ABC and the variation is the initial mnemonic for important steps used by medical professionals and lay people (such as first aid) when dealing with patients. In its original form it stands for Airway, Breathing, Circulation and Circulation. This protocol was originally developed as a memory aid for rescuers performing cardiopulmonary resuscitation, and the best known use of initialism is in the treatment of unconscious or unresponsive patients, although it is also used as a reminder of priorities for assessment and treatment. patients in many medical situations and acute trauma, from first aid to hospital medical care. The respiratory, respiratory, and circulatory tract are all vital to life, and each is required, in that order, in order for the next to be effective. Since its development, mnemonic has been extended and modified to suit the different areas in which it is used, with different versions changing the meaning of letters (such as from 'Circulation' to 'Compression') or adding other letters (such as the optional "D" step for Disability or Defibrillation ).
In 2010, the American Heart Association and the International Liaison Committee on Resuscitation changed the order of recommended CPR interventions for most cases of cardiac arrest to chest compression, airway, breathing or CAB.
Video ABC (medicine)
History
The 'ABC' method of remembering the correct protocol for CPR is almost as old as the procedure itself, and is an important part of the history of cardiopulmonary resuscitation. Throughout history, different methods of resuscitation have been tried and documented, although most produce very bad results. In 1957, Peter Safar wrote the ABC of Resuscitation, which sets the groundwork for CPR mass training. The new concept is distributed in a 1962 training video called "The Pulse of Life" made by James Jude, Guy Knickerbocker and Peter Safar. Jude and Knickerbocker, along with William Kouwenhouen developed an external chest compression method, while Safar worked with James Elam to prove the effectiveness of artificial respiration. Their combined findings were presented at the Maryland Medical Society's annual meeting on September 16, 1960, in Ocean City, and gained rapid and widespread acceptance over the next decade, aided by a video and talking tour by men. The ABC system for CPR training was later adopted by the American Heart Association, which announced the standard for CPR in 1973.
In 2010, the American Heart Association chose to focus CPR on reducing interruptions to compression, and has changed the order in its guidelines to C irculation, A irway, B reathing (CAB).
Maps ABC (medicine)
Importance
At all levels of care, the ABC protocol exists to remind people who care about the importance of respiratory, breathing and circulation for the maintenance of the patient's life. These three problems are paramount in any treatment, because losing (or losing control) any of these items will quickly lead to the death of the patient. Three goals are critical to successful patient care that they form the training ground for not only first aid providers but also participants in many advanced medical training programs.
Hypoxia, a result of a lack of oxygen in the blood, is a potentially lethal condition and one of the main causes of cardiac arrest. Cardiac arrest is the leading cause of clinical mortality for all animals (although with advanced intervention, such as cardiopulmonary bypass cardiac arrest does not always cause death), and this is related to the absence of circulation in the body, for any of a number of reasons. For this reason, keeping the circulation very important to move oxygen to the tissues and carbon dioxide out of the body.
Airway, breathing, and circulation, therefore work in a cascade; If the patient's airways are blocked, breathing will not be possible, and oxygen can not reach the lungs and is transported throughout the body in the blood, which will lead to hypoxia and heart attacks. Making sure the airway is clear is the first step in caring for any patient; once it is established that the patient's airway is clear, the rescuer should evaluate the patient's breathing, as many other things besides airway obstruction may cause absence of respiration.
Simple application for CPR
The basic application of ABC principles is first aid, and is used in the case of unconscious patients to begin treatment and assess needs, and then potentially give birth, cardiopulmonary resuscitation.
In this simple use, a rescue is needed to open the airway (using techniques such as
tilt-chin lift ), then check for normal breathing. These two steps should provide an initial assessment of whether the patient will need CPR or not.In the event that the patient is not breathing normally, current international guidelines (established by the International Liaison Committee on Resuscitation or ILCOR) show that chest compressions should begin.
Previously, the guidelines showed that pulse checks should be performed after respiration is assessed, and this consists of a 'circulation' section of initialism, but this pulse examination is no longer recommended for a lay rescuer. Some trainers continue to use ' circulation' as labels for the third step in the process, as it performs chest compression effectively in artificial circulation, and when assessing patients who breathe, rate 'circulation' is still important. However, some trainers now use C to interpret ' Compression' in their first basic-aid training.
