Stepping away from the anatomy a little this week I wanted to discuss the importance of the cABCDE assessment. As you are reading this blog I presume you understand the basics of this assessment, but I just wanted to emphasise the importance of passing this skill onto family and friends. It really can be lifesaving in an emergency situation and is probably most crucial in the initial phase of an incidence before healthcare professionals arrive at a scene.
What is the point of the cABCDE assessment? Well put simply it is checking through varying various aspects of a patient’s health with the priority given to those that can kill you first.
The most important thing in any scenario is your own safety, despite wanting to rush in a be a hero. It is so important to take a step back and look at a scene to see if there is any potential dangers to yourself. The last thing the emergency services want is another casualty. Something like calling for an ambulance as soon as possible can be lifesaving and this can be done from a safe distance. You can also check a number of things from a distance like shouting out to the patient to see if they are responding to you, this can tell the emergency services a lot about the patient’s condition.
Little c – catastrophic bleeding
This is a relatively recent addition to the primary survey and has been taken from military medicine. It stands for catastrophic haemorrhage, such as explosions and other serious trauma, hence why it was adopted first in a military setting. If a catastrophic bleed is identified this must be stopped before progressing with the rest of the primary survey. These usually involve arteries such as your femoral in the leg. This can result in a high pressure pulsatile arterial bleed and will spurt a distance from the casualty. This type of bleed needs to be stopped and needs to be stopped fast. Application of a clean bandage under pressure with elevation, if this is ineffective haemorrhagic dressings can be used. Or if available and if able to gain proximal control a tourniquet can be applied, the time at which this is used is crucial. A tourniquet provides indirect pressure on a proximal artery and is more effective against a single bone, e.g. femur.
A – Airway (with c-spine)
An airway obstruction can stop oxygen getting to the lungs and therefore cause hypoxia (decreased oxygen transport to the tissues. This can lead to brain hypoxia in minutes causing a range of neurological defects as well as death. An airway can be simply checked in talking to the patient, if they are responding with works you know their airway is patent. If they aren’t responding or you can hear gargling noises or stridor (high pitched sound caused by airway obstruction) then their airway is blocked in some way. This hopefully can be easily corrected with a simple head tilt chin lift; two fingers underneath the chin gently lifting up and a palm on their forehead with gentle pressure downwards. This simple manoeuvre can be done in most patients.
However, this cannot be done if a c-spine injury is suspected. A cervical spine injury can happen for a number of reasons such as a fall from a height, a car accident etc, usually something that has a great force involved. The cervical spine gives rise to the phrenic nerve routes with supply the diaphragm, the most important muscle in respiration. These nerves exit the spinal cord at C3,4 and 5 level (C345 keep the diaphragm alive). Therefore, any damage to this area can greatly disrupt breathing and can leave a patient needing constant ventilatory support. A different manoeuvre than can be done here is a jaw thrust.
Look out for next week’s post where we will look at more of cABCDE.