Basic ABC rules and procedures

• Basic life support (BLS) is the level of medical care which is used for
patients with life-threatening illnesses or injuries until the patient can be
given full medical care at a hospital.
• BLS is generally used in the pre-hospital setting, and can be provided
without medical equipment.
• Many countries have guidelines on how to provide BLS which are
formulated by professional medical bodies in those countries.
• The guidelines outline algorithms for the management of a number of
conditions, such as cardiac arrest, choking and drowning.
• BLS generally does not include the use of drugs or invasive skills.
• Basic life support consists of a number of life-saving techniques focused
on "ABC"s of pre-hospital emergency care:
• Airway: the protection and maintenance of a clear passageway for
gases (principally oxygen and carbon dioxide) to pass between the
lungs and the atmosphere.
• Breathing: inflation and deflation of the lungs (respiration) via the
airway
• Circulation: providing an adequate blood supply to tissue,
especially critical organs, so as to deliver oxygen to all cells and
remove metabolic waste, via the perfusion of blood throughout the
body
 General ABCDE Approaches

 SAFETY CONSIDERATIONS
o scene hazards
o Violence
o infectious disease risk
USE PERSONAL PROTECTIVE EQUIPMENT
CLEANING AND DECONTAMINATION
ASK FOR MORE HELP IF NEEDED
 SAFETY CONSIDERATIONS

Scene hazards
 Is there a fire, electrical wire or chemical spill that could
injure providers or bystanders?
 is the scene closed to oncoming traffic?
 If a building has collapsed, is it safe to enter?
 At the scene of an explosion, always consider the

possibility of further explosions

 SAFETY CONSIDERATIONS…

Violence
 For patients who are aggressive or agitated, request
help as needed from security personnel or police before
beginning your assessment.
Infectious disease risk
 Is there a possibility for disease exposure (such as flu or
haemorrhagic fever)?
 USE PERSONAL PROTECTIVE EQUIPMENT

o You may not know the cause of illness or injury

when you first approach a patient, and without
appropriate personal protective equipment (PPE)
o Gloves
o Eye protection
o Gown
o Mask
 CLEANING AND DECONTAMINATION

 Use PPE and wash your hands before and after every
patient contact

 Decontamination may be required after exposure to

pesticides or other chemicals (dry or wet)
 ASK FOR MORE HELP IF NEEDED

o If multiple people are injured or ill, call for help or send

someone to call.

o If advanced care is needed, begin making arrangements as

early as possible for consultations or transfers.
 ELEMENTS OF THE ABCDE APPROACH
A – Airway: check for and correct any obstruction to movement
of air into the lungs
B – Breathing: ensure adequate movement of air into the lungs
C – Circulation: evaluate whether there is adequate perfusion to
deliver oxygen to the tissues; check for signs of life-threatening
bleeding
D – Disability: assess and protect brain and spine functions
E – Exposure: identify all injuries and any environmental threats
and avoid hypothermia
 SAFETY CONSIDERATIONS…

o The ABCDE approach should be performed in the first 5

minutes and repeated whenever a patient’s condition changes
or worsens.
o REMEMBER... Always check for signs of trauma in each of the
ABCDE sections
 Question 1: Safety
o A person walks into your health post vomiting, bleeding from
the mouth, and complaining of abdominal pain. Describe what
is needed to safely approach this person.
 Airway
ASSESSMENT
YES, the airway is open.
 If the patient cannot talk normally:
 look to see if the chest wall is moving and listen to see if
there is air movement from the mouth or nose.
 listen for abnormal sounds (such as stridor, grunting, or
snoring) or a hoarse or raspy voice that indicates a partially
obstructed airway.
 Look and listen for fluid (such as blood, vomit) in the airway.
 Look for foreign body or abnormal swelling around the
airway, and altered mental status.
 Check if the patient is able to swallow saliva or is drooling.

 Stridor plus swelling and/or hives suggest a severe allergic reaction

(anaphylaxis).
 IMMEDIATE MANAGEMENT
 If the patient is unconscious and not
breathing normally and:
NO TRAUMA: open the airway using the
head-tilt and chin-lift manoeuvre.
CONCERN FOR TRAUMA: maintain cervical
spine immobilization and open the airway
using the jaw thrust manoeuvre.
Place an oropharyngeal or nasopharyngeal
airway to maintain the airway.
If a foreign body is suspected:
–– If the object is visible, remove it – be careful
not to push the object any deeper.
–– If the patient is able to cough or make noises,
keep the patient calm and encourage coughing.
–– If the patient is choking (unable to cough, not
making sounds) use age-appropriate chest
thrusts/ abdominal thrusts/back blows.
–– If the patient becomes unconscious while choking, follow
relevant CPR protocols.
 If secretions or vomit are present, suction
when available, or wipe clean. Consider
placing patient in the recovery position if the
rest of the ABCDE is normal and no trauma is
suspected.
 If the patient has swelling, hives or stridor,
consider severe allergic reaction (anaphylaxis),
and give intramuscular adrenaline.

