The ABCDE and SAMPLE History Approach

Basic Emergency Care Course

Objectives
By the end of this presentation, you will be able to:
• List the hazards and elements that must be considered when approaching an ill or
injured person safely
• Describe the components of the systematic ABCDE approach to emergency patients
• Assess each element of the ABCDE approach
• Identify critical actions for each element of the ABCDE approach
• Describe the signs and symptoms of acute life-threatening conditions
• Identify critical ABCDE actions for acute life-threatening conditions
• Describe special paediatric considerations for the ABCDE approach
• List the elements of and perform a relevant SAMPLE history
• Consider disposition of emergency patients for handover / transfer
The ABCDE and SAMPLE history approach

Part I: Introduction to the ABCDE approach

Why the ABCDE approach?
• Approach every patient in a systematic way
• Recognize life-threatening conditions early
• DO the most critical interventions first; fix problems before moving on!
• The ABCDE approach is very quick in a stable patient.

Goals:

• Identify life-threatening conditions rapidly

• Ensure the airway stays open
• Ensure breathing and circulation are adequate to deliver oxygen to the body
What is a SAMPLE history?
• Categories of questions to obtain a patient’s history
• Signs and Symptoms
• Allergies
• Medications
• Past medical history
• Last oral intake
• Events
• Immediately follows the ABCDE approach
• Allows providers to easily communicate

Goal:
• Rapidly gather history critical to the management of the acutely ill patient
 ABCDE: Initial Approach

The most important step is to stay safe. Ask for help early.

• Scene safety: Consider hazards, violence • Multiple patients

and infectious disease risk
• Examples of hazards • Make arrangements for transfer
if needed
• Fire
• Motor vehicle crash • Know who to call for infectious
• Building collapse outbreaks or hazardous
• Chemical spill exposures

©WHO/Laerdal Medical
Safety considerations
Personal protective equipment Cleaning and decontamination
• Consider appropriate PPE for situation • Use PPE and wash your hands
• Gloves before and after every patient
• Gown contact (or alcohol gel cleanser).
• Mask
• Clean/disinfect surfaces
• Goggles
• Hand washing • Refer to local decontamination
protocols for chemical exposures.

©WHO/Laerdal Medical
Workbook Question 1:
Safety

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 patient:

ABCDE Approach: Elements
cổ cột sống cố định

• Airway with cervical spine immobilization

• Check for obstruction.
• If trauma, immobilize cervical spine.
cố định

• Breathing plus oxygen if needed

• Ensure adequate movement of air into the lungs.

• Circulation with bleeding control and IV fluids

• Determine if there is adequate perfusion.
• Check for life-threatening bleeding
ABCDE Approach: Elements

• Disability
• Assess and protect brain and spinal functions.
• Check AVPU/GCS, pupils and glucose.
đồng tử
• Exposure and keep warm
• Identify all injuries and environmental threats.
• Avoid hypothermia.

This stepwise approach is designed to ensure that life-threatening conditions

are identified and treated early, in order of priority.

A problem discovered (A-B-C-D-E) must be addressed immediately

before moving on to the next step.
Essential skills
Overall • Assessing ABCDE • Intravenous (IV) line placement
• IV fluid resuscitation
• Direct pressure/ deep wound
• Cervical spine immobilization
packing for haemorrhage
• Head-tilt and chin-lift/jaw thrust
control
• Airway suctioning
• Tourniquet for haemorrhage
• Management of choking
control
• Recovery position
• Pelvic binding
• Nasopharyngeal (NPA) and
• Fracture immobilization
oropharyngeal airway (OPA)
• Skin pinch test
placement
• Full spine immobilization
• Oxygen administration • AVPU (alert, voice, pain,
• Bag-valve-mask ventilation unresponsive) assessment
• Needle-decompression for tension • Glucose administration
pneumothorax
• Three-sided dressing for chest • Wound management
wound • Snake bite management
• Log roll
REMEMBER…
Always check for signs of trauma in each of the ABCDE sections and reference the
trauma module as needed.
Airway Assessment
• Can the patient talk normally?

