"improving intensive care in Scotland"

Assessment and treatment of the acutely ill adult

E for Exposure, Examination, and review of Evidence

In the standard scheme derived from Advanced Trauma Life Support this is exposure to look for important injuries. Although this is relevant in that context we would suggest that E is for targeted secondary Examination, review of Evidence (notes, drug/ fluid/observation charts) and Environment (what is the patient attached to ? eg iv infusions such as GTN in the hypotensive patient, epidural infusions or PCA pumps in the post-operative patient and so on).

 

F for Frequent examination and establish monitoring

It is often important to examine the patient more than once to assess the severity of illness (is the patient improving or getting worse?). Use of appropriate non-invasive or invasive monitors should be considered. A central line, for example, will allow us to assess the circulation's response to a fluid challenge.

Worsening of the patient's condition despite appropriate treatment might be an indication for early transfer to ICU.

 

Important

At the same time as ABCDEF assessment and treatment are proceeding immediate monitoring with ECG and pulse oximetry should be established and consideration should be given to whether invasive monitoring is required. Think about the definitive diagnosis and treatment.


This ABCDE approach is grounded in what we might call 'the equations of life'. These delineate the physiology which keeps us alive from minute to minute and this will be considered in more detail throughout the specific modules. However it is appropriate to introduce them here.

 

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