Emergency Medicine - All About the "ABCs"

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There is a universal truth in Emergency Medicine when taking care of critically ill or injured patients, and that is, “always remember the ABCs”. (My first grade teacher, Mrs. Goldstein, would be very proud!) In Emergency Medicine, however, the “ABCs” stand for “Airway”, “Breathing”, and “Circulation”… and in that order. Serious compromise of any one of these 3 physiologic functions can mean rapid death for the patient. It is commonly understood that the brain, starved of oxygen for 4 minutes, will begin to suffer damage, which can become irreversible after only 7 minutes. There are 3 key components in keeping the brain bathed in oxygen rich blood: an open airway passage, an intact breathing mechanism, and an effective circulation of blood.

Whenever we assess any patient in the Emergency Department, Emergency Physicians make a determination regarding that person’s “ABCs”. Often it is clear that the “ABCs” are intact, as when the patient is able to give us a history concerning their visit to the E.D. for, say, their injured ankle. They have an open airway and intact breathing – otherwise they would be unable to speak – and they have an intact circulation – a circulation adequate to pump oxygen rich blood to the brain, feeding those neurologic centers that allow the patient to recall their history and to perform the mechanics of speaking. At other times, it is clear that the “ABCs” are NOT intact, and require immediate intervention. A common example is the victim of cardiac arrest – lying on the ground, unconscious, blue, without any breathing or pulse. This victim needs someone to quickly step up and open his Airway, provide rescue Breathing, and then do cardiac compressions (providing artificial Circulation). This is, of course, the basic, yet critical, sequence of Cardiopulmonary Resuscitation (CPR) as advocated by the American Red Cross and the American Heart Association.

It is just as important for laypeople who are attempting to provide emergency care to a person in the prehospital environment (first aid) to recall and assess the proper sequence of the “ABCs”. Is the person’s airway open and patent – allowing air to move in and out? Is the patient breathing effectively – exchanging enough air with each breath? Is the victim’s circulation adequate to perfuse the brain and other vital organs with enough oxygen rich blood? If the answer is “no” to any one of these questions, then the rescuer must act immediately, addressing the issues in sequence. There is no use to try to provide artificial Breathing if the Airway is not open, as there will be no way for the air to enter the breathing tubes. Likewise, providing external chest compressions is unlikely to be of great benefit if the victim lacks an intact airway and breathing.

So, if called into action to handle any apparent emergency in the street or in the woods, start by assessing the Airway, the Breathing and the Circulation. A basic CPR class (through the American Red Cross or the American Heart Associate) is an excellent way to get the basics on the “ABCs”.

Stay alert and stay safe,

Dr. Bob
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About the Author

The Stanford Emergency Room is the center of emergency care at Stanford University.

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