ABC (medicine)
ABC and its variations are
In 2010, the
Medical use
At all levels of care, the ABC protocol exists to remind the person delivering treatment of the importance of airway, breathing, and circulation to the maintenance of a patient's life. These three issues are paramount in any treatment, in that the loss (or loss of control of) any one of these items will rapidly lead to the patient's death. The three objectives are so important to successful patient care that they form the foundation of training for not only first aid providers but also participants in many advanced medical training programs.[5][6][7][8][9]
Airway, breathing, and circulation, therefore work in a cascade; if the patient's
CPR
The basic application of the ABC principle is in first aid, and is used in cases of unconscious patients to start treatment and assess the need for, and then potentially deliver, cardiopulmonary resuscitation.
In this simple usage, the rescuer is required to open the
In the event that the patient is not breathing normally, the current international guidelines (set by the International Liaison Committee on Resuscitation or ILCOR) indicate that chest compressions should be started.
Previously, the guidelines indicated that a pulse check should be performed after the breathing was assessed, and this made up the 'circulation' part of the initialism, but this pulse check is no longer recommended for lay rescuers. Some trainers continue to use circulation as the label for the third step in the process, since performing chest compressions is effectively artificial circulation, and when assessing patients who are breathing, assessing 'circulation' is still important. However, some trainers now use the C to mean Compressions in their basic first aid training.
Airway
Unconscious patients
In the unconscious patient, the priority is
.At a basic level, opening of the airway is achieved through manual movement of the head using
Higher level practitioners such as
Conscious patients
In the conscious patient, other signs of airway obstruction that may be considered by the rescuer include paradoxical chest movements, use of accessory muscles for breathing, tracheal deviation, noisy air entry or exit, and cyanosis.[14]
Breathing
Unconscious patients
In the unconscious patient, after the airway is opened the next area to assess is the patient's breathing,
Rescuers are often warned against mistaking
If a patient is breathing, then the rescuer will continue with the treatment indicated for an unconscious but breathing patient, which may include interventions such as the recovery position and summoning an ambulance.[15]
Conscious or breathing patients
In a conscious patient, or where a pulse and breathing are clearly present, the care provider will initially be looking to diagnose immediately life-threatening conditions such as severe
- Checking for general respiratory distress, such as use of accessory muscles to breathe, abdominal breathing, position of the patient, sweating, or cyanosis
- Checking the respiratory rate, depth and rhythm - Normal breathing is between 12 and 20 in a healthy patient, with a regular pattern and depth. If any of these deviate from normal, this may indicate an underlying problem (such as with Cheyne-Stokes respiration)
- Chest deformity and movement - The chest should rise and fall equally on both sides, and should be free of deformity. Clinicians may be able to get a working diagnosis from abnormal movement or shape of the chest in cases such as haemothorax
- Listening to external breath sounds a short distance from the patient can reveal dysfunction such as a rattling noise (indicative of secretions in the airway) or stridor (which indicates airway obstruction)
- Checking for surgical emphysema which is air in the subcutaneous layer which is suggestive of a pneumothorax
- Auscultation and percussion of the chest by using a stethoscope to listen for normal chest sounds or any abnormalities
- Pulse oximetry may be useful in assessing the amount of oxygen present in the blood, and by inference the effectiveness of the breathing
Circulation
Once oxygen can be delivered to the lungs by a clear airway and efficient breathing, there needs to be a circulation to deliver it to the rest of the body.
Non-breathing patients
Circulation is the original meaning of the "C" as laid down by Jude, Knickerbocker & Safar, and was intended to suggest assessing the presence or absence of circulation, usually by taking a
In modern protocols for lay persons, this step is omitted as it has been proven that lay rescuers may have difficulty in accurately determining the presence or absence of a pulse, and that, in any case, there is less risk of harm by performing chest compressions on a beating heart than failing to perform them when the heart is not beating.[16] For this reason, lay rescuers proceed directly to cardiopulmonary resuscitation, starting with chest compressions, which is effectively artificial circulation. In order to simplify the teaching of this to some groups, especially at a basic first aid level, the C for Circulation is changed for meaning CPR or Compressions.[17][18][19]
It should be remembered, however, that health care professionals will often still include a pulse check in their ABC check, and may involve additional steps such as an immediate
Breathing patients
In patients who are breathing, there is the opportunity to undertake further diagnosis and, depending on the skill level of the attending rescuer, a number of assessment options are available, including:
- Observation of color and temperature of hands and fingers where cold, blue, pink, pale, or mottled extremities can be indicative of poor circulation
- Capillary refill is an assessment of the effective working of the capillaries, and involves applying cutaneous pressure to an area of skin to force blood from the area, and counting the time until return of blood. This can be performed peripherally, usually on a fingernail bed, or centrally, usually on the sternum or forehead
- Pulse checks, both centrally and peripherally, assessing rate (normally 60-80 beats per minute in a resting adult), regularity, strength, and equality between different pulses
- Blood pressure measurements can be taken to assess for signs of shock
- Auscultation of the heart can be undertaken by medical professionals
- Observation for secondary signs of circulatory failure such as edema or frothing from the mouth (indicative of congestive heart failure)
- ECG monitoring will allow the healthcare professional to help diagnose underlying heart conditions, including myocardial infarctions
Variations
Nearly all first aid organisations use "ABC" in some form, but some incorporate it as part of a larger initialism, ranging from the simple 'ABCD' (designed for training lay responders in defibrillation) to 'AcBCDEEEFG'[citation needed] (the UK ambulance service version for patient assessment).
