Objectives

On successfully completing this topic, you will be able to:

• identify the correct sequence to be followed in assessing and managing seriously ill or seriously injured patients

• understand the concept of the primary and secondary surveys.

Introduction

The structured approach refers to the ‘ABCDE’ approach to lifesaving. The aim of the structured approach is to provide a system of assessment and management that is effective, and simple to remember, in the heat of an emergency. It can be applied to any patient with a threat to life, be that from illness or injury. Assessment is divided into primary survey and secondary survey. The approach is the same for all: adults, children, the elderly and pregnant women.

Primary survey

The system follows a simple ABCDE approach, with resuscitation taking place as problems are identified, i.e. a process of simultaneous evaluation and resuscitation.

Airway

Assess whether the airway is open and, if not, open the airway using simple manoeuvres, such as head tilt and chin lift, followed by more complex actions (as detailed in Chapter 8) where necessary. Manoeuvres to secure the patient's airway should not cause harm, or further harm, to the cervical spine. Therefore, if an injury to the cervical spine is suspected in caring for the airway, the cervical spine must be immobilised.

Breathing

Look, listen and feel for respiration, using supplementary oxygen and ventilatory support as required.