What is the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) protocol?

The ABCDE Protocol for Patient Assessment and Management

The ABCDE (Airway, Breathing, Circulation, Disability, Exposure) protocol is a universal, priority-based systematic approach for the assessment and treatment of critically ill patients that enables healthcare professionals to identify and respond to life-threatening conditions in order of priority. 1, 2

Core Components of the ABCDE Approach

A - Airway

• Establish and maintain a patent airway while protecting the cervical spine during trauma assessment 1
• Consider temporary measures such as oro- or nasopharyngeal airways 1
• Perform endotracheal intubation for definitive airway protection in severe cases with altered consciousness (GCS <8) 1
• Assess for airway obstruction, stridor, gurgling, or other abnormal sounds 2

B - Breathing

• Ensure adequate oxygenation and ventilation 1
• Assess respiratory rate, effort, symmetry of chest movements, and oxygen saturation 2, 3
• Apply supplemental oxygen if needed to maintain appropriate saturation 4
• Perform initial normoventilation if no signs of imminent cerebral herniation 1

C - Circulation

• Apply tourniquets or local compression to stop life-threatening bleeding 1
• Initiate IV fluid resuscitation for hypotension 1
• Assess pulse rate, rhythm, quality, blood pressure, and capillary refill time 2, 3
• Monitor cardiac rhythm via electrocardiogram when appropriate 5

D - Disability

• Rapidly assess neurological status using the Glasgow Coma Scale 1
• Evaluate pupillary size and reactivity 2
• Check blood glucose level to rule out hypoglycemia as a cause of altered mental status 1, 4
• Control seizures if present 1

E - Exposure

• Completely undress the patient to facilitate thorough examination 1
• Remove wet clothing to prevent hypothermia 1
• Implement warming measures as needed 1
• Examine for additional injuries, rashes, or other findings 2

Implementation in Clinical Practice

Assessment Tools and Documentation

• Multiple assessment tools exist with varying complexity (5-36 items) to guide ABCDE implementation 6
• Vital signs should be recorded using a track and trigger tool to enhance recognition of physiological abnormalities 3
• Point-of-care ultrasonography (POCUS), including FAST (Focused Assessment with Sonography for Trauma), should be performed for patients with thoracoabdominal injuries 1

Team Performance and Communication

• Team leader presence improves adherence to the ABCDE approach 6
• Healthcare professionals should report ABCDE assessment findings using a structured communication tool to optimize communication and escalation of care for deteriorating patients 3
• Simulation training has been shown to improve adherence to the ABCDE approach from 29-35% pre-intervention to 65-97% post-intervention 6

Knowledge and Training Requirements

• Knowledge of the ABCDE approach varies among healthcare professionals, with nurses generally scoring lower (74.9%) than residents (92.3%) and medical specialists (88.0%) 7
• Departments vary in their knowledge levels, with emergency departments and specialized critical care units typically showing higher proficiency 7
• Regular training and cognitive aids can improve performance of the ABCDE approach 8

Clinical Applications

Emergency Stabilization and Resuscitation

• The ABCDE approach is recommended for directing patient assessment and potentially life-saving interventions during resuscitation 5
• This approach is taught in life support courses such as Pediatric Advanced Life Support, Advanced Pediatric Life Support, and Advanced Trauma Life Support 5
• When used systematically, it helps healthcare professionals focus on the most life-threatening clinical problems first 2

Acute Stroke Care

• In stroke assessment, determining the time when the patient was last known to be well (last known well time) is crucial 5
• The ABCDE approach helps standardize the initial evaluation of potential stroke patients 5

Acute Confusional States

• The American Heart Association recommends immediately assessing and securing the airway, breathing, and circulation as the first priority in any patient with acute confusional state 4
• Checking blood glucose level promptly is crucial to rule out hypoglycemia as a reversible cause 4

Common Pitfalls and Challenges

• Adherence to the ABCDE approach in clinical practice varies widely (18-84%) 6
• Healthcare professionals often skip steps or perform them incompletely, particularly during high-stress situations 5
• Use of cognitive aids for ABCDE assessment helps practitioners perform more procedures and more frequently in the right order without prolonging assessment time 8
• Younger healthcare professionals tend to score higher on ABCDE knowledge tests than older professionals 7