ABCD
There are several protocols taught which add a D to the end of the simpler ABC (or DR ABC). This may stand for different things, depending on what the trainer is trying to teach, and at what level.[20] The D can stand for:
- Defibrillation[21] — Defibrillation is the definitive treatment step for those cases of cardiac arrest that involve a shockable rhythm, or one correctable by defibrillation (pulseless unstable ventricular tachycardia, coarse or fine ventricular fibrillation; it will not work for asystole or pulseless electrical activity)
- Disability, deformity, or Dysfunction[2][22] — Disabilities or deformities caused by the injury, not pre-existing conditions
- Deadly Bleeding[23][24]
- (Differential) Diagnosis[25]
- Decompression[26]
ABCDE
Additionally, some protocols call for an 'E' step to patient assessment. All protocols that use 'E' steps diverge from looking after basic life support at that point, and begin looking for underlying causes.[27] In some protocols, there can be up to 3 E's used. E can stand for:
- Expose and Examine[2][22] — Predominantly for ambulance-level practitioners, where it is important to remove clothing and other obstructions in order to assess wounds.
- Environment[28][29] — only after assessing ABCD does the responder deal with environmentally related symptoms or conditions, such as cold and lightning.
- Escaping Air — Checking for air escaping, such as through a sucking chest wound, which could lead to a collapsed lung.
- Elimination[26]
- Evaluate — Is the patient "time-critical" and/or does the rescuer need further assistance.
ABCDEF
An 'F' in the protocol can stand for:
- Fundus — relating to pregnancy, it is a reminder for crews to check if a female is pregnant, and if she is, how far progressed she is (the position of the fundus in relation to the bellybutton gives a ready reckoning guide).[30]
- Family (in France) — indicates that rescuers must also deal with the witnesses and the family, who may be able to give precious information about the accident or the health of the patient, or may present a problem for the rescuer.
- Fluids[26] — A check for obvious fluids (blood, cerebro-spinal fluid (CSF) etc.)
- Fluid resuscitation[29]
- Final Steps[31] — Consulting the nearest definitive care facility
ABCDEFG
A 'G' in the protocol can stand for
- Go Quickly! — A reminder to ensure all assessments and on-scene treatments are completed with speed, in order to get the patient to hospital within the Golden Hour
- Glucose — The professional rescuer may choose to perform a
- Girl Check — Is also used as a reminder that all women of child-bearing age need to be tested for potential pregnancy, as this may guide treatment.
AcBC
Some trainers and protocols use an additional (small) 'c' in between the A and B, standing for '
CABC
The military frequently use a CABC approach, where the first C stands for "catastrophic haemorrhage". Violent trauma cases indicate that major blood loss will kill a casualty before an airway obstruction, so measures to prevent hypovolemic shock should occur first.[35] This is often accomplished by immediately applying a tourniquet to the affected limb.
DR ABC
One of the most widely used adaptations is the addition of "DR" in front of "ABC", which stands for Danger and Response.
In some areas, the related SR ABC is used, with the S to mean Safety.[19]
DRsABC
A modification to DRABC is that when there is no response from the patient, the rescuer is told to send (or shout) for help and to send some signal to your location' [38][39]
DRSABCD
Incorporates the additional S for "shout" (in the UK) or "send for help" (in Australia), and D for "defibrillation".[40][41]
MARCH
An expansion on CABC that accounts for the significantly increased risk of hypothermia by a patient due to hypovolemia and the body's subsequent cold weather-like reaction.
- Massive Haemorrhage
- Airway
- Respiratory
- Circulation
- Head injury/Hypothermia
History
The 'ABC' method of remembering the correct
As of 2010, the American Heart Association chose to focus CPR on reducing interruptions to compressions, and has changed the order in its guidelines to Circulation, Airway, Breathing (CAB).[48]
See also
- Cardiopulmonary resuscitation
- Artificial respiration
- Recovery position
- First aid
References
- ^ a b Wright, Pearce (2003-08-13). "Obituary: Peter Safar". The Guardian. London. Retrieved 2014-12-06.
- ^ a b c "A systematic approach to the acutely ill patient". Resuscitation Council (UK). June 2005. Archived from the original on 18 July 2005. Retrieved 2008-12-20.
- S2CID 1031566.
- PMID 20956249.
- ^ "First Aid (City of Dearborn MI FD website)". Archived from the original on December 9, 2007. Retrieved 2008-12-23.
