Airway, Breathing, Circulation, Disability, Exposure Research Articles

Using the NEWS2 and ABCDE assessment to identify early signs of clinical deterioration.

Nurses may encounter deteriorating patients in their clinical practice, so they require an understanding of the early physiological signs of deterioration and a structured approach to patient assessment. This enables appropriate management and a timely response to the most life-threatening issues identified, such as a compromised airway. This article describes how nurses can use early warning scores and a structured patient assessment, using the ABCDE (airway, breathing, circulation, disability, exposure) framework, to identify early signs of deterioration and facilitate the timely escalation of patient care where necessary.

Physicians' Knowledge of the Systematic ABCDE Approach in Riyadh, Saudi Arabia.

To evaluate physicians' knowledge of the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach components. A cross-sectional study was conducted in 2023 using an online questionnaire in order to collect data about the knowledge of the ABCDE approach's components among physicians in different specialties in Riyadh, Saudi Arabia. The number of participants were 165 in total and the median knowledge score for all participants was 15.0, with an associated interquartile range (IQR) of 10.0 to 20.0. Intensive Care Medicine had the highest median knowledge score of 19.0 (IQR: 12.0-21.0), followed by Internal Medicine at 17.0 (IQR: 13.0-20.0). Conversely, Cardiology and Anesthesiology showed lower scores, with medians of 8.0 (IQR: 4.0-10.0) and 7.5 (IQR: 4.0-13.5), respectively (p = 0.011). Senior Registrars demonstrated the highest median knowledge score of 20.0 (IQR: 14.0-22.0), while Fellows had the lowest at 8.5 (IQR: 7.0-13.0) (p < 0.001). Practicing for 10 to 15 years and more than 15 years having medians of 20.0 (IQR: 16.0-23.0) and 19.0 (IQR: 17.0-22.0), respectively. However, participants with less experience, working for less than 5 years, had a median score of 12.0 (IQR: 8.5-16.5) (p < 0.001). Knowledge scores of physicians representing various medical specialties found diverse levels regarding the ABCDE approach. Knowledge scores were significantly influenced by the primary area of practice, level of experience, and duration worked in the profession, highlighting the need for tailored training and education across different specialties and career stages. On the other hand, future studies should concentrate on finding new factors that influence practice adherence to the ABCDE approach and tying theoretical knowledge to clinical practice.

Health care professionals most relevant phrases used in a digital medical translation tool in 24-7 communication with minority speaking heart surgery patients during hospitalization

Abstract Background/Introduction Health care professionals’ communications with hospitalized minority speaking heart patients are even in 2023 still frequently limited to non-verbal language, notes from informal caregivers and "google translate" in situations where interpreters are not available. Health care based digital solutions aiding translation may help improve health care professionals’ assessment, information about and treatment of minority speaking patients, and there is an urgent need for innovative research into this area. Purpose To describe the most relevant phrases used by health care professionals’ in a digital, medical translation tool for 24-7 communication with minority speaking heart surgery patients during hospitalization. Methods A digital medical translation tool was customized using the internationally recognized ABCDE (Airway, Breathing, Circulation, Disability, Exposure) systematic approach to assess and treat, in addition with the pre-operative surgical safety checklist employed as a framework. Health care professionals’ use of phrases in the digital tool when communicating with the minority speaking heart surgery patient’s during their clinical hospital pathway (Figure 1) were then counted, categorized, and finally linked to health care professionals’ actions. Results Fifty-five health care professionals (i.e. registered nurses, intensive care nurses, operating room nurses, anaesthesia nurses and physiotherapists) were during 60 shifts with 24-7 follow-up of five minority speaking heart surgery patients using a total of 410 phrases from the digital medical translation tool. The phrases were categorized and counted into the ten most common categories (Figure 2): 1. Pain (e. g. are you in pain?), 2. Nutrition (e. g. are you hungry?), 3. Respiration (e.g. breathe in), 4. Mobilisation (e.g. you have to get up and stand), 5. Psychological support (e.g. the surgery went well), 6. Safe surgery (e.g. do you have any teeth that are loose?), 7. Medications (e.g. pain relievers), 8. Communication (e.g. just answer "yes" or "no"), 9. Examination (e.g. you are going to have an x-ray examination), 10. Circulation (e.g. do you feel dizzy?). Health care professionals’ actions (i.e. assessment, information and reassurance, and instructions) were categorized and related to these phrases. Conclusions A health care based digital medical translation tool can aid in communication with minority speaking patients in situations when interpreters are not available. This study shows how health care professionals’ use of such a translation tool when communicating with minority speaking heart surgery patients during hospitalization can employ phrases and categories 24-7 to improve patients’ healthcare.Fig.1 Clinical pathwayFig.2 HCP communication

