.

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WHEN INJURY OCCURS

When encountering a victim it is very important not to panic. If calmed

down we must check the scene and determine safety of the scene, possible

causes of injuries and number of victims. Checking the safety of scene is

vital so victim can be kept from more harm and to keep ourselves uninjured.

This means removing all objects that can make harm or calling adequate

public services like firefighters for help making the scene safer in cases such

as fire, traffic accidents etc. Also we must protect ourselves by using medical

exam gloves. While approaching a victim we introduce ourselves and come

from front so the victim does not get scared of us. After getting to victim we

start ABCDE approach.

ABCDE APPROACH

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The Airway, Breathing, Circulation, Disability, Exposure (ABCDE)

approach is a systematic approach to the immediate evaluation and

treatment of injured or ill patients and it is used because there is no

equipment needed at all. The aims of this procedure are recognising the

injury on time, treating it properly, reducing the pain and shortening the

recovery time. The ABCDE approach is applicable for all patients and kinds of

injuries or conditions except in cardiac arrest where cardiopulmonary

resuscitation (CPR) is needed. The mnemonic “ABCDE” stands for Airway,

Breathing, Circulation, Disability, and Exposure. First, life-threatening airway

problems are recognised and treated; second, life-threatening breathing

problems are recognised and treated; and so on. Using this structured

approach, the goal is to quickly identify life-threatening problems and try to

treat them.[2] The ABCDE approach should be repeated every 15 minutes or

often if necessary.

A - Airway

Airway can be patent, partially obstructed or completely obstructed.

Before looking at the airway we can recognise obstructions by listening to

victim's breathing. Signs of partially obstructed airway are strange noises,

increased breathing effort, changed voice while signs of completely

obstructed airway is that there is no breathing despite great effort.

Obstructed airway is often followed by passing out if not treated. To make

sure that airway is patent we open victim's mouth and look for any

obstructions such as tongue or small objects. If there are any, we remove

them quickly or we tilt victim's head and lift chin which keeps airway open.

[1]

B - Breathing

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After making sure that airway is patent we check victims breathing by

looking, listening and feeling. First we tilt victim's head which is followed by

positioning our cheek in front of victim's mouth with our eyes looking at

victim's chest.[2] We stay in this position for about 8 to 10 seconds. If there

is no breathing, we start with CPR procedure while checking for foreign

bodies in victim's mouth. If the victim is breathing we can determine

respiratory rate (normal rate is between 12 and 20 breaths per minute), the

depth of each breath, the pattern of respiration and whether chest expansion

is equal on both sides.[3] The variations of depth of breath or pattern of

respiration can be signs of life-threatening conditions like choking or

pneumothorax. Also, we listen to the victim's breath sounds in search for any

irregularities like snoring, gurgling, crowing or wheezing which indicates

different obstructions in victim's airway. Snoring is caused by partially

obstructed airway, usually by tongue. Gurgling is caused by fluids in throat.

Crowing which is birdlike sound is caused by spasm of the larynx or foreign

body. Wheezing is caused by spasm or partial obstruction in bronchi.[1] After

checking and ensuring sufficient breathing, we can proceed onto the next

step.

C - Circulation

In this step we palpate peripheral and central pulses, look for

haemorrhages, check the capillary refill and skin condition. Central pulse is

being palpate at the carotid artery down and left or right from laryngeal

prominence while peripheral pulse is being palpate at the radial artery about

3 centimeters up from the wrist. By palpating pulse we can assess its

presence, rate (normal pulse rate is between 60 to 80 beats per minute),

quality, regularity and equality.[3] If pulse is not present, we need to start

CPR. Irregularities in pulse that we determine can be signs of different life-

threatening conditions like internal bleeding, shock, external bleeding and so

on. After checking the pulse we look for external haemorrhages from wounds

by searching for pools of blood around and on the victim. If external

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haemorrhage is found, we need to stop it by applying pressure and treating

it with a bandage. It is very important to avoid contact with victim's blood.

Next step is checking the capillary refill by pressing part of the victim's skin

where it is close to the bone (eg. forehead). Normal time of capillary refill is

up to 2 seconds and everything above that indicates poor circulation.[1]

Checking the victim's skin means checking the skin colour, temperature and

condition which can be providing extra information about victim's condition.

