ABCDE
Primary Survey — Trauma & ACLS
Work top-down — airway kills first.
What this mnemonic does is force a strict order of operations when the patient is unstable and you have seconds, not minutes. ABCDE — Airway with cervical spine, Breathing and ventilation, Circulation with hemorrhage control, Disability (neuro and glucose), Exposure with environment control — runs the same way in trauma, code blue, and any rapid response. Skip a step and you miss the thing that kills first. AANP boards rarely ask the acronym in isolation; they bury it inside vignettes where the right answer is whatever ABCDE tells you to do before anything else.
- AAirwayPatent? Protected? In trauma, maintain c-spine stabilization.
- BBreathingRespiratory rate, effort, breath sounds, SpO₂. Is the patient moving air?
- CCirculationPulse, blood pressure, capillary refill. Stop external hemorrhage.
- DDisabilityNeuro status — GCS, pupils, gross motor. Check glucose.
- EExposure / EnvironmentFully expose to find injuries, then warm — hypothermia worsens coagulopathy.
Clinical Context
The order reflects lethality: a blocked airway kills in minutes, massive hemorrhage in tens of minutes, hypothermia in hours. Always reassess ABC before advancing after any intervention — "finger sweep before chest thrust" in arrest.
In trauma, "D" includes glucose (hypoglycemia mimics TBI) and "E" reminds you to roll the patient and check the back — missed posterior injuries are a classic board trap. In ACLS the rhythm check and compressions sit under C; D and E get abbreviated.
Practice Questions
A 54-year-old man in the urgent care waiting room suddenly clutches his chest and slumps to the floor. The nurse practitioner is the first responder at the scene. The patient is unresponsive when his name is called, and a coworker is calling 911. Applying the ABCDE primary survey, what is the priority first action?
Related Mnemonics
Sources
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