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Overview
The ABCDE process, also known as the A-E approach, stands for:
- Airway
- Breathing
- Circulation
- Disability
- Exposure
In any emergency, the aim of the nurse, and other healthcare professionals, is to assess the healthcare needs of the patient in a structured, systematic and meaningful way so that they can provide lifesaving treatment as efficiently and effectively as possible (Soltan and Kim, 2016). The ABCDE approach is a tool for prioritising assessments and treatment (Smith and Bowden, 2017). It allows healthcare staff to identify and treat the most life-threatening issues which face a patient methodically, therefore buying time to address other concerns and make a full diagnosis (Resuscitation Council UK, 2022).
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Purpose
Working repeatedly in a structured, universal way, means that the team working in the emergency department, for example, all know what is expected of them, when and why. It is therefore vital that nurses understand the ABCDE process if they are to play a meaningful part in managing emergencies. However, the use of ABCDE is not confined to emergency situations as it has great value in other areas of clinical practice, e.g. in post-operative patient assessment (Taherkhani, 2018), and it is also not confined to the hospital setting (Thim et al, 2012).
Ideally, ABCDE should be used with a ‘track and trigger’ tool, such as the National Early Warning Score II (The Royal College of Physicians, 2017) to allow for recognition of physiological abnormalities that may signal deterioration (Smith and Bowden, 2017). A structured form of communication should be used when passing information on to colleagues such as the SBAR
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Assessment, equipment and procedure
Before applying the ABCDE approach to patient assessment and treatment, the nurse should ensure that the situation is safe and it remains so, for example, wearing personal protective equipment such as disposable gloves and an apron (Cochrane and Jersby, 2019). ABCDE may be applied away from the hospital setting, e.g. when undertaking first aid in the community, and so assessing for danger, e.g. traffic, is an important first step in the assessment process (St John’s Ambulance, 2021).
Various equipment, may be needed to aid the assessment and early management of a patient including:
- personal protective equipment, e.g.:
- disposable gloves
- disposable apron
- surgical mask
- eye protection
- stethoscope
- pulse oximeter
- sphygmomanometer
- thermometer
- suctioning equipment
- airways
- oxygen and associated tubes, masks and venturi valves
- blood bottles
- normal saline
A = Airway
The obstruction of a person’s airway is a medical emergency as it leads to hypoxia and can be fatal.
Signs
A
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Risks and complications
Failure to follow a structured assessment process may result in a patient’s deterioration going unnoticed (Smith and Bowden, 2017). If the nurse does not follow the ABCDE method when working with colleagues, there is a risk of confusion, duplication of effort and of signs and symptoms of injury or disease being missed.
Emergency clinicians often only use the ABCDE approach after they have formed an initial impression that it may be useful during triage. Therefore, in some cases its use may be unnecessarily delayed or avoided, which can be harmful (Olgers et al, 2017).
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Next steps
Adherence to the ABCDE routine in neonatal care may be enhanced if the training is given using videos rather than lecturers (Linders et al, 2021). Research shows good adherence to the procedure in practice following simulation training, but that the abilities of the trainees, especially relating to managing clinical scenarios, deteriorated over time (Drost-de-Klerck et al, 2020). This suggests that ABCDE training needs to be focussed on skills acquisition rather than theory and that it needs to be repeated regularly to keep practitioners at the peak of their performance.
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Resources
References
Cochrane J. Jersby M. When to wear personal protective equipment to prevent infection. B J Nurs. 2019;28(15): 982-984. https://doi.org/10.12968/bjon.2019.28.15.982
Jevon P, Gallier H. How to measure capillary refill time in patients who are acutely ill. Nurs Times. 2020;116(8):29–30
Linders M, Binkhorst M, Draaisma JMT et al. Adherence to the ABCDE approach in relation to the method of instruction: a randomized controlled simulation study. BMC Emerg Med. 2021; 21(1):121. https://doi.org/10.1186/s12873-021-00509-0
McCrory M, Aboumatar H, Custer JW et al. “ABC-SBAR” Training Improves Simulated Critical Patient Hand-Off by Pediatric Interns. Pediatric Emergency Care. 2012; 28(6):538-543. https://doi.org/10.1097/PEC.0b013e3182587f6e
Morgan S. Emergency care. In: Delves-Yates (ed.) Essentials of Nursing Practice (3rd edn). Sage; 2022 pp.509-530
Olgers TJ, Dijkstra RS, Drost-de Klerck AM, Ter Maaten JC. The ABCDE primary assessment in the emergency department in medically ill patients: an observational pilot study. Neth J Med. 2017; 75(3):106-111.
Resuscitation Council UK. The ABCDE Approach. 2022.
https://www.resus.org.uk/print/pdf/node/123 (accessed 27
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