Implementation of Prehospital Handover in the Emergency Department: A Proposed Novel SRCA Checklist in Saudi Arabia

Background: Maintaining effective clinical handover between prehospital services and emergency departments is crucial to recognize critical cases, guiding proper management, and determining final outcomes. Methods: This is a single-center cross-sectional study that was conducted between October 15, 2021, and July 30, 2022, in a tertiary care center in Riyadh, Saudi Arabia. A novel handover tool (SRCA checklist) was developed, and eight emergency medicine consultants checked its content validity. It contains 4 domains and 12 items and is based on previously validated tools after an extensive literature review and experts&amp;apos; opinions. The primary outcome of this study was to validate the newly developed tool aimed at assessing the quality of handover skills between prehospital medical care providers and emergency departments. The tool\&amp;apos;s reliability was examined using Cronbach\&amp;apos;s alpha method, while factor analysis with varimax rotation was used to examine the construct validity. Results: 147 handovers were captured in this study. Almost 50% of the observed handovers adhered to 7 out of 12 checklist criteria for assessing the handover quality. The chief complaint and associated symptoms were reported in 94.56% (n=139) of cases, and verbalizing of the Airway–Breathing–Circulation–Disability–Exposure (ABCDE) was seen in 75% (n=111) of cases.

"Bproblems" in non-traumatic resuscitation room management

Beim Primary Survey des nichttraumatologischen Schockraummanagements kritisch kranker Patienten dient das ABCDE-Schema zur sofortigen Erkennung und Therapie vitaler Gefährdungen. „B-Probleme“ gehen mit einer Störung der Atmung einher und bedürfen einer sofortigen Behandlung. Die Pathogenese von „B-Problemen“ ist gerade im nichttraumatologischen Schockraum vielfältig. Klinische Untersuchung, Notfallsonographie und Kenntnisse in den Oxygenierungstechniken und der Beatmung stellen hier wichtige Bestandteile der Diagnostik und Therapie dar. Hierzu sind ein standardisiertes Vorgehen und regelmäßiges Training in der Notaufnahme von elementarer Bedeutung.

Assessing and managing post-operative haemorrhage and haemorrhagic shock.

Improved surgical outcomes have been achieved as a result of preoperative risk assessments and developments in surgical and anaesthetic techniques. However, post-operative haemorrhage remains a life-threatening complication requiring swift recognition and management. This article explores the compensatory mechanisms the body employs during haemorrhage and how these may present as altered observations that can aid early recognition. It also describes the rapid assessment of patients using the ABCDE (airway, breathing, circulation, disability, exposure) approach and outlines the management interventions used to halt the bleeding and restore intravascular volume.

Undertaking a systematic assessment of patients with a traumatic brain injury.

Traumatic brain injury (TBI) is a time-critical injury, which means it is essential that patients with suspected TBI are assessed promptly and systematically using an approach such as ABCDE (airway, breathing, circulation, disability, exposure). Existing or emerging abnormal physiological parameters must be identified and addressed to maintain adequate brain perfusion, limit neurological cell death and minimise long-term disability. This article explains the pathophysiology of TBI and outlines the elements of a systematic patient assessment using the ABCDE approach.

