Expansion
Airway, Breathing, Circulation, Disability, Exposure, treating as you go
Expansion
- A - Airway: patency, added sounds (stridor, gurgling), talking normally means a patent airway. Interventions: head tilt chin lift or jaw thrust, suction, adjuncts, call for anaesthetic help
- B - Breathing: rate, saturations, symmetry of expansion, percussion, auscultation, tracheal position. Give oxygen, treat pneumothorax, bronchospasm, oedema
- C - Circulation: heart rate, blood pressure, capillary refill, peripheral temperature, urine output, JVP. Obtain intravenous access, take bloods including cultures, give fluids, ECG
- D - Disability: AVPU or GCS, pupils, blood glucose (never omitted), temperature, drug chart review
- E - Exposure: full examination front and back, rashes, wounds, calves, abdomen, while preserving dignity and preventing hypothermia
Governing principles
- Treat as you go: do not complete the survey before intervening
- Reassess from A after every intervention
- Call for help early, and use structured communication such as SBAR
- Take a collateral history and review the notes and observation chart in parallel
The commonest omissions in practice are glucose, the back, the calves and the drug chart.