• Look for foreign body, swelling around the Problem

airway identified
Manage airway
• Look for altered mental status
• Listen for abnormal sounds suggesting
obstruction
• Look and listen for fluid in the airway
• Look to see if the chest wall is moving in or out
• Listen and feel for air movement from the
mouth and nose
Normal LOOK, LISTEN, FEEL ©WHO/Laerdal Medical

for air movement

Breathing Assessment
Airway Management
• If the patient is unconscious and not breathing normally:

• If no concern for trauma

à open airway using HEAD-TILT / CHIN-LIFT manoeuvre.

• If trauma suspected ©WHO/Laerdal Medical

à maintain C-SPINE IMMOBILISATION and use JAW-THRUST manoeuvre.

• Consider placing an AIRWAY DEVICE to keep the airway open

• Oropharyngeal airway
• Nasopharyngeal airway
Airway Management: Choking
If foreign body is suspected:
• If there is a visible foreign body à carefully REMOVE IT
• If the patient is able to cough or make noise
à keep the patient calm and ENCOURAGE to cough.
©WHO/Laerdal Medical

• If the patient is choking (unable to cough/make sounds)

à use age-appropriate CHEST THRUSTS/ABDOMINAL THRUSTS/
BACK BLOWS.

• If the patient becomes unconscious while choking à follow CPR

PROTOCOLS.
Airway Management
• If secretions are present:
à SUCTION airway or wipe clean
à Consider RECOVERY POSITION if the rest of the ABCDE is normal and no
trauma
• If the patient has swelling, hives, or stridor à consider a severe allergic reaction
(anaphylaxis)
• Give intramuscular ADRENALINE RECOVERY
• Allow patient to stay in position of comfort. POSITION

• Prepare for HANDOVER/TRANSFER to a

location capable of advanced airway management.
©WHO/Laerdal Medical
Breathing: Assessment
Look, listen and feel to see if the patient is breathing
Assess if the breathing is very fast, very slow or very shallow.
Look for increased work of breathing.
• Accessory muscle work
• Chest indrawing
• Nasal flaring
• Abnormal chest wall movement
Listen for abnormal breath sounds.
REMEMBER with severe wheezes there may be no audible breath sounds because
of severe airway narrowing .
Breathing: Assessment
Listen to see if breath sounds are equal.
Check for the absence of breath sounds on one side. PERCUSSION
• If dull sound with percussion to the same side
• THINK large pleural effusion or haemothorax.
• If hyperresonance on percussion on same side
• THINK simple pneumothorax.

• If also hypotension, distended neck veins or

tracheal shift. ©WHO/Laerdal Medical

• THINK tension pneumothorax.

Check oxygen saturation.
Breathing: Management
• If unconscious with abnormal breathing à perform BAG-VALVE-MASK-
VENTILATION with OXYGEN and follow CPR PROTOCOLS.

• If not breathing adequately (too slow or too shallow) à begin BAG-VALVE-

MASK-VENTILATION with OXYGEN
• If oxygen is not immediately available, do not delay ventilation.
• Plan for immediate TRANSFER for airway management.

©WHO/Laerdal Medical
Breathing: Management
NOT BREATHING ADEQUATELY
• If breathing fast or hypoxia à give OXYGEN.
• If wheezing à give SALBUTAMOL .
• If concern for anaphylaxis à give intramuscular ADRENALINE.
• If concern for tension pneumothorax ©WHO/Laerdal Medical

à perform NEEDLE DECOMPRESSION, give OXYGEN, give IV FLUIDS.

