ABCDE

• Airways


  • Self ventilation or artificial
  • Airway sounds (wheezing, strider, snoring, crowing, grunting)
  • Trachea position (central, shortening, tug)
  • Colour of oral mucosa, lips and facial skin (central cyanosis)
• Breathing


  • Oxygen requirements
  • Short of breath, able to speak (effort and work of breathing)
  • Sputum (colour, quantity, consistency)
  • Drains or epidurals
  • SOBOE - short of breath on exertion, SOBAR - short of breath at rest
  • Mode of ventilation
• Chest shapes


  • Kyphosis
  • Scoliosis
  • Kyphoscoliosis
  • Pecus Carinatum (pigeon chest)
  • Pecus Excavatum (funnel chest)
  • Chronic hyperinflation (barrel chest)
• Chronic hyperinflation (barrel chest)


  • Displaced apex beat- downwards from 5th IC space
  • Hoovers sign
  • Loss of bucket handle movement
  • Tracheal tug during inspiration due to downward traction of the tracheobronchial tree
• Chest and abdominal movement shapes can limit either pump or bucket handle movement during breathing, leading to hypo-inflation, crushing, and more prone to infection and stagnation of O2 and CO2
• Signs of problems


  • Tracheal tug
  • Hoovers sign - intercostal drawing
  • Displaced apex beat
  • Sculpturing
  • High effort to breathe -tachypnoea, using accessory muscles, nasal flaring, pursed lip breathing, active and prolonged expiration
• Chest and abdominal movement


  • Asymmetry -one side of chest has reduced movement
  • Abdominal distension -impede lowering of diaphragm
  • Intercostal indrawing -skin between ribs inwards during inspiration (hoovers sign)
  • Supraclavicular indrawing -skin above clavicle draws inwards (acute asthma)
  • Flail chest -2 or more breaks in each rib
  • Paradoxical breathing -chest moves inwards on inspiration and outwards on expiration due to weakness or paralysis
• Effort of breathing


  • Tachypnoea
  • Accessory muscle use- scalene, sternomastoid
  • Nasal flaring
  • Pursed lip breathing
  • Active + prolonged expiration time
• Measuring


  • RR
  • Stats
  • Extra oxygen?
  • Arterial blood gases
  • Lung function tests
  • Peak cough flow
  • Breathlessness
  • Thoracic imaging
• Circulation


  • Blue or pale (peripheral cyanosis)
  • Diaphoretic (excessive sweating)
  • Lip and tongue moist or dry
  • Cardiovascular support (blood pressure mediation, pulmonary artery catheters, venous lines, central lines)
  • Skin turgor (ability of skin to return to normal elastic state, sign of dehydration)
  • Capillary Refill Time (CRT - time taken for blood flow to return to capillaries after brief compression, normal under 3s)
  • Peripheral oedema (fluid build up, sign of chronic cardiac failure, common in ankles)
  • Urine colour and quality (Oliguria, cloudy, concentrated, incontinence)
• Jugular Venous Pressure (JVP)


  Indicates volume of blood entering right side of heart. If elevated, right heart failure is suggested.
• Cor Pulmonale


  A condition causing right sided heart failure.
• Measure


  • Body temperature
  • ECG
  • BP
  • Central venous pressure (CVP - reflects amount of blood return to the heart and the ability of the heart to pump blood back into the arterial system)
  • Fluid balance (input/output)
  • Exercise testing (6 minute walk test, shuttle test, CPET)
• Disability


  • Alertness (responsive to voice, pain, moving, agitated, aggressive, confused)
  • Head trauma, surgical interventions (ICP monitors, normal 10-15mmHg)
  • Drugs (sedatives, analgesics, over medicated or self overdosed, pinpoint pupils, over sedated can stop breathing)
  • GCS/AVPU (Alert, Verbal stimuli, Painful stimuli, Unresponsive)
  • Disability measure (neuromusculoskeletal, tone, weakness, ROM, sensation)
  • Blood glucose (hypoglycaemia, hyperglycaemia, diabetic, ketoacidosis)
  • Functional ability (gait, balance, ADLs)
• Measure


  • Neuro-musculoskeletal assessments
  • Tone
  • Weakness
  • ROM
  • Sensation
  • Blood glucose (normal 4-7)
  • Functional ability (gait, balance, ADLs)
• Exposure


  • Skin deformity (mould, cold, burns, cuts, rashes)
  • Nutrition (NG tube, TPN)
  • Abdomen (stoma, drains, PEG feeding, BMI)
  • Hands (tremor, warm and sweaty, flapping (COPD), nail clubbing (cystic fibrosis))
  • Skin colour and condition (peripheral cyanosis, jaundice, pale skin, ulcers, blisters, long nails, sweat)
  • Limb exposure (deformity, muscles mass)
  • Lab works (cultures (infection), blood tests)