Approach to Medical Emergencies: ABCDE, Primary and Secondary Survey, FHQ Syndromes

Medical Emergencies are pathological conditions with sudden onset and rapid clinical evolution which, in the absence of adequate treatment, compromise the vital functions of the organism causing an evident danger of life. The evaluation and treatment of the critical patient by the 118 System takes place with a series of systematic, standardized and homogeneous actions in order to manage in an optimal and effective manner according to the fundamental principles of BLS, P-BLS, ALS, P-ALS.


In the event of Medical Emergencies, the SCENARIO is generally safe for operators, however illnesses can also occur in potentially dangerous scenarios. It is necessary to continually re-evaluate the scenario before intervening. The assessment of the scene is therefore based on the observation of the environment and on the GLANCE when approaching the patient, taking into consideration the context, posture, spontaneous movements, language, smells, general appearance. .

PRIMARY EVALUATION is used to identify and immediately treat EMERGENCIES, conditions that quickly put the victim’s life at risk. Regularly reassess and support vital functions.

SECONDARY EVALUATION allows us to identify URGENCIES and other problems that are not immediately dangerous for the patient’s life, collecting ADDITIONAL INFORMATION (available clinical documentation, laboratory tests and instrumental investigations) and completing the anamnesis complete by the patient himself, by relatives or friends. In the local area, the patient’s clinical framework is specifically fast and dynamic to allow a timely life-saving treatment. Therefore follows a syndromic approach to differential diagnoses, oriented to the symptom or main emerging disorder to immediately identify all potentially lethal conditions or seriously and quickly invalidating the patient’s health. Unconsciousness, shock, severe dyspnea, acute pain syndromes, severe traumatic injuries, intoxications, pediatric and pregnancy diseases are the daily challenges of the 118 System.

approach ABCDE guarantees always a rating rapid and effective, also if the CAB approach is currently indicated for potentially lethal events such as Cardiac Arrest and potentially major Trauma as well.

A. (AIRWAYS) – Assessment of the state of consciousness and airways.

Approach the patient, shaking him slightly by both shoulders, calling him out loud and looking him in the face.

This triple stimulus evaluation phase is also essential for those patients who may have neurological problems, be visually impaired or deaf and dumb or sufferers of psycho-physical disabilities.

If he responds to stimuli, remembers what has happened and answers questions (what is his name, where he is, what day is today) he is VIGILE, oriented and he passes to secondary evaluation.

The patient disoriented in time and space is defined as CONFUSED (see chapter on confusional state).

If he does not respond to stimuli, the patient has alterations in his state of consciousness (from the sleep state, to the stupor state, to coma) it is essential to OPEN THE AIRWAYS with the hyper-extension of the head to facilitate breathing, paying attention to the dentures, food or vomiting (neutral position in the child).

If cervical trauma is suspected, the head hyperextension maneuver should not be performed to avoid any further injury. (see chapter TRAUMA).

B. (BREATHING) – breath assessment.

This phase is facilitated by the acronym, OPACS:

OR -> I LOOK at the chest (movements, expansion, deformity)

P -> PALPO (integrity, deformity, crackles, pain to touch)

A -> LISTENING (breathing noises such as rales, hissing, whistling) C -> ACCOUNT (attention to FR <10 acts / min> 25-30 acts / min) S -> SATURATION (attention to values <90%)

In the absence of breath but in the presence of a carotid pulse, the patient is in STOP RESPIRATORY: immediately begin the rescue breaths at a frequency of 10 – 12 per minute (1 every 5 -6 seconds) with oxygen supply. If the patient is breathing but not conscious, place him in a lateral safety position.

C. (CIRCULATION) – evaluation of the circle

Observe the color, the temperature of the extremities, measure the capillary filling time, measure the rhythmic or arrhythmic heart rate (HR), palpate the peripheral arterial pulses, measure the blood pressure (BP), auscultate the heart (murmurs, rubs ), look for bleeding sites. In the absence of spontaneous circulation, the patient is in CARDIAC ARREST (see chapter): IMMEDIATELY START CPR with chest compressions and rescue breaths in the ratio 30: 2 and connect the defibrillator (CAB diagram).

If hemodynamic compensation appears precarious, restore tissue perfusion, find peripheral or intraosseous venous access, possibly place bladder catheter.

D. (DISABILITY) – evaluation of the neurological status

The AVPU scales (Alert, Verbal, Pain, Unresponsive), Glasgow Coma Scale (eye opening, verbal response and motor response), pupillary status, sensitivity and motility of the limbs and facial expressions are used.

E. (EXPOSURE) – head – toe exposure / assessment

It includes the complete physical examination.

The 118 Emergency Systems in particular represent a fundamental link for the survival of patients affected by five pathological conditions defined First Hour Quintet or “Quintet of the First Hour” which groups the following time dependent pathologies:

x cardiac arrest,

x acute coronary syndrome,

x acute respiratory failure,

x stroke,

x major trauma

A common feature of this group of pathologies is the need for a rapid evaluation and rapid treatment already in the pre-hospital context as well as a kidnapped transport to the hospital facility suitable for the management of the specific pathology.

For these pathologies, specific Diagnostic Therapeutic Assistance Pathways (PDTA) have been developed in conjunction with the hospital phase. Territory-Hospital care pathways allow for better outcomes.