title: "Deteriorating Patient: ABCDE"

Deteriorating Patient: ABCDE

ABCDE approach: treat life-threatening problems as you find them — do not complete the full assessment before intervening. If the airway is compromised, secure it before moving to B.

ABCDE Framework

ABCDE Assessment

Systematic approach to the deteriorating patient

MET Call Criteria

MET Call Thresholds

Parameter	Threshold
Airway	Threatened
RR	<8 or >30
SpO₂	<90% on O₂
HR	<40 or >130
SBP	<90 mmHg
GCS	Drop ≥2 points
Concern	"I'm worried"

Clinical Pearl

Q: The "canary" vital sign in deterioration? A: Respiratory rate (RR (Respiratory Rate))

Respiratory rate is often the first vital sign to change and the most frequently under-recorded. Count it properly.

Key Interventions by Letter

A — Airway

Suction, head tilt–chin lift, airway adjuncts
Stridor = partial obstruction = call for help NOW
Anaphylaxis → IM adrenaline 0.5mg

B — Breathing

O₂ to target SpO₂ 94-98% (88-92% COPD)
Sit upright, nebulised salbutamol for wheeze
Tension pneumothorax → needle decompression

C — Circulation

Two large-bore IV cannulae
Fluid bolus 250-500mL if hypotensive
12-lead ECG, bloods including lactate

D — Disability

Check glucose → treat if <4 mmol/L
GCS ≤8 cannot protect airway → call anaesthetics
Naloxone 400mcg if opioid toxicity

E — Exposure

Temperature, rashes, surgical sites
Check the back
Keep warm

Warning

Falling GCS = losing airway. Don't wait for aspiration to call for help.

ISBAR Escalation

ISBAR Handover

Structured clinical communication framework

Lead with your worry. "I'm calling because I'm worried about sepsis" tells the reviewer what to expect and how fast to come.

Pattern Recognition

Pattern	Think
Fever + tachycardia + confusion	Sepsis
Post-op day 1-3 + hypotension	Bleeding, PE, anastomotic leak
Unilateral absent breath sounds	Pneumothorax, effusion
Wheeze + accessory muscles	Asthma/COPD exacerbation
Crackles + pink frothy sputum	Pulmonary oedema
Pleuritic pain + hypoxia + tachycardia	PE