• Plan for immediate transfer for chest tube.
• If concern for pleural effusion or haemothorax à give OXYGEN.
• Plan for immediate transfer for chest tube.
• If cause unknown à consider trauma.
Circulation: Assessment
Look, listen and feel for signs of poor perfusion.
• Cool, moist extremities
• Delayed capillary refill
• Diaphoresis
• Low blood pressure
• Tachypnoea
• Tachycardia
• Absent pulses ©WHO/Laerdal Medical
Circulation: Assessment
Look for internal and external signs of bleeding.
• Chest
• Abdomen
• From stomach or intestines
• Pelvic fracture
• Femur Fracture
• From wounds
Check for pericardial tamponade.
• Hypotension
• Distended neck veins
• Muffled heart sounds
©WHO/Laerdal Medical
Check pulse, capillary refill, blood pressure.
Circulation: Management
• For cardiopulmonary arrest, follow relevant CPR PROTOCOLS.

• If poor perfusion à GIVE IV FLUIDS.

• If external bleeding à APPLY DIRECT PRESSURE .
• If internal bleeding or pericardial tamponade ©WHO/Laerdal Medical

à plan HANDOVER / TRANSFER to centre with surgical capabilities.

• If unknown cause à remember trauma.

• Apply BINDER for pelvic fracture or SPLINT for femur fracture with
compromised blood flow.
Disability: Assessment
Assess level of consciousness.
• AVPU or GCS in trauma
Check for low blood glucose (hypoglycaemia).
Check pupils (size, reactivity to light and if equal).
Check movement and sensation in all four limbs.
Look for abnormal repetitive movements or shaking. ©WHO/Laerdal Medical

• Seizures/convulsions
Disability: Management
• If altered mental status, no trauma, ABCDEs otherwise normal
à Place in RECOVERY POSITION.
• If altered mental status, low glucose (<3.5mmol/L or <60 mg/dL) or if unable to
check glucose
à Give GLUCOSE.
• If actively seizing
à Give BENZODIAZEPINE.
• If pregnant and seizing
à Give MAGNESIUM SULPHATE. ©WHO/Laerdal Medical
Disability: Management

• If small pupils and slow breathing, consider opioid overdose

à Give NALOXONE.

• If unequal pupils, consider increased pressure in the brain ©WHO/Laerdal Medical

à RAISE HEAD OF BED 30 DEGREES if no concern for spinal

injury.
à Plan for early TRANSFER/REFERRAL.

©WHO/Laerdal Medical
• If unknown cause of altered mental status, consider trauma
à IMMOBILIZE the cervical spine.
Exposure: Assessment
Examine the entire body for hidden injuries, rashes, bites or other lesions.
• Rashes, such as hives, can indicate an allergic reaction
• Other rashes can indicate infection

©WHO/Laerdal Medical
Exposure: Management
• If snake bite is suspected
àIMMOBILIZE the bitten extremity.
àTake a picture of the snake (if possible and safe) to send to referral hospital.
• General exposure considerations.
• REMOVE constricting clothing and jewelry
• COVER the patient to prevent hypothermia
• Acutely ill patients may be unable to regulate body temperature
• PREVENT hypothermia
• Remove wet clothing and dry patient thoroughly
• Respect the patient’s modesty
• If cause unknown à remember trauma
• LOG ROLL for suspected spinal cord injury.
©WHO/Laerdal Medical
The ABCDE and SAMPLE history approach
Part 2: In-depth Acute Life-Threatening Conditions
In-Depth, Acute, Life-Threatening Conditions

