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A-B-C Every time—Pro edition

Airway, Breathing, Circulation. Either you have heard this mnemonic before or you will be learning it soon in your next CPR, First Aid, ACLS, or PALS class. Either way, in my opinion it is the holy grail of medicine. Alright, maybe that’s stretching it a little but in the Emergency Medicine world it forms a very strong foundation of assessment and intervention. At the very least it gets your brain working when confronted with an unusual or confusing situation. This is part 2 of my series on the importance of ABC. As I type this I can hear some medic or ER nurse saying “ABC’s, please I can calculate an Amiodarone drip in my head and drop ET tubes in anaphylactic toddlers”, “I think I got my ABC’s down.”. Well, if you are that good consider that you probably do the ABC’s within about 2 seconds of seeing every patient you come across. Imagine an asthma patient in distress. Sometimes even before you get in the room, and immediately upon meeting your patient, you get bombarded with information. For example, take an asthma patient. Immediately upon entering the room you see the Pt. is awake, making eye contact and breathing with difficulty. You see skin color, agitation and work effort. This tells you his Airway is open-but in jeopardy, his Breathing is rapid, labored, and he’s using excessory muscles, his Circulation is there-he’s breathing so he must have a pulse. With the exact same pt. you hear wheezing before you enter the room. You hear very little air movement without even pulling out your stethoscope, and the pt. is only gasping out clipped sentences. ABC’s done. Down and dirty, yes. More assessment and investigation needed? Of course, but within 5 seconds of meeting your patient you have a good idea of your patient’s condition and what you need to do. So the pro’s do this unconsciously. “So Duh” says the seasoned pro, “If I already do this why am I even reading this?” Well first, you are probably avoiding doing something more important like checking on that new admit GI bleed or cleaning the suction unit. And two, because at some point in your medical career you will be confronted by something unexpected. At some point you will come upon a scene or enter a pt.’s room and be shocked. That is when the ABC’s will save you. When your mind goes blank, when everything starts to move too fast, DO YOUR ABC’s. Open up, clear or protect that Airway. Make sure the Pt. is Breathing or do it for him. Finally, make sure his blood is Circulating to his brain and heart. My point; doing your ABC’s not only saves patients but it gets your brain and hands working while you get a grip on a stressful situation.

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