A-E Respiratory Assessment

Original Editor - Natalie Patterson Top Contributors - Natalie Patterson and Kim Jackson


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.


  • 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


  • 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:


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


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


  • 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,



  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>