Simultaneously assess and resuscitate
- A – Airway
- Is the airway patent?
- Signs of obstruction (stridor, gurgling, silence)?
- Interventions:
- Airway manoeuvres (chin lift/jaw thrust)
- Suction, airway adjuncts (OPA/NPA)
- Consider need for intubation or expert help
- Call for anaesthetics early if any doubt
- B – Breathing
- Look for RR, effort, symmetry, oxygen saturation
- Auscultate, percuss chest
- Consider causes of deterioration: pneumonia, atelectasis, aspiration, PE
- Interventions:
- Oxygen, nebulisers
- Chest imaging (CXR), ABG
- Escalate for ventilatory support if needed
- C – Circulation
- Assess pulse, BP, CRT, urine output, peripheries
- Consider bleeding (surgical site, drain output), sepsis, hypovolaemia
- Interventions:
- 2x large-bore IVs, bloods, crossmatch
- Fluid resuscitation (e.g. 500 mL crystalloid)
- Activate transfusion protocols or sepsis bundle if indicated
- Consider lactate, ECG, bedside US
- Reassess response to fluids
- D – Disability
- GCS/AVPU
- Pupils
- Glucose (hypoglycaemia is a reversible cause)
- Consider pain, sedation, drugs, metabolic causes (e.g. Na, Ca, hepatic encephalopathy)
- E – Exposure & Everything Else
- Full exposure: look for signs of bleeding, infection, surgical complications
- Check drain outputs, stoma function, wounds, signs of compartment syndrome
- Temperature — hypothermia is common and important
- Skin: rashes, pressure areas, bruising
- Consider: recent surgery, comorbidities, medications