In this micro-lecture, we discuss danger response DABCDE primary mnemonics. Enrolled students have unlimited access to a rich library of learning materials such as this.
In today’s micro lecture we’re going to talk about the danger response, ABCDE primary survey mnemonics in relation to what it looks like for you guys attending the face-to-face clinical workshops. Now, danger is always the first, at the top of the list for anybody, whether you’re a first aider, whether you’re a paramedic, whether you an emergency service worker working in a hospital, or even as a doctor, it doesn’t matter who you are. Checking for danger is always the first thing.
Think about the typical types of danger paramedics are faced with when they arrive on scene at, say, a car incident or somebody who’s taken a drug overdose. Now this can be anything from other people who are intoxicated. It could be high moving, fast moving vehicles. It could be wet surfaces, it could be any of or all of those things. So, it’s in your first instinct to, number one, be aware of the dangers, and to number two, try your best to eradicate the dangers, or to make it as safe as possible.
Then you need to check for a response. Now we do this using the AVPU scale, so that’s alert, voice, pain or unresponsive. When you’re checking for using the AVPU scale, you need to think about, when you walked up to your patient, did they look at you in the eye, or did you have to shout out to them? Now, if you’re walking up to them and then they call you over and they’re alert, and they’re looking at you, that’s the alertness. If they’re not alert, if they’re in a semi-comatose, or semi-conscious state, and then you say, “Hail an ambulance,” and they look at you, that means they’re responding to voice. If they don’t respond to voice, give them some gentle pressure on their shoulder, on the trapezius squeeze, and if they respond to that and they open their eyes, that’s called pressure. We’re moving away from using the word pain because it’s not accurate anymore. And if they don’t respond to that, then they are unresponsive. So, that’s danger response.
The next thing you will do is check for airway. Now, when we’re checking for the airway, what we do is, we do a head tilt, chin lift if they are unconscious, but only if they’re unconscious. If they’re not unconscious, then, and they’re talking to you, then you can assume that the airway is clear. But you need to have a consideration that the airway will not always be clear, because just in as quickly as they’re talking to you, they can go unconscious and stop talking to you. So, the airway is clear if they’re conscious and talking, but you need to be mindful that it could change. If they’re unconscious, do your head tilt, chin lift that you will practice at the workshops, or the jaw thrust or triple maneuver if they’re suspected of having some kind of trauma, remembering the whole purpose of doing a head tilt, chin lift it to get that tongue off the back of the throat to stop hypoxia.
Now then. Danger response, airway breathing. When you’re checking the breathing, if they’re conscious, one of the things you’re checking for is that they are, the breathing rate is between 12 and 20. You’re getting good rise and fall of the chest, and it’s not abnormal. Now, if they are unconscious and you’re suspecting a cardiac arrest, you’re checking that the breathing is there and that it’s within normal limits. If the patient’s looking cold, clammy, sweaty, and pale, and they’re unconscious, then you’re within your rights to use your clinical judgment and get straight onto the chest to do CPR.
Now, if they are breathing, the next thing you check for is circulation. You can do this by using your peripheral pulses. You can do this by choosing your central pulses, so your peripheral and central pulses. You can check for up to 15 seconds. If it’s regular, then times that number by four. You’re checking for regularity. You’re checking for rate. You can also use the capillary refill time using your fingernail bed or anywhere where there’s a circulation.
Once you’re happy with the circulation moving to disability. So if the patient is actually unconscious, this is where you would do the head to toe survey, so that we’re not going to talk about that at this point here, but if the patient is unconscious, you do the disability first. Remember, we only expose them to try and look for signs of injury, and many paramedics would actually leave that part to the back of the ambulance…
QUICK SUMMARY: what we’ve talked about here today is danger, response, airway breathing, circulation, disability, and exposure, which you may or may not have heard before. My name is Sam Willis and I hope you’ve enjoyed this micro lecture and I look forward to talking to you again shortly.