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Let's delve deeper into patient care by expanding the ABCD approach and adding "E" to it, transforming it into the comprehensive ABCDE approach.
The "A" in ABCDE represents the Airway. Any airway obstruction is a critical emergency, necessitating immediate expert intervention. In many cases, airway obstruction occurs due to the tongue falling to the back of the throat. To assess and maintain the airway, consider the Head Tilt – Chin Lift technique. However, if you suspect a spinal injury, opt for the Jaw Thrust method. Clearing the airway allows the casualty to breathe.
Next, the "B" signifies Breathing. In the primary assessment of breathing, it's crucial to promptly identify and address life-threatening conditions such as the absence of breathing. Assess breathing by opening the airway, positioning your ear near their mouth to observe. Look, listen, and feel for signs of breathing. Ensure you can differentiate regular breathing from agonal breathing. If the casualty isn't breathing, initiate CPR immediately.
Wheezing, often caused by bronchospasms, is common in conditions like anaphylaxis. Oxygen should be administered to all critically ill patients.
The "C" denotes Circulation. Check for adequate blood circulation by assessing capillary refill in an uninjured toe or finger and by feeling for a radial pulse. While you can also check for a Carotid pulse in the neck, it provides less information about blood pressure than the radial pulse. Note that femoral pulses are typically not assessed in a pre-hospital setting. Patients in anaphylactic shock may exhibit significantly low blood pressure.
The "D" represents Disability, focusing on any abnormalities not covered in the previous assessments. For conscious patients who can communicate, inquire about unusual sensations, pain, or any abnormal feelings. This information can be invaluable, as it may reveal hidden issues not detected in the primary assessment. Internal problems like chest pain or nausea may also be disclosed by the casualty.
Finally, "E" stands for Exposure. To conduct a thorough examination, it's essential to expose the patient fully. Some changes, such as skin abnormalities, may be difficult to discern without full exposure. Prioritize maintaining the patient's warmth and dignity during this process. Gather a comprehensive clinical history from the patient, their relatives, friends, and other healthcare staff. If possible, review the patient's medical notes and charts to gain a more comprehensive understanding of the situation.
When following the ABCDE approach, always seek assistance and operate within your training and qualifications. Do not attempt any procedure unless you are fully qualified and authorised to do so.
