IT’s as simple as ABC

Airway Breathing Circulation

When we way ABCs, we are not talking about children’s building blocks. We are talking about the building blocks of life.

Before you begin any treatment, you must first assess whether your patient is in mortal danger. Don’t be distracted by a lot of blood or environmental factors (provided you and your patient are safe). First check ABCs, that is Airway, Breathing and Circulation (which included significant, life-threatening bleeding because if you patient bleeds out, they will lose circulation. If you find something wrong during your ABC assessment, fix it before moving onto anything else. Below are some important actions to take.

Airway — Is the patient’s airway open so air can flow through. The most common obstruction of the airway is the tongue. While it is not possible to swallow the tongue, it can roll back and block the airway. Other potential obstructions are food, mucus, objects. In the case of children, small toys are also an obvious potential hazard.

  • Treatment — If the patient is conscious, attempt an abdominal thrust (formerly known as the Heimlich Maneuver) and keep trying until the item dislodges.
  • If the airway is obstructed by the tongue, try turning the head one way or the other or better yet, roll the patient to his side which may do the trick.
  • If that does not work see if you can observe what is blocking the airway. If you can pluck it out, try, but do not blindly sweep your finger into the mouth, that can make thing much more difficult if you lodge the offending obstruction deeper into the airway.
  • If you have long pliers, chopsticks, or anything that can be used in place of your fingers, try that. A tool can give you more reach and is safer.
  • If you cannot dislodge the obstruction, eventually the patient will go into cardiac arrest. Begin CPR.

Breathing — In an emergency we are looking at two aspects of breathing, first is the patient breathing? If not, try to figure out why not and prepare to breath for the patient. Second, how well is the patient breathing. This is a little trickier because the patient  may appear to be breathing, that is, taking air in and out of the lungs, but in reality that breathing is not effective so not much different than not breathing at all.

Look at the patient’s skin, and mucus membranes (curl the bottom lip and look at what should be the pink tissue). Do you see pink or blue or gray? If not pink, this patient is likely not perfusing, meaning oxygen is not getting to the cells. 

If a patient is not breathing and you can’t figure out why to correct the problem, you must start breathing for her. You will need to perform mouth-to-mouth or mouth-to-mask (better!) if you have an airway mask to use. Breath just enough to fill the patient’s lungs which you can determine by stopping when you see the patient’s chest rise as you inhale. 

If the patient is breathing faster than 30 breaths a minute or less than 8 breaths a minute, they are not adequately perfusing. You must begin breaths for this patient. You may find a patient who is breathing agonally breathing, which is normally breathing that sound like snoring, it tends to be very noisy. This can be a sign of all sorts of things but often indicates some sort of cardiac emergency. This patient is not adequately perfusing and needs you to begin breathing for him via mouth to mouth or mouth to bag.

Circulation — This refers to air circulation in the blood stream to all the cells, returning carbon dioxide to the lungs to be exhaled. This is the function of the blood, but if the blood is not capable of doing this because of bleed, or there is another reason, we must restore circulation. 

The first rule of getting out of a hole is stop digging. The first rule of circulation is stop any significant bleeding. If bleeding is not the problem, then take a look at severe dehydration, which can also impede circulation. These are the most likely causes in crisis situations. 


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