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UNIVERSITY OF RIJEKA

FACULTY OF MEDICINE
MEDICAL ENGLISH 1
MAY 12, 2015

PATIENT EVALUATION

NIKOLA COLOVIC
1ST YEAR
doc. dr. sc. ARIJANA KRISKOVIC, prof.

CONTENTS
INTRODUCTION

1. WHEN INJURY OCCURS

2. ABCDE APPROACH

2.1. A - AIRWAY

2.2. B - BREATHING

2.3. C - CIRCULATION

2.4. D - DISABILITY

2.5. E - EXPOSURE

3. SAMPLE

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CONCLUSION

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SUMMARY

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REFERENCES

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INTRODUCTION

In my paper work I will be writing about evaluating an injured or ill


person following the ABCDE approach in order to properly help her. First, I
will be writing about correct approach at the scene then step by step explain
ABCDE approach - what to do; what to check; what to expect; what to look
for. After thoroughly explaining ABCDE approach I will be writing about
SAMPLE which helps you gather more information about the victim.

WHEN INJURY OCCURS


When encountering a victim it is very important not to panic. If calmed
down we must check the scene and determine safety of the scene, possible
causes of injuries and number of victims. Checking the safety of scene is
vital so victim can be kept from more harm and to keep ourselves uninjured.
This means removing all objects that can make harm or calling adequate
public services like firefighters for help making the scene safer in cases such
as fire, traffic accidents etc. Also we must protect ourselves by using medical
exam gloves. While approaching a victim we introduce ourselves and come
from front so the victim does not get scared of us. After getting to victim we
start ABCDE approach.

ABCDE APPROACH
The Airway, Breathing, Circulation, Disability, Exposure (ABCDE)
approach is a systematic approach to the immediate evaluation and
treatment of injured or ill patients and it is used because there is no
equipment needed at all. The aims of this procedure are recognising the
injury on time, treating it properly, reducing the pain and shortening the
recovery time. The ABCDE approach is applicable for all patients and kinds of
injuries or conditions except in cardiac arrest where cardiopulmonary
resuscitation (CPR) is needed. The mnemonic ABCDE stands for Airway,
Breathing, Circulation, Disability, and Exposure. First, life-threatening airway
problems are recognised and treated; second, life-threatening breathing
problems are recognised and treated; and so on. Using this structured
approach, the goal is to quickly identify life-threatening problems and try to
treat them.[2] The ABCDE approach should be repeated every 15 minutes or
often if necessary.
A - Airway
Airway can be patent, partially obstructed or completely obstructed.
Before looking at the airway we can recognise obstructions by listening to
victim's breathing. Signs of partially obstructed airway are strange noises,
increased breathing effort,

changed voice while signs of completely

obstructed airway is that there is no breathing despite great effort.


Obstructed airway is often followed by passing out if not treated. To make
sure that airway is patent we open victim's mouth and look for any
obstructions such as tongue or small objects. If there are any, we remove
them quickly or we tilt victim's head and lift chin which keeps airway open.
[1]

B - Breathing
After making sure that airway is patent we check victims breathing by
looking, listening and feeling. First we tilt victim's head which is followed by
positioning our cheek in front of victim's mouth with our eyes looking at
victim's chest.[2] We stay in this position for about 8 to 10 seconds. If there
is no breathing, we start with CPR procedure while checking for foreign
bodies in victim's mouth. If the victim is breathing we can determine
respiratory rate (normal rate is between 12 and 20 breaths per minute), the
depth of each breath, the pattern of respiration and whether chest expansion
is equal on both sides.[3] The variations of depth of breath or pattern of
respiration can be signs of life-threatening conditions like choking or
pneumothorax. Also, we listen to the victim's breath sounds in search for
any irregularities like snoring, gurgling, crowing or wheezing which indicates
different obstructions in victim's airway. Snoring is caused by partially
obstructed airway, usually by tongue. Gurgling is caused by fluids in throat.
Crowing which is birdlike sound is caused by spasm of the larynx or foreign
body. Wheezing is caused by spasm or partial obstruction in bronchi.[1]
After checking and ensuring sufficient breathing, we can proceed onto the
next step.
C - Circulation
In this step we palpate peripheral and central pulses, look for
haemorrhages, check the capillary refill and skin condition. Central pulse is
being palpate at the carotid artery down and left or right from laryngeal
prominence while peripheral pulse is being palpate at the radial artery about
3 centimeters up from the wrist. By palpating pulse we can assess its
presence, rate (normal pulse rate is between 60 to 80 beats per minute),
quality, regularity and equality.[3] If pulse is not present, we need to start
CPR. Irregularities in pulse that we determine can be signs of different life6