• Obstruction: • Tension • Pulselessness • Hypoglycaemia • Snake bite

foreign body pneumothorax • Shock • Increased
• Obstruction: • Opiate • Severe pressure on the
burns overdose bleeding brain
• Obstruction: • Asthma/COPD • Pericardial • Seizures/
anaphylaxis • Large pleural Tamponade convulsions
• Obstruction: effusion/
trauma haemothorax
Airway Obstruction: Foreign Body
Signs and Symptoms Management
• Visible secretions, vomit or foreign • REMOVE or SUCTION visible foreign
body body/fluid if possible.
• Abnormal sounds from airway • Do not push further into airway.
• Stridor, snoring, gurgling • If completely obstructed
• Mental status changes leading à Use age-appropriate CHEST
to airway obstruction from tongue THRUSTS/ABDOMINAL THRUSTS/ BACK
• Poor chest rise BLOWS
• For obstruction due to tongue
à Open the airway using HEAD-TILT and
CHIN LIFT or JAW THRUST (trauma)
• Place OPA or NPA as needed.
©WHO/Laerdal Medical
• Plan for HANDOVER/TRANSFER.
Airway Obstruction: Burns
Signs and Symptoms Management
• Burns to head and neck • Give OXYGEN to all patients with burn
• Burned nasal hairs/soot injuries.
• Abnormal sounds from airway • Open the airway using HEAD-TILT and
• Stridor, snoring, gurgling CHIN LIFT or JAW THRUST (trauma).
• Poor chest rise • Place OPA or NPA as needed.
• Rapid airway swelling • Maintain C-SPINE IMMOBILIZATION if there
is trauma.
• Plan for HANDOVER/TRANSFER.

©WHO/Laerdal Medical

Burns can cause airway swelling due to inhalation injuries.

Airway Obstruction:
Severe Allergic Reaction
Signs and Symptoms Management
• Mouth, lip and tongue swelling • MONITOR for airway obstruction.
• Difficulty breathing • Give ADRENALINE for airway obstruction, severe
• Stridor and/or wheezing wheezing or shock.
• Rash or hives • Can wear off in minutes, may need
• Tachycardia and hypotension additional doses
• Abnormal sounds from airway
• Stridor, snoring, gurgling • Give OXYGEN.
• Poor chest rise • Start IV/ give IV FLUIDS.
• REPOSITION AIRWAY as needed. ©WHO/Laerdal Medical

• Sit patient upright (no trauma).

• If severe or not improving àplan for
HANDOVER/TRANSFER
Airway Obstruction: Trauma
Signs and Symptoms Management
• Neck haematoma • SUCTION to remove any blood.
• Abnormal sounds from airway • Open airway using JAW THRUST.
• Stridor, snoring, gurgling • Place an OPA as needed.
• Change in voice • Do not use NPA with facial trauma
• Poor chest rise • Maintain SPINE IMMOBILIZATION.
• Plan for HANDOVER/TRANSFER.

©WHO/Laerdal Medical

In head/neck injuries obstruction can be from blood or due to the trauma itself.
Penetrating wounds to neck cause obstruction from expanding hematoma.
For any abnormal airway sounds, REASSESS the
airway frequently as partial obstruction might worsen
to completely block the airway.

©WHO/Laerdal Medical
Breathing Conditions: Tension Pneumothorax
Signs and Symptoms Management
• Hypotension with difficulty breathing • Perform NEEDLE DECOMPRESSION, give
and any of the following: OXYGEN and IV FLUIDS
• Distended neck veins
• Absent breath sounds on affected
side
• Hyperresonance with percussion
on affected side
• May have tracheal shift ©WHO/Laerdal Medical

away from affected side • Arrange for urgent chest tube.

• Plan for HANDOVER/TRANSFER

Any pneumothorax can become a tension pneumothorax.

Breathing Conditions: Suspected Opiate Overdose
Signs and Symptoms Management
• Slow respiratory rate (bradypnoea) • Give NALOXONE to reverse opioid
• Hypoxia medications.
• Very small pupils • MONITOR closely; Naloxone may wear off
SMALL PUPILS before opiate.
• Give OXYGEN.

©WHO/Laerdal Medical

Opioid drugs (such as morphine, pethidine, oxycodone and heroin) can

decrease the body’s drive to breathe.
Breathing Conditions: Asthma/ COPD
Signs and Symptoms Management

• Wheezing • Give SALBUTAMOL as soon as possible.

