What are the C (Circulation) and D (Disability) parts of the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) patient assessment protocol in first aid?

ABCDE Patient Assessment Protocol: Circulation (C) and Disability (D) Components

The Circulation (C) and Disability (D) components of the ABCDE protocol are critical steps in the systematic assessment of patients that help identify and address life-threatening conditions in order of priority.

Circulation (C)

Assessment of Circulation

• Check for life-threatening external bleeding and apply direct pressure, tourniquets, or local compression to stop it immediately 1
• Assess pulse rate, rhythm, strength, and regularity 1, 2
• Measure blood pressure and assess for signs of shock 3
• Evaluate skin color, temperature, and capillary refill time 2, 4
• Monitor cardiac rhythm via electrocardiogram when appropriate 1
• Calculate shock index (ratio of heart rate to systolic blood pressure) to assess degree of hypovolaemic shock - a shock index ≥0.9-1.0 may indicate significant blood loss 3
• Assess pulse pressure (difference between systolic and diastolic blood pressure) as another indicator of shock 3

Circulation Interventions

• Control any visible, life-threatening bleeding immediately 1
• Initiate IV fluid resuscitation for hypotension 1
• Position the patient appropriately - if shock is suspected and no trauma is present, consider recovery position for patients with decreased alertness of nontraumatic cause 3
• If trauma is suspected, especially to neck, back, hip, or pelvis, leave the patient in the position found unless the airway is compromised or the area is unsafe 3

Disability (D)

Assessment of Neurological Status

• Rapidly assess level of consciousness using the AVPU method (Alert, responds to Voice, responds to Pain, Unresponsive) or Glasgow Coma Scale 1, 2
• Check pupil size, equality, and reactivity to light 2, 4
• Assess limb movements for strength and symmetry 2
• Check blood glucose level to rule out hypoglycemia as a cause of altered mental status 1, 5
• Determine the time when the patient was last known to be well (last known well time) if stroke is suspected 1, 5

Disability Interventions

• Control seizures if present 1
• Correct hypoglycemia if detected 5
• Position patients with decreased alertness of nontraumatic cause who are breathing normally in a recovery (side-lying) position 3
• For patients with difficulty breathing who are awake and alert, allow them to assume a position most comfortable for breathing (usually sitting up) 3
• Provide proper orientation aids (clocks, calendars, familiar objects) for confused patients 5

Important Considerations and Pitfalls

• The ABCDE approach is a universal, priority-based systematic approach that enables healthcare professionals to identify and respond to life-threatening conditions in order of priority 1, 6
• Using a cognitive aid tool for ABCDE assessment has been shown to help providers perform more procedures more frequently in the right order 6
• Avoid using physical restraints as first-line management for confused patients as this can worsen agitation 5
• Do not administer sedatives without addressing the underlying cause of confusion 5
• Remember that the ABCDE assessment is dynamic and should be repeated regularly, especially after any intervention 2, 4
• Communicate findings using a structured communication tool to enhance recognition of deterioration 4

Integration with Other ABCDE Components

• Always remember that Circulation (C) and Disability (D) assessments follow Airway (A) and Breathing (B) assessments in priority 1, 2
• If life-threatening conditions are identified in any component, they should be addressed immediately before moving to the next component 2
• After completing Circulation and Disability assessments, proceed to Exposure (E) to completely examine the patient by removing clothing while protecting from hypothermia 3, 1