 Allow the patient to stay in a position of

comfort and prepare for rapid
handover/transfer to a centre capable of
advanced airway management, if needed.
• If secretions or vomit are
present, suction when available, or
wipe clean. Consider placing patient in
the recovery position if the rest of the
ABCDE is normal and no trauma is
suspected.
 ASSESSMENT
 Look, listen, and feel to see if the patient is breathing.
 Assess if breathing is very fast, very slow, or very
shallow.
 Look for signs of increased work of breathing (such as
accessory muscle use, chest indrawing/ retractions,
nasal flaring) or abnormal chest wall movement.
 Listen for abnormal breath sounds such as wheezing
or crackles.
 With severe wheezing, there may be limited/no
breath sounds on examination because narrowing of
the airways may be so severe that breathing cannot
be heard.
 …ASSESSMENT
 Listen to see if breath sounds are equal
on both sides.
 Check for the absence of breath sounds
and dull sounds with percussion on one
side (large pleural effusion or
haemothorax).
 If there are no breath sounds on one side,
and hypotension, check for distended
neck veins or a shifted trachea (tension
pneumothorax).
 Check oxygen saturation with a pulse oximeter
when available.
 IMMEDIATE MANAGEMENT
 If unconscious with abnormal breathing,
start bag-valve-mask ventilation and
follow relevant CPR protocols.
 If not breathing adequately (too slow for
age or too shallow), begin bag-valve-
mask ventilation with oxygen. If oxygen
not immediately available, DO NOT
DELAY ventilation. Start ventilation while
oxygen is being prepared. Plan for rapid
handover/transfer.
 If breathing fast or hypoxic, give oxygen
…IMMEDIATE MANAGEMENT
 If wheezing, give salbutamol. Repeat salbutamol as
needed.
 If concern for severe allergic reaction (anaphylaxis),
give intramuscular adrenaline.
 If concern for tension pneumothorax, perform needle
decompression immediately and give IV fluids and
oxygen. Plan for rapid handover/ transfer.
 If concern for large pleural effusion or haemothorax,
give oxygen and plan for rapid handover/transfer.
 If cause unknown, remember the possibility of
trauma
 ASSESSMENT
 Look and feel for signs of poor perfusion
(cool, moist extremities, delayed capillary
refill greater than 3 seconds, low blood
pressure, tachypnoea, tachycardia, absent
pulses).
 Look for both external AND internal
bleeding, including bleeding:
 into chest;
 into abdomen;
 from stomach or intestine;
 from pelvic or femur fracture;
 from wounds.
 …ASSESSMENT
 Look for hypotension, distended neck
veins and muffled heart sounds that
might indicate pericardial
tamponade.
 IMMEDIATE MANAGEMENT
 For cardiopulmonary arrest, follow relevant CPR
protocols.
 If signs of poor perfusion, give IV fluids and oxygen and:
o For external bleeding, apply direct pressure or use other
technique to control.
o If internal bleeding or pericardial tamponade are suspected,
refer rapidly to a centre with surgical capabilities.
 If cause unknown, remember the possibility of
trauma: Bind pelvic fractures and splint femur
fractures, or any fracture with compromised
blood flow.
 ASSESSMENT
 Assess level of consciousness with
the AVPU scale (Alert, Voice, Pain,
Unresponsive) or in trauma cases,
the Glasgow Coma Scale (GCS).
 Always check glucose level in the
confused or unconscious patient.
 Check for pupil size, whether the
pupils are equal, and if pupils are
reactive to light.
ASSESSMENT
 ASSESSMENT
 Check movement and sensation in all
four limbs.
 Look for abnormal repetitive
movements or shaking on one or
both sides of the body
(seizure/convulsion).
 IMMEDIATE MANAGEMENT
 If altered mental status and no evidence
of trauma, place in recovery position.
 If glucose low (<3.5 mmol/L) or glucose
test not available and patient has
altered mental status, give glucose.
 For active seizures, give a
benzodiazepine.
 If pregnant and having seizures, give
magnesium sulphate.
 IMMEDIATE MANAGEMENT
 If pupils are small and breathing slow,
consider opioid overdose and give naloxone.
 If pupils are not equal, consider increased
pressure on the brain and raise head of bed
30 degrees if no concern for spinal injury.
Plan for rapid transfer to an advanced
provider or facility with neurosurgical care.
 If cause unknown, remember possibility of
trauma: Immobilize the cervical spine if
concern for trauma.
 Asst
 Examine the entire body for hidden
injuries, rashes, bites or other
lesions.
 Rashes, such as hives, can indicate
allergic reaction, and other rashes
can indicate serious infection.
 Asst…
 If snake bite is suspected, immobilize the
limb. Take a picture of the snake if possible
from a distance and send with patient. Do
not risk additional bites to catch/kill snake.
 Remove constricting clothing and all
jewelry.
 Cover the patient as soon as possible to
prevent hypothermia. Acutely ill patients
have difficulty regulating body
temperature.
 Asst…
 Remove any wet clothes and dry
patient thoroughly.
 Respect the patient and protect
modesty during exposure.
 If cause unknown, remember the
possibility of trauma: Log roll if
suspected spinal injury