Airway
Unconscious patient
In unconscious patients, the priority is airway management, to avoid the cause of preventable hypoxia. Common problems with the patient's airway with a very reduced level of consciousness involve pharyngeal blockage by the tongue, foreign body, or vomit.
At the ground level, airway opening is achieved through the head manual movement using a variety of techniques, with the most taught and used "head tilt - chin lift", although other methods such as "modified thrust" can be used, especially where bone injuries rear suspect, although in some countries, its use is not recommended for a lay rescuer for security reasons.
Higher-level practitioners such as emergency medical service personnel may use more sophisticated techniques, from the oropharynx airway to intubation, as deemed necessary.
Patient awareness
In the conscious patient, other signs of airway obstruction that can be considered by the rescuer include paradoxical chest movements, use of accessory muscles for breathing, tracheal deviation, in or out of noisy air, and cyanosis.
Breathe
Unconscious patient
In unconscious patients, after the airway is opened the next area to be assessed is the patient's breathing, especially to find out whether the patient is doing normal respiratory effort. The normal breathing rate is between 12 and 20 breaths per minute, and if the patient breathes below the minimum, then in the ILCOR basic life support protocol, CPR should be considered, although professional rescuers may have their own protocol to follow, such as artificial breath.
Rescue teams are often warned against missed breathing, which is a series of noisy breaths that occur in about 40% of heart attack victims, to breathe normally.
If a patient is breathing, then the rescuer will continue the indicated treatment for an unconscious but breathing patient, which may include interventions such as a recovery position and an ambulance call.
A conscious or breathing patient
In the conscious patient, or where the pulse and breathing are clearly present, the care provider will initially seek to diagnose immediately life-threatening conditions such as severe asthma, pulmonary edema or haemothorax. Depending on the level of the rescue skill, this may involve steps such as:
- Check for common respiratory disorders, such as the use of accessory muscles for breathing, abdominal breathing, patient position, sweating, or cyanosis
- Checking respiratory rate, depth and rhythm - Normal breathing is between 12 and 20 in a healthy patient, with regular pattern and depth. If any of these deviates from normal, this may indicate a fundamental problem (as with Cheyne-Stokes respiration)
- Deformity and chest movements - Chest should rise and fall equally on both sides, and should be free of deformities. The doctor may be able to get a working diagnosis of abnormal movements or forms of the chest in cases such as pneumothorax or haemothorax
- Listening to external breath sounds not far from the patient can reveal dysfunction such as crunching sound (indication of airway secretion) or stridor (which shows airway obstruction)
- Examine the surgical emphysema which is the air in the subcutaneous layer indicating the presence of pneumothorax
- Auscultate and chest percussion using a stethoscope to listen to normal chest or any abnormalities
- The pulse oximeter may be useful for assessing the amount of oxygen present in the blood, and by deducing the effectiveness of breathing
Circulation
Once oxygen can be sent to the lungs through clear airways and efficient breathing, there needs to be a circulation to deliver it throughout the body.
Patients who are not breathing
Circulation is the original meaning of "C" as defined by Jude, Knickerbocker & amp; Safar, and is intended to suggest assessing the presence or absence of circulation, usually by taking a carotid pulse, before taking further treatment steps.
In modern protocols for the layman, this step is omitted because it has been proven that a lay rescuer may have difficulty in accurately determining the presence or absence of a pulse, and that, in any case, there is a lesser risk of harm by compressing the chest at the heart rate rather than failing to do them when the heart does not beat. For this reason, the lay rescuer directly conducts cardiac pulmonary resuscitation, beginning with chest compression, which is effectively an artificial circulation. To simplify this teaching to some groups, especially at the first aid base level, C for circulation is changed to mean CPR or Compression.
It should be remembered, however, that health care professionals will often still include pulsation checks in their ABC examinations, and may involve additional measures such as ECG immediately when a heart attack is suspected, to assess heart rhythm.