• Cough • Give OXYGEN if indicated.
• Accessory muscle use
• May have history of asthma/COPD,
allergies or smoking

©WHO/Laerdal Medical

Asthma and COPD are conditions causing spasm in the lower airway.
Breathing Conditions:
Large Pleural Effusion/ Haemothorax
Signs and Symptoms Management
• Difficulty in breathing • Give OXYGEN.
• Decreased breath sounds on affected • Plan for HANDOVER/TRANSFER.
side • Patient may need a chest tube.
• Dull sounds with percussion on affected
side
• With large amount of fluid could have
tracheal shift
©WHO/Laerdal Medical

Pleural effusion occurs when fluid builds up in the space between the lung
and the chest wall or diaphragm limiting the expansion of the lungs.
Circulation Conditions: Pulselessness

Signs and Symptoms Management

• No pulse • Follow relevant CPR PROTOCOLS.
• Unconscious
• Not breathing

©WHO/Laerdal Medical
Circulation Conditions: Shock
Signs and Symptoms Management
• Rapid heart rate (tachycardia) • LAY FLAT if tolerated.
• Rapid breathing (tachypnoea) • Give OXYGEN.
• Pale and cool skin • STOP and CONTROL any bleeding.
• Capillary refill >3 seconds • Give IV FLUIDS.
• Sweating (diaphoresis)
• May have:
• Dizziness
• Confusion ©WHO/Laerdal Medical

• Altered mental status • If sign of infection à give ANTIBIOTICS.

• Hypotension • Plan for HANDOVER/TRANSFER.

Poor perfusion is failure to deliver enough oxygen-carrying blood to vital organs

Shock is when organ function is affected which can lead to death
Circulation Conditions: Severe Bleeding
Signs and Symptoms Management
• Bleeding wounds • Stop bleeding depending on source.
• Bruising around the umbilicus, over the • DIRECT PRESSURE
flanks can be sign of internal bleeding • Use DEEP WOUND PACKING if large
• Vomiting blood, blood per rectum or and gaping.
vagina • TOURNIQUET- Only for uncontrolled
• Pelvic or femur fractures bleeding not responding to direct
• Decreased breath sounds on one side pressure
• Signs of poor perfusion • BIND pelvis or SPLINT femur fracture.
• Hypotension, tachycardia, pale skin, • Give IV FLUIDS.
diaphoresis • REFER for blood transfusion and on-going
surgical management .
If severe bleeding is not controlled, it can lead to shock. Large amounts of blood
can be lost in the chest, pelvis, thigh, abdomen and externally.
Circulation Conditions:
Pericardial Tamponade
Signs and Symptoms Management
• Signs of poor perfusion • Treatment is drainage by pericardiocentesis
• Tachycardia, tachypnea, • IV FLUIDS to counter the pressure from fluid
hypotension, pale skin, cold in heart sac
extremities, capillary refill >3 • Plan for HANDOVER/TRANSFER
seconds • Needs facility capable of draining fluid
• Distended neck veins
• Muffled heart sounds
• May have dizziness, confusion, altered
mental status

Pericardial tamponade occurs when there is a fluid build-up in the sac around the
heart. Pressure build-up keeps the heart from filling properly.
Disability Conditions: Hypoglycaemia
Signs and Symptoms Management
• Sweating (diaphoresis) • Give GLUCOSE immediately.
• Altered mental status • If they can speak/swallow à give oral
• Seizures/convulsions GLUCOSE.
• Blood glucose <3.5mmol/L or <60 mg/dL • If they cannot speak or is
• History of diabetes, malaria or severe unconscious à give IV GLUCOSE.
infection • If unavailable à give buccal
• Responds quickly to glucose (inside of cheek) glucose.

