What does the ‘c’ refer to in cABCDE?
Stabilise C-spine and stop massive catastrophic haemorrhage.
What are the steps of ‘A’ in cABCDE?
- Ask the patient how they are, if they respond then move to B.
- Assess for airway obstruction - swelling, gurgling, snoring, choking, stridor, flail chest.
How do you respond to airway obstruction?
- Head tilt/chin lift
- Jaw thrust in c-spine trauma
- Remove foreign object, suction secretions
- Guedel OP/NPA especially in seizure
- If it persists - escalate (ENT, anaesthetics)
What are the steps of ‘B’ in cABCDE?
- Give 100% oxygen if hypoxic
- Resp rate, sats, tracheal deviation
- Inspect, palpate, percuss, auscultate chest
What could a dullness on auscultation of the chest in an emergency represent?
Pleural effusion, collapse, consolidation
What could reduced sounds on auscultation of the chest in an emergency represent?
Collapse, pneumothorax, pleural effusion
What could a wheeze on auscultation of the chest in an emergency represent?
Bronchospasm
What could crackles on auscultation of the chest in an emergency represent?
Pulmonary oedema, fibrosis, consolidation
What is the next step in management if the respiratory effort is poor?
- Get help
- Manual ventilation via bag-valve mask
- Naloxone in opioid toxicity
What is the next step in management in a tension pneumothorax?
Immediate needle aspiration
What is the next step in management in widespread wheeze?
Check for anaphylaxis, if not then give bronchodilators.
When do you aim for sats between 88-92%?
Chronic T2RF
What are the steps of ‘C’ in cABCDE?
- Check colour and temperature of hands
- Capillary refill time
- Palpate radial and carotid pulses
- Blood pressure
- JVP
- Auscultate heart sounds
- ECG
- 2 large bore IV cannulas - routine bloods and cross match
What are the signs for shock and how do you manage it?
- Increased CRT, cold peripheries, thready pulse, tachycardia, hypotension.
- Give fluid challenge unless evidence of pulmonary oedema.
What are the recommendations for fluid challenge (ml/kg) in these three scenarios?
- Poor urine output
- Low blood pressure
- Congestive heart failure and poor urine output
- 10
- 20
- 5
What is the management of a massive haemorrhage?
- 1:1:1 of packed RBC, FFP, and platelets
- Reverse warfarin with IV vitamin K and PTCC
- Consider tranexamic acid
What is the management of VT?
Synchronised DC shock
What is the management of bradycardia?
- Give atropine 0.5-3mg
2. If no response - get help, transcutaneous pacing or IV adrenaline
What are the steps of ‘D’ in cABCDE?
- Capillary blood glucose
- ABG
- GCS/AVPU
- Pupillary reflexes
How is a CBG of <3 managed?
- Send blood for formal lab glucose
2. Give immediate IV dextrose
What is the pharmaceutical cause of bilateral pinpoint pupils?
Opioid intoxication
What is the pharmaceutical cause of bilateral dilated pupils?
Cocaine, amphetamine, TCA, atropine
What could to cause of a unilateral fixed pupil be?
Raised ICP or CN III palsy
What are the steps of ‘E’ in cABCDE?
- Body temperature
- Fully expose body - bleeding, injuries, rashes, jaundice, medic alert bracelet, DVT, leg swelling
- Examine abdomen
- Bowels and water works
- Allergies, meds, PMHx