Management of haemorrhage and haemorrhagic shock.

Haemorrhage is defined as the acute loss of blood from the circulating volume, while haemorrhagic shock is characterised by suboptimal perfusion caused by bleeding. Their prompt recognition and management is vital to ensure optimal outcomes. This article discusses the assessment and management of patients experiencing haemorrhage and developing haemorrhagic shock. It also outlines how these conditions are classified, and explains their pathophysiology. The article emphasises the importance of a thorough ABCDE (airway, breathing, circulation, disability, exposure) assessment and prompt identification of the source of bleeding, along with the initial management of a patient who is bleeding.

Use of simulation training to teach the ABCDE primary assessment: an observational study in a Dutch University Hospital with a 3–4 months follow-up

ObjectivesTo investigate short-term and long-term effectiveness of simulation training to acquire a structured Airway Breathing Circulation Disability Exposure (ABCDE) approach for medical emergencies; and to examine which skills were learnt...

ABCDE approach to victims by lifeguards: How do they manage a critical patient? A cross sectional simulation study.

IntroductionDecision-making in emergencies is a multifactorial process based on the rescuer, patient, setting and resources. The eye-tracking system is a proven method for assessing decision-making processes that have been used in different fields of science. Our aim was to evaluate the lifeguards’ capacity to perform the ABCDE (Airway-Breathing-Circulation-Disability-Exposure) approach when facing a simulated critically ill-drowned victim.MethodsA cross-sectional simulation study was designed to assess the skills and sequence of the ABCDE approach by 20 professional lifeguards. They had to assess a victim and act according to his/her clinical status by following the ABCDE primary assessment approach. The two kinds of variables were recorder: those related to the quality of each step of the ABCDE approach and the visual behaviour using a portable eye-movement system. The eye-tracking system was the Mobile Eye system (Bedford, USA).ResultsNone of the study participants were able to complete correctly the ABCDE approach. Lifeguards spent more time in the Circulation step: Airway (15.5±11.1 s), Breathing (25.1±21.1 s), Circulation (44.6±29.5 s), Disability (38.5±0.7 s). Participants spent more time in viewpoints considered as important (65.5±17.4 s) compared with secondary ones (34.6±17.4 s, p = 0.008). This was also represented in the percentage of visual fixations (fixations in important viewpoints: 63.36±15.06; fixation in secondary viewpoints: 36.64±15.06; p = 0.008).ConclusionProfessional lifeguards failed to fully perform the ABCDE sequence. Evaluation by experts with the help of eye-tracking technology detected the lifeguards’ limitations in the assessment and treatment of an eventual critically ill victim. Such deficits should be considered in the design and implementation of lifeguards’ training programmes.

A pre-post study of behavioural determinants and practice change in Ugandan clinical officers

Background. Understanding the drivers of ‘provider behaviour’ has been highlighted as one of the six domains of behaviour change in strengthening healthcare systems. Objectives. To assess changes in healthcare provider behaviour, i.e. use of the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach in acute illness management, after participating in a 1-day course on the assessment and management of acutely ill patients. We aimed to assess whether changes in psychological determinants of the ABCDE approach were associated with changes in the use of the approach. Methods. We used a pre-post design to study self-reported change in behaviour after a 1-day training course from pre-course to follow-up 1 month later. We also measured psychological determinants of behaviour immediately before and after and at 1-month follow-up. We explored if changes in psychological determinants were associated with change in practice 1 month later. Results. We found the following: firstly, use of the ABCDE approach increased at 1 month post-course from a median use of 50 - 90%. Secondly, the increase in the ABCDE approach was associated with a positive change in only one of the determinants of practice from pre- to post-course: perception of environmental determinants ( r =0.323; p <0.05). Finally, there were no other significant associations with practice change or practice at follow-up. Conclusions. Change in perceptions of availability of resources was associated with increased use of an ABCDE approach, but evidence was limited owing to the pre-post design.