©WHO/Laerdal Medical
Disability Conditions:
Increased Intracranial Pressure
Signs and Symptoms Management
• Headache • RAISE the head of the bed 30 degrees.
• Seizure/convulsions • If trauma à MAINTAIN CERVICAL SPINE
• Nausea, vomiting IMMOBILIZATION.
• Altered mental status • Check glucose.
• Unequal pupils • If seizures à give BENZODIAZEPINE.
• Weakness on one side of the body • Plan for HANDOVER/TRANSFER.
• Pressure must be reduced as soon as
possible which requires neurosurgery

©WHO/Laerdal Medical

Increased ICP can occur from trauma, tumors, increased fluid, bleeding or infection.
Any swelling, fluid or mass increases pressure around the brain, and limits blood flow.
Disability Conditions: Seizure/ Convulsions
Signs and Symptoms Management
• Active seizure • Prevent hypoxia and injury.
• Repetitive movements • Protect from falls/dangerous objects..
• Fixed gaze to one side or • Do not stick anything in their mouth
alternating rhythmically • SUCTION as needed .
• Not responsive • Give OXYGEN.
• Recent seizure • Check glucose.
• Bitten tongue • Give GLUCOSE if needed.
©WHO/Laerdal Medical
• Urinated on self • Give a BENZODIAZEPINE .
• Known history of seizures • Monitor breathing.
• Confusion gradually returning over • Place in RECOVERY POSITION (if no trauma)
minutes or hours • Give MAGNESIUM SULPHATE if pregnant or
recently pregnant .
If cause unknown, consider trauma.
Exposure Conditions: Snake Bite
Signs and Symptoms Management
• History of snake bite • Limit the spread of venom and the effects
• Bite marks may be seen on the body
• Oedema • IMMOBILIZE THE BITTEN EXTREMITY.
• Blistering of skin • Take a picture of the snake to send with
• Bruising the patient if possible and safe.
• Hypotension • If evidence of shock à give IV FLUIDS.
• Paralysis • Monitor closely for airway obstruction and
• Seizures signs of shock.
• Bleeding from wounds • Plan for RAPID HANDOVER/TRANSFER.
©WHO/Laerdal Medical
Reassess ABCDEs Frequently

The ABCDE approach is designed to quickly identify reversible life-

threatening conditions.

Vital signs should be checked at the end of the ABCDE approach.

Once you find an ABCDE problem and manage it, you need to GO BACK
and repeat the ABCDE again to identify any new problems that have
developed and make sure that the management provided worked.

Ideally, the ABCDE approach should be repeated every 15 minutes or

with any change in condition.
Workbook Question 2

Using the workbook section above, list the management for airway blocked by a
foreign body.
The ABCDE and SAMPLE history approach
Part 3: Special Paediatric Considerations, SAMPLE history and Disposition

This learning content has been developed in collaboration with the WHO Academy.
Special Paediatric Considerations
Paediatric Airway Considerations
Compared to adults, children have:
• Bigger tongues
• Use “sniffing” position
• Shorter necks, softer airway
• Easier to block off
• Avoid over-extending or flexing the neck
• A larger head compared to body ©WHO/Laerdal Medical

• Watch closely for airway obstruction

• Use jaw thrust
• Correct head position with padding under shoulders to open airway
Excessive drooling, stridor, airway swelling, unwillingness to move neck are
high-risk signs in children.
Paediatric Breathing Considerations
Look for signs of respiratory distress :
• Nasal flaring
• Head bobbing
• Grunting
• Chest indrawing or retractions
• Cyanosis, a blue/gray discoloration around lips, mouth or fingertips is a
danger sign
Look at the lower ribs
• Chest indrawing is when the lower chest wall goes IN when the child
breathes IN.
• In normal breathing the whole chest and abdomen move OUT when the
child breathes IN.
Paediatric Breathing Considerations
Listen
• Silent chest is a sign of severe distress in a child
• Severe spasms and airway narrowing cause limited airway movement
and few or no breath sounds may be heard.
• Give SALBUTAMOL and OXYGEN.
• Reassess frequently.

