# Abcde?



## Legal Eagle (May 3, 2011)

Have you guys seen ABCDE acronym for a primary assessment? 
Can someone explain this in depth to me?


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## medicRob (May 3, 2011)

Legal Eagle said:


> Have you guys seen ABCDE acronym for a primary assessment?
> Can someone explain this in depth to me?



You will typically see this in PHTLS. 

Airway, Breathing, Circulation, Disability, Expose

ABC is pretty self explanatory. 

D is disabilities caused by the injury such as inability to move an arm, etc. (In some assessments it can also mean defibrillation)

E is for Expose. Exposing the patient to reveal injuries that are potentially hidden by the clothes. This would be stripping them.


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## Legal Eagle (May 3, 2011)

Ok.. I understand the expose part, but why the disabilities part in the primary survey?  I thought the primary was for life threatening issues, wouldn't a disabled arm be found in the secondary survey(head to toe)? 
MedicRob could you please go into more detail about the disabilities part?


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## medicRob (May 3, 2011)

Legal Eagle said:


> Ok.. I understand the expose part, but why the disabilities part in the primary survey?  I thought the primary was for life threatening issues, wouldn't a disabled arm be found in the secondary survey(head to toe)?
> MedicRob could you please go into more detail about the disabilities part?



Well, neurological deterioration is a perfect example. If a patient has a GCS of < 15, this is a concern. You should  reassess your patient several times, this isn't a one time thing.


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## medicdan (May 3, 2011)

Assessment for neurological disabilities should be done whenever a patient is not fully alert or oriented, and should include an assessment of CSMs/PMS, a stroke assessment (FAST/MASS/CpSC), etc.


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## MrBrown (May 3, 2011)

The disability part of the primary survey is looking at neurological function and any impairments to that function.

Generally we are looking for (if appropriate) AVPU, GCS, stroke score, gross motor function and symmetry in an attempt to exclude brain or spinal cord injury or muscular problem.

For example Nana who is sitting at home drinking a cup of tea when we arrive complaining of feeling feverish, sweaty, unwell and pain upon passing urine probably has a UTI and as such is not the ideal candidate for a full neuro exam and a trip to hospital for a CT scan.  Nana may look at you funny when you ask her what colour the sky in Cincinnati is or to squeeze your hands.  She will slap you with her walker and say "son I do not know you that well"

Some bloke who has been smacked upside the head with a bit of 4x2 or Nana who is sitting at home and spilled her cup of tea all down herself but does not notice because she is talking to the magic pixies on the wall on the other hand, are perfect candidates for a neurological workup.


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## Legal Eagle (May 3, 2011)

Ahhhhh, so it's assessing the patient's neurological function. 
I start my EMT-B later this month so I'll probably be asking lots of questions.
Thanks for the input it was very helpfull.


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## MrBrown (May 3, 2011)

Legal Eagle said:


> Ahhhhh, so it's assessing the patient's neurological function.
> I start my EMT-B later this month so I'll probably be asking lots of questions.
> Thanks for the input it was very helpfull.



Sort of, you are looking for primary insult to neurologic function such brain injury, stroke, decreased level of consciousness (and probable reason) as well as secondary impairment such as Rob mentioned, inability to move your leg because its at a right angle.  

Brown is sure whatever definition your textbook has will differ from that provided by Brown


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## Veneficus (May 3, 2011)

medicRob said:


> You will typically see this in PHTLS.
> 
> Airway, Breathing, Circulation, Disability, Expose
> 
> ...



E is also sometimes used for "exposure" to the elements, etc.

and don't forget F and G

(everyone knows what the "F" word is) 

and G is for "gadgets."


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## MrBrown (May 3, 2011)

Don't forget to keep your patient warm too during exposure, you would be amazed at the wonders of the high tech ambo blanket


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## dixie_flatline (May 3, 2011)

Interesting.... I was taught

Airway
Breathing
Circulation
Dense Bleeding
Expose


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## medicstudent101 (May 3, 2011)

dixie_flatline said:


> Interesting.... I was taught
> 
> Airway
> Breathing
> ...