- ISBN 978-0-7637-2066-7.
- ^ "Emergency Scene Management". Archived from the original on 2009-02-03. Retrieved 2008-12-23.
- ISBN 978-0-7637-3316-2.
- ISBN 978-0-387-32327-5.
- ^ Kastenbaum, Robert (2006). "Definitions of Death". Encyclopedia of Death and Dying. Archived from the original on 3 February 2007. Retrieved 2007-01-27.
- ^ a b c d "Adult Basic Life Support" (PDF). Resuscitation UK Guidelines. Resuscitaton Council (UK): 14. Archived from the original (PDF) on 2 December 2005. Retrieved 2008-12-19.
- ^ "Airway Management". Archived from the original on 21 October 2008. Retrieved 2008-12-19.
- ISBN 978-0-8247-0537-4.
- ^ ISBN 978-1-903812-12-9.
- ^ "Recovery Position". Archived from the original on 2009-02-03. Retrieved 2008-12-19.
- ^ "New CPR Standards". Retrieved 2008-12-19.
- ^ "Emergency Action Plan". Parasol EMT. Archived from the original on 8 January 2009. Retrieved 2008-12-22.
- ^ "Assessor's guide to passing your First Aid at Work exam". Mediaid Training Services. Archived from the original on 2018-10-05. Retrieved 2008-12-22.
- ^ a b "The Priority Action Plan". St John New Zealand. Archived from the original on 2008-10-14. Retrieved 2008-12-22.
- ^ "First Aid: Prehospital Care (Student BMJ website)". Retrieved 2008-12-19.
- ^ Cayley, William E Jr (2006-05-01). "Practice guidelines: 2005 AHA guidelines for CPR and Emergency Cardiac Care". American Family Physician. Archived from the original on 21 August 2008.
- ^ ISBN 9780953941100.
- ^ "Remote Area First Aid Course". Rift Valley Adventures. Archived from the original on 26 January 2004. Retrieved 2008-12-20.
- ^ "Emergency First Aid with Level C CPR". Western Canada Fire & First Aid Inc. Archived from the original on 2008-06-09. Retrieved 2008-12-20.
- .
- ^ PMID 1985304.
- ISBN 978-0-7627-2801-5.
- ^ Cass, D; Dubinsky, I; Thompson, M; Freedman, M; Klompas, M (2000). Emergency Medicine (PDF). MCCQE. Retrieved 2008-12-20.
- ^ a b Accident Compensation Corporation (June 2007). Management of burns and scalds in primary care. New Zealand Guidelines Group.
- ^ Fisher, Joanne; Brown, Simon; Cooke, Matthew; Walker, Alison; Moor, Fionna; Crispin, Pam. UK Ambulance Services Clinical Practice Guidelines 2013. Joint Royal Colleges Ambulance Liaison Committee/Association of Ambulance Chief Executives/Class Professional Publishing.
- ^ "Pediatric clinical practice guidelines for nurses in primary care". Health Canada. Archived from the original on 2008-09-16. Retrieved 2008-12-21.
- ^ Clive Roberts. "Acute Poisoning".
- ^ "The perfect crime". Student BMJ.
- ^ Occupational First Aid. Level 5 (PDF). Further Education and Training Awards Council. July 2008. Archived from the original (PDF) on 2012-02-19. Retrieved 2008-12-21.
- ^ The military's use of advanced medical techniques in emergency care on the battlefield
- ^ "The primary survey". St John Ambulance. Archived from the original on 6 December 2008. Retrieved 2008-12-20.
- ^ Committee on CPR of the Division of Medical Sciences, National Academy of Sciences-National Research Council, Cardiopulmonary resuscitation, JAMA 1966;198:372-379 and 138-145.
- ^ Stebbing, James. "The Primary Survey" (PDF). Archived from the original (PDF) on 2010-02-21. Retrieved 2008-12-19.(website no longer in operation)
- ^ Gibson, Tracey; Cole, Elaine; McLeod, Anne. "Cardio Pulmonary Resuscitation" (PDF). Centre for Excellence in Teaching and Learning.
- ^ Morley, J and Sprenger C (2012), First Aid Handbook, Highfield
- ^ The Ultimate Guide to the DRSABCD action plan, Accidental Health and Safety, (accessed November 1, 2023)
- ^ "Cardiopulmonary Resuscitation (Charles University School of Medicine website)". Retrieved 2008-12-19.
- PMID 12759308.
- ^ Robinson, K. "A student paramedic's tribute to Peter Safar" (PDF). Journal of Emergency Primary Health Care. 1 (1–2). Retrieved 2008-12-19.
- ^ "A Shock to the System". Archived from the original on 2008-12-02. Retrieved 2008-12-19.
- ^ "The Engineer Who Could (Hopkins Medical News website)". Archived from the original on 2012-02-20. Retrieved 2008-12-19.
- PMID 13526920.
- ^ Hazinski, M. F., ed. (October 2010). Highlights of the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. American Heart Association. pp. 2–7.