Using a systematic approach to assess an acutely unwell patient with catatonia: a case study.

Patients in acute settings may present with a variety of signs and symptoms; however, the principles of assessment are applicable to all acutely unwell patients. This article details a case study of a patient who presented to the author's medical ward in a catatonic state, and was assessed using the ABCDE (airway, breathing, circulation, disability, exposure) approach. Catatonia is a disturbed mental state in which a patient exhibits abnormal behaviour, such as the inability to speak and non-responsiveness to stimuli, alongside immobility. Although catatonia is a rare condition, it is important that nurses can identify its signs and symptoms, because it can be fatal if not treated appropriately and rapidly. Thus, it is crucial for nurses to be able to systematically assess acutely unwell patients, including those with catatonia, using the ABCDE approach.

Using the ABCDE approach to assess the deteriorating patient.

Patients who deteriorate without recognition or timely interventions are at risk of critical care admission and increased morbidity or mortality. This article outlines the systematic ABCDE (airway, breathing, circulation, disability, exposure) approach to patient assessment, which enables healthcare practitioners to identify and respond to life-threatening conditions in order of priority. The patient's vital signs should be measured as part of the ABCDE assessment and recorded using a track and trigger tool to enhance recognition of physiological abnormalities that signal deterioration. To optimise communication and escalation of deteriorating patients, healthcare practitioners should report ABCDE assessment findings using a structured communication tool.

Hypovolaemic shock: assessment, pathophysiology and nursing care

Hypovolaemia leads to a number of physiological responses that require systematic assessment and interpretation. This article focuses on a case study of a patient with Parkinson's disease who became hypovolaemic after a fall at home, to illustrate the impact of hypovolaemia and current recommendations regarding fluid resuscitation. ABCDE (airway, breathing, circulation, disability, exposure) assessment and arterial blood gas analysis are considered, and interpretation is explained in light of the patient scenario.

Developments in the management of diabetic ketoacidosis in adults: implications for anaesthetists

### Key points Diabetic ketoacidosis (DKA) is a medical emergency. The diagnostic triad is: 1. Ketonaemia ≥3.0 mmol litre−1 or significant ketonuria (more than 2+ on urine sticks) 2. Blood glucose >11.0 mmol litre−1 or known diabetes mellitus 3. Bicarbonate <15.0 mmol litre−1, venous pH <7.3, or both. DKA can occur in both type 1 and type 2 diabetes mellitus and, although preventable, it remains a frequent and life-threatening complication. Errors in the management of DKA are not uncommon and are associated with significant morbidity and mortality. The majority of mortality and morbidity in DKA are attributable to delays in presentation and initiation of treatment. Rapid recognition and treatment of DKA is critical. To overcome these concerns and to highlight current management strategies, the Joint British Diabetes Societies (JBDS) published guidelines in 2010. This was updated in consultation with the Intensive Care Society in September 2013.1 This article will review the pathophysiology of DKA and highlight the modern management of DKA that is relevant for anaesthetists. A summary of the JBDS guidelines pertinent to intensivists has been published.2 In England in 2010, there were 14 375 admissions to …

How to assess deteriorating patients.

This article aims to help practitioners to undertake the assessment of deteriorating patients using a standardised ABCDE (airway, breathing, circulation, disability, exposure) approach that allows the practitioner to assess the patient in a structured and timely manner, and to identify the specific needs of the patient using the look, listen and feel method. Systematic assessment is central to recognising a deteriorating patient and to taking timely and appropriate action to minimise the incidence of further deterioration. The ABCDE approach can be used to identify patients at risk of becoming acutely unwell and to summon appropriate assistance at an early stage. The practitioner should review obtained physiological data to develop an effective management plan and indicate future investigations

1881 Systematic Method to Improve Management of Critically ill Children

BackgroundAkershus University Hospital is the largest acute care hospital in Norway. It employs 6.200 people to serve 460.000 inhabitants, of which 115.000 are children. Currently, our Department is experiencing an...

Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach

The Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach is applicable in all clinical emergencies for immediate assessment and treatment. The approach is widely accepted by experts in emergency medicine and likely improves outcomes by helping health care professionals focusing on the most life-threatening clinical problems. In an acute setting, high-quality ABCDE skills among all treating team members can save valuable time and improve team performance. Dissemination of knowledge and skills related to the ABCDE approach are therefore needed. This paper offers a practical “how-to” description of the ABCDE approach.

A reply

Thank you for the opportunity to respond to the letter by Dr Hogan concerning resuscitation for cardiac arrest caused by anaphylaxis during anaesthesia. First, Dr Hogan questions the use of a pulse check to diagnose cardiac arrest with pulseless electrical activity (PEA). Second, Dr Hogan suggests that external chest compressions are potentially harmful in PEA caused by anaphylaxis and other states where there is a profound decrease in systemic vascular resistance because loss of a palpable pulse can occur in the presence of a cardiac output and low systemic vascular resistance. Cardiac arrest secondary to anaphylaxis can occur rapidly following a rapid decrease in the patient’s blood pressure [1]. The precise moment when PEA cardiac arrest occurs is difficult to diagnose clinically. Palpation of the pulse as the sole indicator of the presence or absence of cardiac arrest is unreliable [2]. A pulse check alone to diagnose cardiac arrest has not been part of advanced life support guidelines for many years [3]. Dr Hogan is therefore correct that the absence of a palpable pulse alone should not indicate the need for chest compressions if there are other reliable indicators of the presence of an adequate cardiac output. During anaesthesia, continuous monitoring of vital signs in addition to clinical signs will help make the diagnosis. The most recent guidelines for advanced life support reinforce the important diagnostic role of waveform capnography to indicate the return of a spontaneous circulation [4]. Current guidance for the treatment of anaphylaxis from both the Association of Anaesthetists of Great Britain and Ireland (AAGBI) and the Resuscitation Council UK suggests using an ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach with adrenaline and intravenous fluids as key treatments [5, 6]. Adrenaline should be given in small intravenous increments (e.g. 50 μg in adults) or an infusion, if necessary, to treat anaphylaxis during anaesthesia. These treatments may have already started before cardiac arrest occurs and may be useful in the scenario Dr Hogan describes. If cardiac arrest does occur, standard advanced life support guidelines should be followed [7]. These include high quality chest compressions combined with adrenaline and fluid resuscitation. The recommended doses of adrenaline used during cardiac arrest are much higher (1 mg intravenously in adults). Care therefore needs to be taken to confirm cardiac arrest before giving this significantly higher dose of adrenaline. Although chest compressions are undoubtedly less effective in the presence of hypovolaemia, we are not aware of any evidence that chest compressions reduce cardiac output in the presence of a low blood pressure, regardless of whether this has been caused by a low cardiac output or a vasodilatory state. There are few data to provide a basis for specific guidance on the treatment of cardiac arrest from anaphylaxis during anaesthesia. The current guidance may prevent cardiac arrest in many circumstances, and ensures that cardiopulmonary resuscitation with advanced life support measures is started early if cardiac arrest occurs. Following standard guidelines for advanced life support importantly acknowledges the fact that there may be clinical uncertainty about the cause of cardiac arrest during anaesthesia. If the anaesthetist is unable to feel a pulse, chest compressions should be started unless there are other convincing and reliable indicators of the presence of an adequate cardiac output. JS chairs the anaphylaxis working group of the Resuscitation Council UK and contributed to the AAGBI anaphylaxis guidance. He is an editor of Resuscitation. JPN is a member of the anaphylaxis working group of the Resuscitation Council UK and is Editor-in-Chief of Resuscitation. No external funding declared. Previously posted at the Anaesthesia Correspondence website: http://www.anaesthesiacorrespondence.com.

