What are the initial steps in assessing a patient arriving in the Emergency Department (ED) from an ambulance?

Initial Assessment of Patients Arriving in the ED from Ambulance

When a patient arrives in the Emergency Department (ED) from an ambulance, healthcare providers should immediately perform a structured ABCDE assessment, establish IV access, obtain baseline vital signs, and perform a focused neurological examination within the first 10 minutes of arrival. 1

Primary Survey: ABCDE Approach

Airway

• Assess airway patency and provide immediate intervention if compromised 2, 3
• Administer supplemental oxygen to hypoxemic patients (oxygen saturation <94%) 1
• Position the patient appropriately to maintain airway patency 4
• Be prepared for advanced airway management if needed 5

Breathing

• Assess respiratory rate, pattern, and effort 2, 3
• Check oxygen saturation via pulse oximetry 1
• Auscultate lung fields for abnormal sounds 3
• Provide respiratory support as needed based on assessment findings 1

Circulation

• Establish or confirm IV access immediately 1
• Obtain blood samples for baseline studies (complete blood count, coagulation studies, blood glucose) 1
• Assess pulse rate, rhythm, and quality 3
• Measure blood pressure and assess for signs of poor perfusion 1
• Apply cardiac monitoring for all patients with suspected cardiac or neurological issues 1

Disability

• Perform rapid neurological assessment including Glasgow Coma Scale 3, 6
• Check blood glucose levels to identify and treat hypoglycemia promptly 1
• Assess pupillary response and motor function 6
• Document time of symptom onset for time-sensitive conditions like stroke 1

Exposure

• Examine for additional injuries, rashes, or other physical findings 2, 3
• Maintain patient dignity and prevent hypothermia 3

Critical Actions Based on Presentation

For Suspected Stroke

• Assess the patient within 10 minutes of arrival 1
• Verify exact time of symptom onset or last known well 1
• Order emergent CT scan of the brain 1
• Activate stroke team or arrange consultation with stroke expert 1
• Consider eligibility for thrombolytic therapy or endovascular intervention 1

For Suspected Cardiac Issues

• Obtain 12-lead ECG (does not take priority over CT scan in stroke) 1
• Administer aspirin 160-325mg orally for suspected ACS unless contraindicated 1
• Consider sublingual nitroglycerin (unless systolic BP <90 mmHg or heart rate <50 or >100 bpm) 1
• Provide adequate analgesia for chest pain 1
• Activate cardiac catheterization team if STEMI is identified 1

For Pediatric Patients

• Use age-appropriate assessment tools and equipment 1
• Triage as P-CTAS Level 2 in most cases, Level 1 for compromised airway, breathing, or circulation 1
• Consider transport to specialized pediatric hospital when available 1

Communication and Documentation

• Obtain detailed handover from EMS personnel including:

  • Time of symptom onset or last known well 1
  • Vital signs and interventions performed pre-hospital 1
  • Glasgow Coma Scale score 1
  • Relevant medical history 1

• Document all findings and interventions with accurate timestamps 1

• Use structured communication tools when escalating care to specialists 3

Common Pitfalls to Avoid

• Delaying assessment beyond the recommended 10-minute window 1
• Failing to identify time-sensitive conditions requiring immediate intervention 1
• Neglecting to check blood glucose in patients with altered mental status 1
• Overlooking subtle signs of respiratory distress or shock 3
• Initiating unnecessary treatments before completing the primary assessment 1

Remember that "Time is Brain" for stroke patients and "Time is Muscle" for cardiac patients - every minute counts in the initial assessment and management of emergency patients 1.