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Clinical Skills

A to E assessment

A structured guide to performing a rapid A to E assessment of the deteriorating patient.

1. Introduction

The A to E assessment is the standard approach to the acutely unwell patient. It prioritises life threatening problems and combines assessment with immediate treatment.

2. Approach

Introduce yourself if appropriate, call for help early if the patient is critically unwell and use personal protective equipment as needed. Assess and treat airway, breathing, circulation, disability and exposure in sequence, reassessing after each intervention.

3. Assessment and treatment

For airway, check patency and look for obstruction. For breathing, assess respiratory rate, oxygen saturation, work of breathing and chest findings, then provide oxygen if indicated. For circulation, assess pulse, blood pressure, capillary refill and perfusion, then obtain intravenous access and consider fluids. For disability, assess conscious level, pupils and capillary blood glucose. For exposure, look for rashes, bleeding, injury, temperature abnormality and hidden clues while maintaining dignity and preventing heat loss.

4. Completion

At the end of the assessment, summarise the situation, state your differential, escalate appropriately and document clearly.

Preparation

Airway

Breathing

Circulation

Disability

Exposure

Reassessment

Completion