Clinical Approach.

DRSABCDE VAO training resource

Ambulance Tasmania

Department of Health and Human Services

DRSABCDE APPROACH

• The Danger, Response, Send for help, Airway,

Breathing, Circulation, Disability, Exposure

(DRSABCDE) approach is a systematic

approach to the immediate assessment and

treatment of critically ill or injured patients.

• The approach is applicable in all clinical

emergencies. It can be used in the street without

any equipment

WHICH PATIENTS NEED

DRSABCDE? • All patients, both adults and children. The

clinical signs of critical conditions are

similar regardless of the underlying cause.

• This makes exact knowledge of the

underlying cause unnecessary when

performing the initial assessment and

treatment.

WHO NEEDS TO KNOW

DRSABCDE? • All health care professionals can

encounter critically ill or injured persons,

either at work or in private life, and

therefore benefit from knowing the

DRSABCDE approach.

DANGER!

• Assess the scene for any occupational

violence threats to your personal safety

• Assess the scene for hazards and risks to

you and your partners safety

• Don’t forget PPE

• Call for help if needed

RESPONSE

• Is your patient alive

• Is your patient conscious

• Is your patient experiencing altered level

of consciousness

• Is your patient disconnected from reality?

Beware of this patient.

SEND FOR HELP

• Exact location

• Type of situation

• Hazards to be aware of

• Access for backup

• Numbers of patients

• Emergency services required on scene

LETS FOCUS ON ABCDE

ABCDE principles

• With the ABCDE approach, the initial

assessment and treatment are performed

simultaneously and continuously.

ABCDE

• Early recognition and effective initial

treatment prevents deterioration and buys

time

• The mnemonic “ABCDE” stands for

Airway, Breathing, Circulation, Disability,

and Exposure

THE ABCDE APPROACH

A

B

C D

E

Airway & oxygenation

Breathing &

ventilation

Circulation &

shock

management

Disability due to

neurological

deterioration

Exposure &

examination

ASK YOURSELF 6 QUESTIONS

1. Is the patient conscious?

2. Do they have a patent airway?

3. Is their breathing adequate?

4. Is their circulation adequate?

5. Are they neurologically intact?

6. Is the rest of them ok?

If at any point the answer is NO then do something!

THE PRINCIPLES

• Perform primary ABCDE survey (5 min)

• Instigate treatment for life threatening

conditions as you find them

• Reassess when any treatment is

completed

• If condition deteriorates repeat primary

survey

AIRWAY - CAUSES

• GCS

• Body fluids

• Foreign body

• Inflammation

• Infection

• Trauma

INTERVENTIONS

• Head tilt, chin lift

• Jaw thrust

• Suction

• Oral airways

• Nasal airways

ONCE AIRWAY OPEN...

• If required give

oxygen to all

patients via a non-

rebreathing mask

• For COPD patients

re-assess after

primary survey:

keep SpO2 88-92%

BREATHING - CAUSES • GCS

• Resp depressions

• Muscle weakness

• Exhaustion

• Asthma

• COPD

• Infection

• Pulmonary

oedema

• Pulmonary

embolus

• Pneumothorax

• Haemothorax

• Open

pneumothorax

• Flail chest

BREATHING - ASSESSMENT

Rate (<8 or >20), and Rhythm

Auscultate

Tension pneumothorax ?(chest pain? SOB? )

Effort (increased or decreased)

SP02 (<95%?)

BREATHING - INTERVENTIONS

• Consider ventilation with

BVM if RR < 8

• Sit upright if conscious &

SOB

• Specific treatment

– Oxygen

– Salbutamol for wheeze

– If a patient is unconscious

and is not breathing

normally, commence CPR

CIRCULATION – CAUSES

• Loss of volume

– Hypovolaemia

• Pump failure

– Myocardial & non-myocardial causes

• Vasodilatation

– Sepsis, anaphylaxis, neurogenic

Inadequate tissue perfusion

CIRCULATION - ASSESSMENT

• Look at skin colour

• Examine peripheries

• Pulse 60-100

• BP 100-140mmHg &

• CRT<2sec

CIRCULATION - INTERVENTIONS

• Position supine with legs raised

– Left lateral tilt in pregnancy

– Direct control of haemorrhage

– Commence CPR

– Call for back up

DISABILITY - CAUSES

• Inadequate perfusion of the brain

• Sedative side effects of drugs

• Blood Glucose

• Toxins and poisons

• Stroke

DISABILITY - ASSESSMENT

• AVPU (or GCS)

– Alert, responds to Voice, responds to Pain,

Unresponsive

• Limb movements

• Pupil size/response

• Temperature

• BGL

• Pain relief

DISABILITY - INTERVENTIONS

• Optimise airway, breathing & circulation

• Treat underlying cause

– Treat BGL

– Treat anaphylaxis

– Recovery position

– Call for backup

EXPOSURE

• Remove clothes and examine head to toe;

front and back:

– Haemorrhage (incl. concealed), rashes,

swelling etc.

• Keep warm

• Maintain dignity

• Introduce yourself and your patient

• Situation – explain what has happened

• Background – relevant background

• Assessment – what does your ABCDE reveal?

• Recommendations – Can you reassess pt.?

HANDOVER TO BACKUP CREW

DOES DRSABCDE HELP YOU

CONDUCT A CLINICAL

APPROACH?

YES!!!

LETS GO PRACTICE!