• Stridor is a sign of severe airway compromise

• Allow child to stay in position of comfort. ©WHO/Laerdal Medical
• Plan for rapid HANDOVER/TRANSFER.
• Give nebulized ADRENALINE. If unable to transfer immediately, consider
IM ADRENALINE (allergic reaction protocol).
Paediatric Circulation Considerations
Low blood pressure in a child is a sign of severe shock.
• Children will maintain a normal blood pressure longer than adults but then
decompensate quickly.
• Always monitor other signs of poor perfusion.
• Decreased urine output
• Sunken fontanelle, poor skin pinch, lethargy,
altered mental status (severe signs)
©WHO/Laerdal Medical

Rate, volume and type of IV fluid administered depends on body weight, the
cause of poor perfusion and the child’s nutritional status.

Malnourished children require careful fluid management!

Paediatric Disability Considerations
Low blood glucose is a common cause of altered mental status in a sick child.
• When possible, check blood glucose with altered mental status.
• When not possible, give GLUCOSE .
Always check blood glucose with seizures/convulsions .

It may be difficult to determine if a small child is acting normally. Ask family/friends

who know the child to provide this information.

©WHO/Laerdal Medical
Paediatric Exposure Considerations
Infants/children have trouble maintaining temperature and can become
hypothermic or hyperthermic quickly.
• Remove wet clothing and dry skin thoroughly.
• Provide skin-to-skin contact for infants.
• If concerned about hypothermia àCover very small children’s heads
• If concerned about hyperthermia àUnbundle tightly wrapped babies

©WHO/Laerdal Medical
Assess all children for the presence of danger signs.
A child with danger signs needs urgent attention!
• Signs of airway obstruction • Seizures/convulsions
• Increased breathing effort • Low body temperature
• Cyanosis (hypothermia)
• Altered mental status
• Moves only when stimulated or no
movement (AVPU other than ”A”)
• Not feeding well/ cannot drink or
breastfeed
• Vomiting everything

©WHO/Laerdal Medical
Workbook Question 3

Using the workbook section:

One paediatric airway consideration ______________________________

One paediatric breathing consideration ____________________________
One paediatric circulation consideration ___________________________
One paediatric disability consideration _____________________________
One paediatric exposure consideration ____________________________
ABCDE Approach: Summary
Airway with cervical spine immobilization

Breathing plus oxygen if needed

Circulation IV fluids and bleeding control

Disability AVPU/GCS, pupils and glucose

Exposure and keep warm

REMEMBER

If you find a problem with any of the ABCDEs, STOP and CORRECT the
problem.

Then, GO BACK and REASSESS the ABCDEs again to identify any new
problems that have developed and make sure that the management
provided worked.
Elements of the SAMPLE history
S Signs and
symptoms
Patient/family’s report of signs and symptoms is an
essential assessment
A Allergies Important to prevent harm; may also suggest anaphylaxis

M Medications
Obtain a full list and note recent medication or dose
changes
P Past Medical
History
May help in understanding current illness and change
management choices
L Last Oral intake
Note whether solid or liquid; vomiting/choking risk for
sedation; intubation or surgical procedures
E Events
surrounding the
Helpful clues to the cause, progression and severity of
current illness
injury/illness
Workbook Question 4

Using the workbook section above, list what the letters in SAMPLE stand for:
S
A
M
P
L
E
Disposition Considerations
• Disposition (destination of the patient) A good handover includes:
should be considered after ABCDE üBrief identification of the patient
approach, SAMPLE history and üRelevant elements of the SAMPLE
complete physical exam based on the history
specific condition.
üPhysical exam findings
üRecord of interventions given
• If you intervene in any of the ABCDE
categories, immediately plan for üPlans for future care
HANDOVER/TRANSFER to a higher level üThings you may be concerned
of care. about
Quick Cards
Summary
In this presentation, we have covered:
• The hazards and elements that must be considered when approaching an ill or injured
person safely
• The components of the systematic ABCDE approach to emergency patient
• Assessment of each element of the ABCDE approach
• Critical management actions for each element of the ABCDE approach
• The signs and symptoms of acute life-threatening conditions
• The critical ABCDE actions for acute life-threatening conditions
• Special paediatric considerations for the ABCDE approach
• The elements of a relevant SAMPLE history and how to perform
• Disposition considerations for handover/transfer of emergency patients