A-E Respiratory Assessment

Introduction

The A-E assessment; Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach is a systematic approach to the immediate assessment and treatment of critically ill or injured patients[1], it has become widely adopted as a way of documenting the assessment of respiratory patients. This systematic approach should allow you to determine if the patient has one of the following problems:

  • Sputum retention
  • Loss of lung volume
  • Increased work of breathing (breathlessness)
  • Respiratory failure

Patient groups this approach would be beneficial for are: patients on intensive care or high dependency units, post operation respiratory assessments, patients seen on the ward referred for 'chest physio' whether or not it is an on call situation.

Airway

  • Is the airway patent? is it their own?
  • Occluded/Obstructed: indicated by stridor, hoarse voice, orthopnoea, drooling, dysphagia
  • Are they self ventilating? If not, what is the mode of ventilation? CPAP, BiPAP, Ventilated

Breathing

  • What is their respiratory rate? Is it regular?
  • Work of breathing, are they using their accessory muscles?
  • What are the saturation levels? Are they on any oxygen? How is it delivered.
  • Have they had ABGs? what are the PaO2 and PaCO2 levels?
  • What did their chest Xray show?
  • Chest expansion: is it even
  • Auscultation: Are there breath sounds throughout? Are there any added sounds e.g. crackles, a wheeze crepitation?
  • Palpation: What can you feel? secretions? tactile fremitus. Do they feel hot/cold? compare centrally to peripherally. Is there any Oedema?
  • What is their cough like? Strong or weak? Dry or Wet? productive or unproductive.
  • Are they able to expectorate their secretions?
  • Percussion:

Circulation

  • Heart Rate
  • Blood Pressure
  • Skin colour
  • Sweating
  • Urine Output
  • Blood Sugar levels (BMs)

Disability

  • Level of consciousness; Alert, Voice, Pain, Unresponsive
  • Are they sedated?

Exposure

  • Injuries
  • Are there any surgical wounds? Are these contraindications for any interventions?
  • Do they have any drains? Are they swinging and bubbling
  • Attachments: Catheter, Arterial line, NG tubes,

[2][3]

References

  1. Thim T, Krarup NH, Grove EL, Rohde CV, Løfgren B. Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. Int J Gen Med. 2012;5:117-121. doi:10.2147/IJGM.S28478
  2. Harden, B. Cross, J. Broad, M A. Quint, M. Ritson, P. Thomas, S. Respiratory Physiotherapy; An on call Survival Guide. Churchill Livingstone Elsevier 2009
  3. Respiratory Physiotherapy 2002 98;23 58 Available at https://www.nursingtimes.net/clinical-archive/respiratory-clinical-archive/respiratory-physiotherapy-21-03-2002/ Accessed 26 August 2020<article> </article>