Take PHTLS?


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## dixie_flatline (May 3, 2011)

medicstudent101 said:


> Take PHTLS?



http://en.wikipedia.org/wiki/Advanced_Trauma_Life_Support

Indeed.

No exposure to PHTLS here, I was taught ABCDE in my Basic class, with D being Dense Bleeding.


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## Handsome Robb (May 3, 2011)

dixie_flatline said:


> http://en.wikipedia.org/wiki/Advanced_Trauma_Life_Support
> 
> Indeed.
> 
> No exposure to PHTLS here, I was taught ABCDE in my Basic class, with D being Dense Bleeding.



Wouldn't Dense Bleeding fall under circulation? Seems repetitive to me...

I agree with the other ABCDE, thats what I was taught.


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## Scout (May 3, 2011)

A Airway
B Breathing/Major chest problems
C Circ/ Major hemorrhage  
D Disability, AVPU/GCS Etc, Eyes
E Expose and Examine ( looking for life threatening injuries.)

F ****ing
G Glucose


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## medicstudent101 (May 3, 2011)

dixie_flatline said:


> http://en.wikipedia.org/wiki/Advanced_Trauma_Life_Support
> 
> Indeed.
> 
> No exposure to PHTLS here, I was taught ABCDE in my Basic class, with D being Dense Bleeding.



To each there own I suppose. 

Dense bleeding would seemingly fall under 'C'. 

No worries though. B)


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## zmedic (May 5, 2011)

"F" was fluid (blood/saline/plasma etc) and finger (rectal) 

though rectal is falling out of favor in trauma assessment as being useless in most cases.


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## wlgorman (May 9, 2011)

here is how I was taught. 

CC-Chief Complaint
C-C-Spine (if trauma suspected)
A-Airway
B-Breathing
C-Circulation
D-Neurological Deficits
E-Exposures
      -Is patient exposed to dangerous elements? Can you give the patient 
        the needed/appropriate care in the position/environment they are in?


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## Melclin (May 9, 2011)

We were offered a number of ideas when it came to primary surveys.

Officially, the service I work for endorses. 

Dangers
Response
Airway
Breathing
Circulation
Defibrillation 
Haemorrhage 

Its pretty outdated, in that its basically a first aid approach, but I'm sure there are some massively complex (and expensive) issues that surround formally changing something as fundamental as a 1 survey and there's no reason anyone who wants to can't tweak it a little.

At uni we learned ABCDE (disability and exposure being the D and E). I added to it in developing my approach based on ideas I came across or trouble I was having.

-Scene assessment and safety - dangers, BSI, sitreps, activation of triage/transport officer roles in MCI.
-Airway
-Breathing
-Circulation
-Disability (GCS)
-Exposure (ambient temp, expose pt), 
-Egress (this I added because there were a number of things you might find in ABCDE that would mean need Intensive Care backup wicky-tick, so I think of egress as meaning escaping to IC or hospital).
-Family & friends (this reminded me in scenarios to ask bystanders and family for information and has been a useful reminder in real life to turn my thoughts to other sources of information about unconscious pts after running the ABCs).
-Glucose (I was often neglecting to do BSLs in unconscious pts, early on at uni).
-Haemorrhage (its really part of circulation, but I added it on as a reminder to verbalize looking for haemorrhage in scenarios).


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## Veneficus (May 10, 2011)

*I just have to know*



Melclin said:


> We were offered a number of ideas when it came to primary surveys.
> 
> Officially, the service I work for endorses.
> 
> ...




If you defib somebody that is hemorrhaging does it cause the blood to squirt out higher?


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## Melclin (May 10, 2011)

Veneficus said:


> If you defib somebody that is hemorrhaging does it cause the blood to squirt out higher?



It probably would wouldn't it! Oh now I really wanna see that.


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## daj72 (May 10, 2011)

Veneficus said:


> If you defib somebody that is hemorrhaging does it cause the blood to squirt out higher?



Is does... It really do! B)


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## Veneficus (May 10, 2011)

daj72 said:


> Is does... It really do! B)



Awesome. I have to see that.


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