# CAB and ABC



## paramedic911 (May 2, 2013)

hello every one , we use CAB in unconscious patient and ABC in conscious patient is that right ?


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## Ecgg (May 2, 2013)

paramedic911 said:


> hello every one , we use CAB in unconscious patient and ABC in conscious patient is that right ?



When you perform patient assessment you always do your scene size up and check for ABC Airway, Breathing, Circulation in that order. CAB is a CPR Algorithm it stands for compressions, airway ,breathing. Thus, as soon as you identify a patient that is unresponsive, no pulse, no breathing or no normal breathing only gasping you will proceed with CAB CPR Algorithm except for newborns for which Neonatal Resus Program guidelines still have ABC algorithm. 

I think AHA screwed this up royally, as this is a big topic of confusion among pre-hospital and hospital personnel.

Read A Change From A-B-C to C-A-B

http://www.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/downloadable/ucm_317350.pdf


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## CameronStorer (May 3, 2013)

paramedic911 said:


> hello every one , we use CAB in unconscious patient and ABC in conscious patient is that right ?



CAB is a term for management of a patient that CPR is indicated for, where as in our primary assessment ABC(D/Neuro exam) is always boss on the BLS level at least. 

CAB is in terms of priority in management, compressions are the most important part of CPR, then without the airway, you can't deliver breaths to the patient, then finally once the airway is open you can assist breathing.


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## paramedic911 (May 11, 2013)

*thaks*

thank you alllllllllllll


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## intellectualfish (May 13, 2013)

*Not to add confusion, but...*

In my experience, all three are checked simultaneously by good providers. I can put my ear over the patient's mouth to feel/listen for breath sounds while looking for chest rise and using my hand to palpate a pulse. I was taught (correctly or not) that CAB still stood for Circulation-Airway-Breathing. The logic behind this being that of the three, circulation was the most important. You can have an apneic patient with a pulse, but it's unlikely you'll have a pulseless patient who is breathing. Really, the mnemonic is more to help you to remember to check all three of these in a patient first. In my experience, I will do any vairation of ABC, CAB, BAC, etc. depending on the presentation of the patient and the circumstances surrounding the call. There's not necessarily a right or a wrong way as long as all are addressed and treated accordingly.


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## STXmedic (May 13, 2013)

I despise mnemonics. And trying to explain how the book's mnemonics aren't necessarily how it's done in the field. :glare:

That is all.


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## BateMan (May 22, 2013)

I have a question:

does the C in CAB stand for circulation or compressions.
because if you would palpate for a pulse it'll be circulation, but if you do compressions itll be compressions


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## Mariemt (May 22, 2013)

compressions


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## Melclin (May 28, 2013)

Ecgg said:


> When you perform patient assessment you always do your scene size up and check for ABC Airway, Breathing, Circulation in that order. CAB is a CPR Algorithm it stands for compressions, airway ,breathing. Thus, as soon as you identify a patient that is unresponsive, no pulse, no breathing or no normal breathing only gasping you will proceed with CAB CPR Algorithm except for newborns for which Neonatal Resus Program guidelines still have ABC algorithm.
> 
> I think AHA screwed this up royally, as this is a big topic of confusion among pre-hospital and hospital personnel.
> 
> ...



Late to this party as usual, but I totally agree. 

I much prefer the 'abcd, ABCDE, ABCDE' idea particularly because its also a conceptual approach that is very applicable to EMS in general. Get the basics that the pt needs right now done quickly. Then go back to the start and get the next lot of assessment/treatments done. I think that repeating cycle of ever increasing complexity to assessment and treatment is a great way to structure out approach in general and a much better way of communicating the idea than all that BLS before ALS rubbish.


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## AnthonyM83 (May 30, 2013)

PoeticInjustice said:


> I despise mnemonics. And trying to explain how the book's mnemonics aren't necessarily how it's done in the field. :glare:
> 
> That is all.



Do you have examples?
I ask because I tend to dislike a lot of comments about how things are done differently in the field than from the classroom. That usually (but not always) is a sign of inadequate field performance....


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## AnthonyM83 (May 30, 2013)

intellectualfish said:


> In my experience, all three are checked simultaneously by good providers. I can put my ear over the patient's mouth to feel/listen for breath sounds while looking for chest rise and using my hand to palpate a pulse. I was taught (correctly or not) that CAB still stood for Circulation-Airway-Breathing. The logic behind this being that of the three, circulation was the most important. You can have an apneic patient with a pulse, but it's unlikely you'll have a pulseless patient who is breathing. Really, the mnemonic is more to help you to remember to check all three of these in a patient first. In my experience, I will do any vairation of ABC, CAB, BAC, etc. depending on the presentation of the patient and the circumstances surrounding the call. There's not necessarily a right or a wrong way as long as all are addressed and treated accordingly.



I disagree. 

The new CPR takes into account what a lot of providers were already doing. Realizing this guy is probably in cardiac arrest, let's go straight for the pulse check to start compressions sooner.

It theoretically takes more time to do a good head-tilt chin-lift, putting your face all the way down to his mouth to feel for breathing (as you mentioned above), and find that pulse. 

How much more time? For an ideal patient and experienced provider, probably almost negligible. For a slippery patient with vomit, or a neck trauma patient, or someone requiring suction, (or if still doing the old give to breaths to ensure clear airway), or someone with slippery head, or simply a new EMT, or if you're the rest of the people who get AHA BLS cards who rarely deal with emergencies, it can be a bit.

Compare it to noticing he's not breathing adequately as you walk up. When you reach the patient, you're beginning your pulse check pretty much immediately (after maybe a tap/shout) and start compressions. Fewer steps for one to mess up, drag out, delay, be unsure about.

No need to confirm that you don't feel breathing on your cheek or in your ear. 


Also, C-A-B are actions steps (not order of assessment, as explained earlier) so they do need to be done in order.


I very much appreciate the ABCDEs. And whenver taught, they're usually an explanation that they're done simultaneously...but you should know the order of priority for the times you can't do them simultaneously. Know the rules before you break them.


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## Jim37F (May 30, 2013)

The is how it was taught to me in my EMT class:

You put on your BSI and do your scene size up, approach your patient and get AVPU. If the patient is alert, or responsive to verbal or painful stimuli you go into the normal Airway, Breathing, Circulation, etc assessment. 

If the patient is not responsive in AVPU, then you immediately check the carotid pulse. If that's present, normal assessment. 

But it's when the patient is unresponsive and without a carotid pulse you start CAB, Compressions Airway Breathing.


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## STXmedic (May 30, 2013)

AnthonyM83 said:


> Do you have examples?
> I ask because I tend to dislike a lot of comments about how things are done differently in the field than from the classroom. That usually (but not always) is a sign of inadequate field performance....



My comment was directed towards the idea that students get their thinking is very linear and must follow the pneumonics. "Okay, I just asked Q, now I need to ask R... What is R again?..." or "So what's the next step after considering C-spine?" In the classroom you're taught that everything is systematic and one thing after the other. In reality, you need to be more dynamic, and you are processing and working with multiple lines of information at once.

I agree with you on the "this is how we do it in the field" shortcuts that people tend to make up out of laziness; or in the field the book doesn't really matter crap.


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## eonefireemt3 (Jul 13, 2013)

I think CAB makes much more sense. C= circulation. And part of that is assessing pulse. If you can't get a pulse, the rest is a moot point and compressions are a higher priority than breathing or airway. Again, this is evidence based treatment and we will do well to do it like AHA wants us to.


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