ABCDE APPROACH

Airway
Inspection
- Patent
- Partially obstructed
NOISY BREATHING
Snoring: partial airway obstruction by tongue or soft Wheezing (expiratory): lower airway obstruction
palate
Gurgling: fluid in upper airway
Stridor/croup/crowing (inspiratory): laryngeal
spasm or obstruction Crepitation/crackle: fluid in lungs
DD
Intramural: foreign body / secretion
Mural: angioedema / epiglottitis
Extramural: tumors
maneuvers
1. Foreign body? → attempt to remove
2. Secretions? → suction
3. Basic maneuvers
- Head-tilt-chin-lift
- Jaw thrust (if suspected cervical injury)
4. Basic adjuncts
- Oropharyngeal airway (unconscious)
- Nasopharyngeal airway (to avoid gag reflex)
5. Advanced adjuncts
- Laryngeal mask
- Endotracheal tube
- Unprotected Coma/confused (GC≤8) → Endotracheal tube
- Completely obstructed Silent chest – no pulse → ALS
O2 mask
_______________________________________________________________________________________________

Breathing
RR (N 12-20)
Pattern
PARADOXICAL BREATHING
A) Partial obstruction→ basic maneuvers SILENT CHEST → complete obstruction
B) Diaphragm fatigue→ assisted ventilation
Inspection look, listen, feel
- Accessory/abdominal muscles
- Depth. rhythm
- chest deformity , raised JVP
- Trachea in suprasternal notch , deviation to one side indicates mediastinal shift ( pneumothorax, lung fibrosis or
pleural fluid
Palpation
- Tenderness
- Feel the chest wall to detect surgical emphysema or crepitus ( suggest a pneumothorax until proven otherwise)
- Click (fracture)
Percussion
Hyperresonant→ pneumothorax (air)
Dull→ consolidation (solid) or effusion (fluid)

Auscultation
 Supramammary-mammary-inframammary
 Upper axillary-lower axillary
 Suprascapular-intrascapular-infrascapular

-types: normal vesicular, harsh vesicular, bronchial, wheezes

- bronchial breathing indicate lung consolidation with patent airway
- lungs end at 5th rib
- wheezes (late exp→whole exp→both exp & insp)
DD
- Pneumonia - Pulm. oedema - PE
- Asthma - ECOPD - Pleural pathology (air / fluid / blood)
+ Resp. fatigue / Opiates / Rib # or abdominal pain / Hyperoxygenation in retainers
Pulse O2→ mask
N.B. dyspnea = SOB w/↑ RR (respiratory, DKA,…) OR chest pain w/o RR (cardiac e.g. MI)

circulation
inspection → signs of shock (pale, clammy, cold)
palpation
 Pulse
o X Central (arrest)
o X peripheral (shock)
o Diff on both arms→aortic dissection
N.B. pain that quickly transfers from chest→subscapular→intraabdominal→loin→LL (think AD)
 CRT (N <2)
 Pulse different on both arms → aortic dissection
 temperature
2 wide pore IV cannulas DD
1. CBC, Bl. culture 1. Hypovolaemic (Internal or External bleeding /
2. ABG ( PH, lactate) D&V / Severe burns) → 1000 saline if not he
3. Urea, creatinine, Na, K or cardiac→ tranexamic acid for hemorrhagic
shock
4. ECG 2. Cardiogenic
5. Urinary catheter a. (MI
6. Dyspnea→ cardiac enz, DDimer i. (4aspirin+4plavix/2brilique)
7. Blood transfusion matching ii. Morphine (excpt inf or shocked or
8. Coag profile dinitra :pethidine)
b. - Acute HF – Arrhythmias)
3. Septic
4. Anaphylactic → adrenaline-hydrocortisone
 5. Obstructive: (PE / Tamponade / Tension 7. Blood transfuisonO+ until matching results in 1
pneumothx) hr)
6. Electrolytes: K

Disability
1. GCS DD
2. Pupil
- Pinpoint: pontine, opiate, organophosphorus 1. Hypoglycemia →Glucagon IM 20% - 50% IV
- Dilated fixed: ↑ ICP (1 eye is dural sinus Dextrose
thrombosis, 2 eyes is midbrain lesion) 2. Opioid toxicity (morphine→naloxone)
3. Random blood glucose 3. Electrolytes (Na, Ca)
4. CVA or intracranial pathology
5. ?→ CT head
6. Fits→ lorazepam-diazepam

Exposure Segmental (temp rectal, tongue dentation, neck rigidity, rash, bed sores