threatening conditions like internal bleeding, shock, external bleeding and so


on. After checking the pulse we look for external haemorrhages from wounds
by searching for pools of blood around and on the victim. If external
haemorrhage is found, we need to stop it by applying pressure and treating
it with a bandage. It is very important to avoid contact with victim's blood.
Next step is checking the capillary refill by pressing part of the victim's skin
where it is close to the bone (eg. forehead). Normal time of capillary refill is
up to 2 seconds and everything above that indicates poor circulation.[1]
Checking the victim's skin means checking the skin colour, temperature and
condition which can be providing extra information about victim's condition.
Skin colour can be determined by looking at it. Pink skin is normal; red or
flushed skin means dilated blood vessels and excess circulation to that part
of the body; white or pale skin means constricted blood vessels from blood
loss, shock, hypothermia; blue or cyanosis skin means lack of oxygen in the
blood from breathing or heart problems while yellow or jaundice skin means
liver disease or failure.[1] After determining the skin colour, we can roughly
determine the skin temperature and moisture by putting back of our hand on
the victim's forehead. Warm and dry skin is normal; hot and dry or moist
skin means excessive body heat caused by heat stroke or high fever; cool
and moist skin means poor circulation, heat exhaustion, shock, acute stress
reaction; cold and moist skin means that body is loosing heat while cold and
dry skin is sign of hypothermia.[1]

D - Disability
After checking airway, breathing and circulation, comes checking the
level of consciousness by using AVPU method and checking the pupils. AVPU
mnemonic stands for alert (A), verbal (V), pain (P) and unresponsive (U).
Victim is alert if his or hers eyes are open, he or she can answer the
questions clearly, knows where he or she is and his or her name. Victim is
responsive to verbal stimulus if he or she responds in some meaningful way
when spoken to. Victim is responsive only to painful stimulus if he or she
moves or cries out in response to a painful stimulus such as pinching. Victim
is unresponsive to any stimulus if he or she does not response to any
stimulus.[1] Pupils are checked with flashlight or similar source of light and
we are looking the size, equality and reaction to light of victims pupils. This
can help us decide if there is brain damage or is the victim dead if he or she
does not breathe or has pulse.
E - Exposure
The last step in ABCDE approach means removing clothes of the victim
so we can look at his or her body for hidden injuries. While removing clothes
we must do it to respect victims dignity and to prevent heat loss.[3] Then
comes thorough examination of victims body part by part using the
mnemonic DOTS where D stands for deformity (abnormal shape of the
body part compared to uninjured part caused by broken bone or dislocated
joint), O stands for open wounds (parts where skin is broken and there is
bleeding),

stands

for

tenderness

(parts

where

touching

causes

sensitivity, discomfort or pain) and S stands for swelling (parts that looks
larger than usual because of excess fluid in the tissue). First body part that
is being checked is head. We check for DOTS and if there is any clear or
blood-tinged fluid coming out of the ears and nose. After head, the neck is
being checked for DOTS. After neck, both chest and abdomen are being
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checked for DOTS by gently presses. Same as chest and abdomen, pelvis is
being checked for DOTS by gently presses. After checking the body we are
passing to extremities where we check both arms and legs for DOTS. If the
victim is responsive we can also check for spinal injury by asking the victim
if he or she can feel us squeezing his or her fingers and toes; if he or she
can wiggle his or her fingers and toes; if he or she can squeeze our hand or
he or she can push his or her foot against our hand. After concluding that
there is no spinal injury, we can check victims back for DOTS.[1]

SAMPLE
After finishing ABCDE procedure, we need to gather information about
victim by asking the victim or someone close to him or her if possible. In this
part of evaluating the patient we are using mnemonic SAMPLE in which S
stands for symptoms (also known as chief complaint, usually the pain in
injured part of the body), A stands for allergies (medications or something
else), M stands for medications (ones that victim is regularly using lately),
P stands for past medical history (if victim is ill in some way, usually if
victim is diabetic or similar), L stands for last meal (what was the last thing
victim has ate or drank) and E stands for events preceding the incident
(what caused the injury). These information are significant for doctors at the
emergency room so they can properly dosage the right medications if
needed.[1]

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CONCLUSION
The ABCDE approach is a strong clinical tool for the initial assessment
and treatment of victims in acute medical and surgical emergencies,
including both prehospital first-aid and in-hospital treatment. It aids in
determining the seriousness of a condition and to prioritize initial clinical
interventions. Widespread knowledge of and skills in the ABCDE approach
are likely to enhance team efforts and thereby improve patient outcome.[2]

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SUMMARY
When we see that someone is injured or ill it is our duty to approach
him so we can help him. The easiest and the most organized way of
approaching to injured or ill person is by ABCDE approach. By using it we
can determine if victims airway is patent, if the breathing is sufficient, if the
circulation is sufficient, the level of consciousness and possible causes of
victims condition. After stabilizing the victim, we must gather information if
there are any allergies or diseases that victim is suffering from. Also we
need to know what caused the injuries and the symptoms. This is very
important so victim can be treated properly at the hospital which will help
shorten the recovery.

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REFERENCES
[1] Alton L. Thygerson, Benjamin Gulli, Jon R. Krohmer: First Aid, CPR, and
AED; 5th edition; Jones & Bartlett Learning, 2007; 42-54
[2] Initial assessment and treatment with the Airway, Breathing, Circulation,
Disability,

Exposure

(ABCDE)

approach;

available

at

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273374/; accessed May 10,


2015
[3] A systematic approach to the acutely ill patient; available at
http://www.resus.org.uk/pages/alsabcde.htm; accessed May 10, 2015

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