Patients who breathe
In patients who breathe, there is an opportunity to make further diagnoses and, depending on the level of rescue skills present, a number of assessment options are available, including:
- Observing the color and temperature of the hands and fingers where the extremities are cold, blue, pink, pale, or dappled can be an indication of poor circulation Capillary refill is an assessment of capillary effective work, and involves applying skin pressure to the skin area to force blood from the area, and calculate the time until the return of blood. This can be done peripherally, usually in a nail bed, or centrally, usually in the sternum or forehead
- Pulse checking, either centrally or peripherally, assesses the level (typically 60-80 beats per minute in resting adults), regularity, strength, and equality between different beats
- Blood pressure measurements can be taken to assess signs of shock
- Cardiac auscultation can be performed by medical professionals
- Observation for secondary signs of circulatory failure such as edema or foam from the mouth (indication of congestive heart failure)
- ECG monitoring will enable health care professionals to help diagnose underlying heart conditions, including myocardial infarction
Variations
Almost all first aid organizations use "ABC" in some forms, but some include it as part of a larger initialism, ranging from simple 'ABCD' (designed to train lay respondents in defibrillation) to 'AcBCDEEEFG' (English ambulance service version for assessment patient).
DR ABC
One of the most widely used adaptations is the addition of "DR" in front of "ABC", which means Hazard and Response . This refers to guiding principles in first aid to protect yourself before trying to help others, and then ensure that patients are unresponsive before attempting to treat them, using systems like AVPU or Glasgow Coma Score. Because original initialism is designed for use in hospitals, this is not part of the original protocol.
In some areas, the associated SR ABC is used, with S means Security .
DRsABC
Modifications to DRABC are when no response from the patient, the rescuer is told to send (or shout) to ask for help â â¬
ABCD
There are several taught protocols that add D to the simpler end of ABC (or DR ABC). It may represent different things, depending on what the trainer is trying to teach, and at what level. It can stand for:
- Defibrillation - The definitive treatment step for cardiac arrest
- Defects, deformities, or Dysfunctions - Disabilities or defects caused by injuries, not pre-existing conditions
- Deadly Bleeding
- (Differential) Diagnosis
- Decompress
ABCDE
In addition, some protocols require the 'E' step for patient assessment. All protocols that use the 'E' steps deviate from seeking basic live support at the time, and start looking for the underlying cause. In some protocols, there can be up to 3 E used. E can stand for:
- Show and Check - Mostly for ambulance-level practitioners, where it's important to remove clothes and other obstructions to assess injuries.
- Environment - only after assessing ABCD, responders respond to environmental related symptoms or conditions, such as cold and lightning.
- Escaping Air - Examine the exit air, such as through a sucking chest wound, which can cause the lung to collapse.
- Elimination
- Evaluation - Is the patient "critical time" and/or rescuer needing further assistance.
ABCDEF
An 'F' in the protocol can be used to:
- Fundus - related to pregnancy, this is a reminder for the crew to check whether a woman is pregnant, and if she is, how far she is developing (the fundus position in relation to the navel provides a ready-to-suction guide ).
- Family (in France) - indicates that rescuers should also deal with witnesses and families, who may be able to provide valuable information about a patient's accident or health, or perhaps present a problem for the savior.
- Fluids - Clear fluid checks (blood, cerebro-spinal fluid (CSF), etc.)
- Liquid resuscitation
- End Step - Consult the nearest definitive care facility
ABCDEFG
A 'G' in the protocol can be used
- Hurry up! - Reminders to ensure all assessment and on-site treatment is completed at speed, to bring patients to the hospital in Golden Hour
- Glucose - Professional saviors may choose to perform a blood glucose test, and this may form a 'G' or alternately, 'DEFG' can stand for " Do not Always Forget Glucose "
AcBC
Some trainers and protocols use an extra (small) 'c' between A and B, standing for 'cervical spine' or 'considering C-spine'. This is a reminder to realize the potential for neck injury in the patient, since opening the airway can cause further damage unless a special technique is used.
CABC
The military often uses the CABC approach, where C first means "disaster bleeding". Cases of violent trauma suggest that large blood loss will kill the victim before airway obstruction, so action to prevent hypovolemic shock should occur first. This is often done by immediately applying the tourniquet to the affected limb.
MARCH
The expansion in CABC contributes to a significant increase in the risk of hypothermia by patients due to hypovolemia and reactions such as subsequent cold weather.
- Massive Haemorrhage
- Airline
- Breathing
- Circulation
- Head injury/Hypothermia
See also
- Cardiopulmonary Resuscitation
- Artificial Respiracy
- Recovery position
- First aid
References
External links
Source of the article : Wikipedia