A-E Assessment

Question 1

What are the reasons for patient assessment?

Answer 1

• Understand the patient
• Baseline observations – detect change
• Clues to diagnosis
• Correct immediate/life threatening problems
• Plan management/care
• Resource allocation
• Health education

Question 2

What are the 5 assessment “tools”?

Answer 2

• Ask: use of open/closed questions.
• Eyes: what can you see; does the patient’s demeanour/behaviour match symptoms?
• Ears: what is the patient saying or not saying, any abnormal sounds eg wheeze, stridor.
• Nose: smell for ketones, alcohol, etc.
• Hands: take the pulse, feel the skin, use of appropriate touch.

Question 3

What does ABCDE cover?

Answer 3

A= airway (oxygenation)
B= breathing (ventilation)
C= circulation 
D= disability (neurological deterioration)
E= exposure (examination)

Question 4

Describe the purpose of the initial assessment (A-E) and how it should be carried out?

Answer 4

• Prompt and swift – especially if patient unwell/unstable
• Identify immediate life threatening problems
• No longer than 5 minutes but repeated as necessary
• Request assistance if clinically indicated and delegate tasks

Question 5

What would you look for when assessing airway?

Answer 5

• Able to speak normally?
• Airway closed – do you need to open it?Any obstruction: blood, vomit, foreign body, swelling
• Laryngeal oedema
• Bronchospasm
• Sounds: gurgling, wheeze, stridor

Question 6

What would you look for when assessing breathing?

Answer 6

• Look: respiration rate and depth, symmetry, pattern, use of accessory muscles, colour
• Listen: abnormal sounds, air entry, able to talk in sentences, silent!
• Feel: percussion, expansion, central trachea (medic/ANP)
• Normal: 9 - 20

Question 7

What would you look for when assessing circulation?

Answer 7

• Colour
• Examine peripheries
• Pulse: Rate, rhythm, volume
• BP
• Capillary refill time
• Decreasing urine output can also be a sign of poor circulation

Question 8

What would you look for when assessing disability?

Answer 8

Any obvious injury/condition eg DVT
Level of consciousness: Any confusion apparent, Level of mobility, AVPU 
Check temperature 
Pupil size/response 
GCS
Posture 
BM
Pain assessment

Question 9

What would you look for when assessing exposure?

Answer 9

Remove clothing and examine head to toe, front and back
Remove dressings
Examine for Rash/haemorrhage/wound, Swelling/oedema, Sores/infection, Any attachments: central line, catheter, syringe driver, pacemaker etc., Any other area of concern

Question 10

What else should you consider during the exposure part of assessment?

Answer 10

• Maintain patient dignity at all times
• Provide emotional and informational support to patient as appropriate
• Communicate with family/NOK

Question 11

What does secondary assessment involve?

Answer 11

• Detailed history: new and existing medical complaints
• Investigations: bloods, ECG, ABGs, imaging (x- ray, u/s, CT/MRI etc), swabs/specimens
• Referral to specialist
• Management plan

Question 12

Summary of A-E Assessment:

ABCDE ensures a _______ and thorough approach to patient assessment.
Initial assessment should be performed within _ minutes then repeated as necessary.
Complete one part/correct before ___________.
Repeat as necessary until patient stable then perform ________ _________.

Answer 12

Summary of A-E Assessment:

ABCDE ensures a SYSTEMATIC and thorough approach to patient assessment.
Initial assessment should be performed within 5 minutes then repeated as necessary.
Complete one part/correct before MOVING ON TO NEXT.
Repeat as necessary until patient stable then perform SECONDARY ASSESSMENT.