First-line attitudes in acute medicine

First-line attitudes in acute medicine. The often complex problems of the trauma and/or severely ill patient present many challenges to front-line emergency staff. Multiple injuries and/or systems of the body involved require careful and timely prioritization and intervention. Optimum evaluation and resuscitation involves repetitive, systematic approaches that are known as the “primary”, “secondary” and “tertiary” surveys. The primary survey focuses in general on the ABCDE approach of “Airway, Breathing, Circulation, Disability, Exposure”, and is designed to recognize and to treat immediate life-threatening conditions within the initial minutes. This primary resuscitation of non-trauma patients does not differ from the ABCDE approach used to evaluate severely traumatized patients. This approach is applicable in all clinical emergencies, whether the patient is located in the street, at home, in the emergency room, and even in the intensive care or the general wards of the hospital. This approach is widely accepted by experts, and is likely to improve outcomes by helping healthcare professionals to focus on the most life-threatening clinical problems. In an acute setting, high-quality ABCDE skills among all treating team members can save valuable time and improve team performance. The secondary and the tertiary surveys are intended to diagnose all injuries before formulating definitive management strategies.

This chapter briefly describes how to perform the ABCDE approach in general, and how to conduct the secondary and the tertiary surveys. A more detailed use of this approach within a specific medical condition will be described in later chapters of this report.