# First step in assessing unresponsive pt



## intelli78 (Sep 23, 2012)

Hello all. I am a few weeks in to my EMT-B class. We're using the AAOS book. I have a question about NREMT versus AHA guidelines in regard to unresponsive patients. 

Let's say that you have an unresponsive adult patient. The NREMT trauama/medical skills sequence (source: 2011 version, latest) indicates that an airway check comes before a pulse check. But, AHA says that a pulse check comes before airway (in fact, before the CAB sequence entirely)  (source: p8 of 2011 BLS for Healthcare Providers manual).

Can someone explain the logic to me here? It seems there are two authoritative sources that contradict each other. Thanks in advance.


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## DesertMedic66 (Sep 23, 2012)

Responsive patients are ABC. 

Unresponsive patients are CAB. 

The NREMT skill sheets are set up for a guideline for both responsive and unresponsive patients. The NREMT would have to make up 2 different skill sheets for both medical and trauma in order to make the changes depending on the patients LOC.


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## Jambi (Sep 23, 2012)

firefite said:


> Responsive patients are ABC.
> 
> Unresponsive patients are CAB.



This


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## jameswf (Sep 23, 2012)

Look at the BVM skill sheet. 

It says pulse, If pulse is present then bag 30 sec and recheck pulse. 

Remember this Pulmonary and Cardio work together and one is generally useless without the other.

O2 means nothing without blood to move it.
Blood is useless without O2


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## hibiti87 (Sep 23, 2012)

to answer your question yes there are two opposing authorities. Go with your NREMT guide lines so that you will get the questions correct when testing for your course.

also from your previous thread the reasoning behind CAB for AHA, CPR can be messy at time and it has been found that bystanders are more incline to perform chest compressions as it is a less invasive procedure compared to rescue breathing along with numerous other reasons


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## WuLabsWuTecH (Sep 27, 2012)

I was taught that even after the revision, CAB only has to do with the procedure of CPR.  Everything else is still ABC including assessment of both types of patients (responsive and unresponsive).

Is this no longer correct?  I guess it doesn't make much sense, but it was what I learned this last time through...


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## Chimpie (Sep 27, 2012)

First step is bsi and scene safety.


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## DesertMedic66 (Sep 27, 2012)

WuLabsWuTecH said:


> I was taught that even after the revision, CAB only has to do with the procedure of CPR.  Everything else is still ABC including assessment of both types of patients (responsive and unresponsive).
> 
> Is this no longer correct?  I guess it doesn't make much sense, but it was what I learned this last time through...



For the new standards you start off with C (checking for a pulse) then you go into compressions if no pulse. Then you go to airway and then breathing. 

For your unresponsive patient it's the same way (at least how we teach it). 

If you treat unresponsive patients with ABC (full arrests are unresponsive) then your also treating CPR patients with ABC with the last step being pulse check and compressions. 

I couldn't think of a better way to explain it.


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## RackCityEMT (Sep 27, 2012)

They taught us to kind of check all three at once for unresponsive. Look Listen Feel type thing. I know I am not a seasoned EMT but it does make sense to do all at once. I may be wrong and correct me if I am but it sounds like it works.


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## mike1390 (Sep 27, 2012)

WuLabsWuTecH said:


> I was taught that even after the revision, CAB only has to do with the procedure of CPR.  Everything else is still ABC including assessment of both types of patients (responsive and unresponsive).
> 
> Is this no longer correct?  I guess it doesn't make much sense, but it was what I learned this last time through...




How would you know that an unresponsive pt wasn't a full arrest?


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## RackCityEMT (Sep 27, 2012)

mike1390 said:


> How would you know that an unresponsive pt wasn't a full arrest?



this


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## mycrofft (Sep 27, 2012)

Layperson CPR doesn't do pulses. Professional responder and higher: pule taken, pupils checked etc.

I used to have an ammonia inhalant ready, not only do you see if they are alive, but conscious. Under one second. Then rapidly go to VS etc. Had a lot of factitious man downs.


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## WuLabsWuTecH (Sep 27, 2012)

mike1390 said:


> How would you know that an unresponsive pt wasn't a full arrest?



Guess I never thought about it.  I do in fact do all three simultaneously...


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## leoemt (Sep 28, 2012)

WuLabsWuTecH said:


> I was taught that even after the revision, CAB only has to do with the procedure of CPR.  Everything else is still ABC including assessment of both types of patients (responsive and unresponsive).
> 
> Is this no longer correct?  I guess it doesn't make much sense, but it was what I learned this last time through...



I graduated EMT class this past May. We were taught to NREMT Standards and had to take the NR test. 

Our instruction was ALL assessment is the pretty much the same in regards to ABC's.

Unresponsive pt. is ABC's UNTIL you determine CPR is necessary, then it becomes CAB. 

Just because a patient is unresponsive does not mean CPR is necessary. You need to find out why they are unresponsive.


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## mycrofft (Sep 28, 2012)

Bingo.


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## benasack2000 (Jul 9, 2015)

And that includes taking the time to open the airway, check breathing, and check for a pulse before beginning compressions. Wouldn't this be going against the AHA guidelines?

Would you just check the pulse before even going into the ABCs to determine if compressions are necessary in an unresponsive patient? I realize it is extremely unlikely you can have no pulse but be breathing. Then if you did find the PRECENSE of a pulse, then move into the ABCs and actually assess it (rate,rhythm,quality)? Sorry but these opposing guidelines confuse me.


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## Aprz (Jul 9, 2015)

AHA and NREMT are two different organizations so they might use different standards or adopt some from each other. For example, the NREMT is going to recommend high flow oxygen for most patients (pretty much non rebreather unless they can't tolerage it) while the new AHA ACLS standard is maintain a SpO2 of at least 94; 100 is not necessary. So remember that one organization standards or tests will be different from the other. Pick the answer that the organization / class wants to hear.

I was under the impression that it is ABC unless it is an unresponsive patient. Download the medical or trauma assessment skill sheet direct from the NREMT and you'll see it is still ABC. It is CAB in their cardiac arrest scenario / skill station.

https://www.nremt.org/nremt/about/psychomotor_exam_emt.asp

In real life, most of it is simultaneous and (trying to) using sound judgement.

Patients in cardiac arrest can have agonal respirations especially within the first couple minutes.


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## RedAirplane (Jul 11, 2015)

People are getting assessment and treatment mixed up, I think. 

CAB is for compressions, airway maneuver, (rescue) breaths. It's an algorithm. 

ABC is for airway? Breathing? Circulation? (Is there air going in and out? Do you feel a pulse?) this can be done wiith two fingers on the carotid while looking for chest rise and fall

I think confusion comes from the fact that ABC also was the algorithm before the current guidelines.


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