Emergency care and Resuscitation involve rapid assessment and early intervention. Approach to Emergency care and resuscitation need to be systematic hence the use of the ABCs approach.The ABCs approach provides the framework for the evaluation and treatment of severely ill patients.A stand for Airway, B for Breathing, C for Circulation

 

perfomingcpr

Primary survey

I. Airway

Assess the airway to establish patency of the airway. This includes:

·        Looking for signs of airway obstruction (signs of trauma, swelling, secretions,

presence of foreign body).

·        Listen for abnormal sounds like stridor, snoring.

If there are signs of airway obstruction intervene by positioning, opening, and clearing the airway.

Perform chin lift or jaw thrust maneuver to open the airway (If suspecting cervical spine injury use

the jaw thrust maneuver). Use suction to remove the secretions. Airway adjuncts like

oropharyngeal or nasopharyngeal airway can be used.

 

Note

·        Remember to reassess the airway after performing interventions

·        Some the patient may require the use of advance airway devices like endotracheal intubation or

surgical airway

 

II. Breathing

Upon completing airway assessment and intervention, assess for the presence of breathing, signs

of respiratory distress such as tachypnea, hypoxia, cyanosis, apnoea, and abnormal breath

sounds.Provide oxygen when oxygen saturation is below 92% or the patient is dyspnoeic.

Oxygen can be administered using the nasal prong, simple face mask, non-rebreather mask or

Ambu bag. Advance interventions include mechanical ventilation.

 

III. Circulation

Check for pulse (central pulse) for not more than 10 seconds. If absent start CPR

 




. Assess for poor peripheral perfusions

(shock) signs such as cold extremities, prolonged capillary refill, dry mucous membrane, and

hypotension. If there are signs of shock, establish two (2) IV large bore cannula and give IV

fluids (crystalloids) bolus (2lts in adults and 20mls/kg in pediatrics). Limit fluids to individuals

whom you suspect to have heart failure, renal failure, or malnourished children.

IV. Disability

This involves rapid assessment of the neurological status. This includes assessment for the

level of consciousness (use of AVPU or Glascow coma scale), signs of convulsions, random

blood glucose level, examination of the pupils and presence of focal neurological

deficit.Interventions that can be performed during the disability assessment include: correction

of hypoglycemia, airway protection, stopping the convulsions by administering anticonvulsant

 

V. Exposure

This involves fully exposing the patient and rapid assessment of the body for signs of trauma,

rashes or infection.

 

Secondary survey

After assessment and stabilization of ABCs during the primary survey, the focus is turned into

a secondary survey. The secondary survey is a systematic assessment of the rest of the body to

identify injuries and illnesses. Common approaches include a head to toe or organ –system-based

assessment. It is important to note that the secondary survey is performed after the primary

assessment and interventions. When performing a secondary survey, if the patient condition

changes then you must stop immediately and redo the primary survey and necessary interventions.

Note:

All patients with compromised airway, breathing, circulation, or disability must be attended in the

resuscitation rooms.

REFERENCES;

•      Braunwald & Fauci (2001). Harrison’s principles of internal medicine 15th Ed.  Oxford: McGraw Hill

•      Davidson, S (2006). Principles and practice of medicine 20th Ed.  Churchill: Livingstone.

Kumar & Clark (2003) Textbook of clinical medicine. Churchill: Livingstone.

•      Douglas Model (2006): Making sense of Clinical Examination of the Adult patient. 1st Ed. Hodder Arnold

•      Longmore, M., Wilkinson, I., Baldwin, A., & Wallin, E. (2014). Oxford handbook of clinical medicine. Oxford

•      Macleod, J. (2009). Macleod's clinical examination. G. Douglas, E. F. Nicol, & C. E. Robertson (Eds.). Elsevier Health Sciences.

•      Nicholson N., (1999), Medicine of Non-communicable diseases in adults. AMREF

•      Stuart and Saunders (2004): Mental health Nursing principles and practice. 1st Ed. Mosby

•      Swash, M., & Glynn, M. (2011). Hutchison's clinical methods: An integrated approach to clinical practice.