Burns and Trauma: A PBL Module for the Surgical Clerkship

OPEN ACCESSSeptember 17, 2010Burns and Trauma: A PBL Module for the Surgical Clerkship Maureen Burke, Megan Frantz, Steven Healan, Stephanie Camaglia Reznick Maureen Burke Case Western Reserve University School of Medicine Google Scholar More articles by this author , Megan Frantz Case Western Reserve University School of Medicine Google Scholar More articles by this author , Steven Healan Case Western Reserve University School of Medicine Google Scholar More articles by this author , Stephanie Camaglia Reznick Case Western Reserve University School of Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.8282 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail Abstract Introduction: This paper-based problem-based learning (PBL) module, intended for students involved in their third-year year surgical clerkship, provides an opportunity for students to integrate clinical and basic science concepts related to the pathophysiology and clinical management of burns as well as to briefly review how to respond to a trauma. Methods: The content of this module, intended to be completed in a single 3-hour session, includes two written cases with “probing questions” for discussion. These cases are intended to help students achieve educational objectives related to acid-base homeostasis, principles of fluid management, principles of burn management, principles of wound healing and skin grafts, and clinical reasoning skills for responding to a trauma. The module also includes guidelines for how to supplement the PBL cases with an expert-led question-and-answer session. Results: This module has been ran three times with third-year medical students who were rotating through surgery (or who had recently completed their surgery rotations). Over 100 students and nine different facilitators have participated. Each time we ran the module, we collected feedback from the students and facilitators. Examples of comments include “Many learning points that are valuable. Enjoyed the case, everyone learned a lot. Good use of specific values and equations to apply our knowledge,” “Review of anion gap, respiratory vs metabolic acidosis was good. Also review of primary/secondary survey was good.” Much of which has been used to update and modify the module to better meet the goals and objectives. Discussion: This PBL module for third-year students was designed with the idea that basic science concepts can and should be revisited during the clinical years, in a way that encourages students to integrate these concepts into their clinical thought processes. Feedback from students speaks to the module's effectiveness in teaching basic concepts of trauma and burn care (which many students do not experience first-hand during their surgical rotation) as well as reviewing topics such as acid-base problems and differential diagnosis. Educational Objectives By the end of this session, learners will be able to: Compare primary versus secondary survey.Define airway, breathing, circulation, disability, exposure (ABCDE).Calculate acid-base status.List differential diagnosis for metabolic acidosis.Contrast maintenance vs. resuscitation fluids.Calculate resuscitation fluids for burns with Parkland formula.Calculate total body surface area (TBSA).List diagnostic criteria for four classes of burns.Describe management principles for minor burns.Describe how timing of a burn infection influences choice of empiric antibiotics.Explain when to treat a burn with a skin graft.Explain when to refer to a burn unit.Define primary and secondary wound closure.Describe three cellular stages of wound healing.Contrast contraction versus contracture.List three causes of impaired wound healing.Describe three steps for a skin graft to take. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Timeline.doc Facilitator's Guide.doc Instructor's Guide.doc Post-Module Handout for Students.doc Pre-Case and Case for Students.doc Sample Letter of Invitation for Expert.doc To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationBurke M, Frantz M, Healan S, Camaglia Reznick S. Burns and Trauma: A PBL Module for the Surgical Clerkship. MedEdPORTAL. 2010;6:8282. https://doi.org/10.15766/mep_2374-8265.8282 Copyright & Permissions© 2010 Burke et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsTraumaWound HealingBurnsSkin GraftingMetabolic AcidosisSkin TransplantationAcid-Base HomeostasisResuscitation FluidContracture Disclosures None to report. Funding/Support None to report. Loading ...