Skin colour can be determined by looking at it. Pink skin is normal; red or

flushed skin means dilated blood vessels and excess circulation to that part

of the body; white or pale skin means constricted blood vessels from blood

loss, shock, hypothermia; blue or cyanosis skin means lack of oxygen in the

blood from breathing or heart problems while yellow or jaundice skin means

liver disease or failure.[1] After determining the skin colour, we can roughly

determine the skin temperature and moisture by putting back of our hand on

the victim's forehead. Warm and dry skin is normal; hot and dry or moist skin

means excessive body heat caused by heat stroke or high fever; cool and

moist skin means poor circulation, heat exhaustion, shock, acute stress

reaction; cold and moist skin means that body is loosing heat while cold and

dry skin is sign of hypothermia.[1]

D - Disability

After checking airway, breathing and circulation, comes checking the

level of consciousness by using AVPU method and checking the pupils. AVPU

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mnemonic stands for alert (A), verbal (V), pain (P) and unresponsive (U).

Victim is alert if his or hers eyes are open, he or she can answer the

questions clearly, knows where he or she is and his or her name. Victim is

responsive to verbal stimulus if he or she responds in some meaningful way

when spoken to. Victim is responsive only to painful stimulus if he or she

moves or cries out in response to a painful stimulus such as pinching. Victim

is unresponsive to any stimulus if he or she does not response to any

stimulus.[1] Pupils are checked with flashlight or similar source of light and

we are looking the size, equality and reaction to light of victim’s pupils. This

can help us decide if there is brain damage or is the victim dead if he or she

does not breathe or has pulse.

E - Exposure

The last step in ABCDE approach means removing clothes of the victim

so we can look at his or her body for hidden injuries. While removing clothes

we must do it to respect victim’s dignity and to prevent heat loss.[3] Then

comes thorough examination of victim’s body part by part using the

mnemonic DOTS where “D” stands for deformity (abnormal shape of the

body part compared to uninjured part caused by broken bone or dislocated

joint), “O” stands for open wounds (parts where skin is broken and there is

bleeding), “T” stands for tenderness (parts where touching causes

sensitivity, discomfort or pain) and “S” stands for swelling (parts that looks

larger than usual because of excess fluid in the tissue). First body part that is

being checked is head. We check for DOTS and if there is any clear or blood-

tinged fluid coming out of the ears and nose. After head, the neck is being

checked for DOTS. After neck, both chest and abdomen are being checked

for DOTS by gently presses. Same as chest and abdomen, pelvis is being

checked for DOTS by gently presses. After checking the body we are passing

to extremities where we check both arms and legs for DOTS. If the victim is

responsive we can also check for spinal injury by asking the victim if he or

she can feel us squeezing his or her fingers and toes; if he or she can wiggle

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his or her fingers and toes; if he or she can squeeze our hand or he or she

can push his or her foot against our hand. After concluding that there is no

spinal injury, we can check victim’s back for DOTS.[1]

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SAMPLE

After finishing ABCDE procedure, we need to gather information about

victim by asking the victim or someone close to him or her if possible. In this

part of evaluating the patient we are using mnemonic SAMPLE in which “S”

stands for symptoms (also known as chief complaint, usually the pain in

injured part of the body), “A” stands for allergies (medications or something

else), “M” stands for medications (ones that victim is regularly using lately),

“P” stands for past medical history (if victim is ill in some way, usually if

victim is diabetic or similar), “L” stands for last meal (what was the last thing

victim has ate or drank) and “E” stands for events preceding the incident

(what caused the injury). These information are significant for doctors at the

emergency room so they can properly dosage the right medications if

needed.[1]

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CONCLUSION

The ABCDE approach is a strong clinical tool for the initial assessment

and treatment of victims 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.[2]

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SUMMARY

When we see that someone is injured or ill it is our duty to approach

him so we can help him. The easiest and the most organized way of

approaching to injured or ill person is by ABCDE approach. By using it we can

determine if victim’s airway is patent, if the breathing is sufficient, if the

circulation is sufficient, the level of consciousness and possible causes of

victim’s condition. After stabilizing the victim, we must gather information if

there are any allergies or diseases that victim is suffering from. Also we need

to know what caused the injuries and the symptoms. This is very important

so victim can be treated properly at the hospital which will help shorten the

recovery.

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REFERENCES

[1] Alton L. Thygerson, Benjamin Gulli, Jon R. Krohmer: First Aid, CPR, and

AED; 5th edition; Jones & Bartlett Learning, 2007; 42-54

[2] Initial assessment and treatment with the Airway, Breathing, Circulation,

Disability, Exposure (ABCDE) approach; available at

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273374/; accessed May 10,

2015

[3] A systematic approach to the acutely ill patient; available at

http://www.resus.org.uk/pages/alsabcde.htm; accessed May 10, 2015

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