The ABCDE Approach
● The ABCDE approach is a systematic approach to the assessment of the ‘sick’ patient recommended by the Resuscitation Council (UK).
● It stands for Airway, Breathing, Circulation, Disability and Exposure.
● You should perform these actions in the following sequence:
- A is airway care
- B is breathing
- C is circulation of the blood
- D is disability and brain and spinal cord damage
- E is exposure and examination of the person’s bodyylaxis
If you suspect that somebody is experiencing the symptoms of anaphylaxis then immediately call 999 for an ambulance and tell the operator that you think the person has anaphylaxis.
If you can see a potential trigger, such as a wasp or bee sting embedded in their skin, then remove it.
An adrenaline injection must be given as soon as a serious reaction is suspected.
If the person is carrying an adrenaline auto-injection kit, they may be able to inject themselves or you can help them to use it.
There are three types of auto-injectors:
● EpiPen. This needle releases adrenaline when it is jabbed against the outer thigh.
● Anapen. You hold the syringe against the outer thigh and push a button, which plunges the adrenalin-loaded needle into muscle.
● Jext. This works in much the same way as Anapen.
● Using the Epipen
With your dominant hand, get a solid grip on the shot.
To do so, wrap your fingers around it like you’re making fist, and place your thumb perpendicular across your fingers. Almost all epinephrine shots employ an auto-injection system, so there’s no need to press
Remove the Rear Cap Using your free hand, remove the cap from the rear of the shot.
If you can’t tell which end is the rear, keep in mind that the sharp end (the one you don’t want to mess with) tends to be black. An unused Epinephrine auto-injector keeps the needle hidden inside the tube for
Pick an Injection Site
Pretty much any spot on the outside of the thigh will work for administering the shot. NEVER inject into the buttocks as you risk severe nerve damage.
However, it’s useful to pick a spot ahead of time so you can visualize the act.
Also, even though most epinephrine auto- injectors are designed to pierce clothing, it couldn’t hurt to find a location with minimal resistance.
If the person is wearing shorts or a skirt, expose the skin.
Press It
Place the tip of the injector on your chosen injection site holding the body at a 90 degree angle and press firmly.
DO NOT use a stabbing action. Just press the tip firmly into the skin until you hear or feel the auto-injector engage.
Once the needle has entered the skin and the injection has begun, hold it in place for roughly ten seconds. This brief period should allow the injection system to deliver the medicine.
Upon completing the ten count, pull the shot away and rub the injection site for another ten seconds. Epinephrine injections cause a burning sensation that may cause the patient to pull away suddenly. It’s a good idea to warn the patient before hand and, if they are a child, you may want to gently restrain the leg receiving the shot by wrapping your own leg around it
Most people should experience a rapid improvement in symptoms once the adrenaline has been used.
If there is no improvement after five minutes then you should inject a second dose of adrenaline, if one is available.
If the person is unconscious, check their airways are open and clear and check their breathing. Then put them in the recovery position.
Putting someone who is unconscious in the recovery position ensures that they do not choke on their vomit.
Place the person on their side, ensuring that they are supported by one leg and one arm. Open the airway by tilting the head and lifting the chin.
If the person’s breathing or heart stops, cardiopulmonary resuscitation (CPR) should be performed.
Even if adrenaline is given, the person will probably need to be admitted to hospital for observation for up to 24 hours as occasionally the symptoms can return a few hours later.
An oxygen mask can be used to help breathing and once in hospital, fluids given via an intravenous drip can help increase blood pressure.
As well as adrenaline, additional medications such as antihistamines and corticosteroids can be used to help relieve symptoms.
The Recovery Position
If a person is unconscious but is breathing and has no other life-threatening conditions, they should be placed in the recovery position.
Putting someone in the recovery position will ensure their airway remains clear and open. It also ensures that any vomit or fluid will not cause them to choke.
What does Adrenaline do?
Adrenaline causes the blood vessels to constrict (become narrower), which raises the blood pressure and reduces swelling.
It also causes the airways to open, relieving breathing difficulties and suppresses the release of histamine.
As per FSHC Anaphylaxis Guidance please note:
Administering adrenaline should not harm an individual Resident if an incorrect diagnosis has been made – although there are very few conditions that can be mistaken for anaphylactic shock.
There may be a risk to Residents with thyrotoxicosis, hypertension or coronary heart disease but it is the responsibility of the Administer to weigh up the balance of risk.
