ABC (medicine)
ABC and its variations are initialism mnemonics for essential steps used by both medical professionals and lay persons (such as first aiders) when dealing with a patient. In its original form it stands for Airway, Breathing, and Circulation.[1] The protocol was originally developed as a memory aid for rescuers performing cardiopulmonary resuscitation, and the most widely known use of the initialism is in the care of the unconscious or unresponsive patient, although it is also used as a reminder of the priorities for assessment and treatment of patients in many acute medical and trauma situations, from first-aid to hospital medical treatment.[2] Airway, breathing, and circulation are all vital for life, and each is required, in that order, for the next to be effective: a viable Airway is necessary for Breathing to provide oxygenated blood for Circulation. Since its development, the mnemonic has been extended and modified to fit the different areas in which it is used, with different versions changing the meaning of letters (such as from the original 'Circulation' to 'Compressions') or adding other letters (such as an optional "D" step for Disability or Defibrillation).
In 2010, the American Heart Association and International Liaison Committee on Resuscitation changed the recommended order of CPR interventions for most cases of cardiac arrest to chest compressions, airway, and breathing, or CAB.[3]: S642 [4]
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Breathing[edit]
Unconscious patients[edit]
In the unconscious patient, after the airway is opened the next area to assess is the patient's breathing,[11] primarily to find if the patient is making normal respiratory efforts. Normal breathing rates are between 12 and 20 breaths per minute,[14] and if a patient is breathing below the minimum rate, then in current ILCOR basic life support protocols, CPR should be considered, although professional rescuers may have their own protocols to follow, such as artificial respiration.
Rescuers are often warned against mistaking agonal breathing, which is a series of noisy gasps occurring in around 40% of cardiac arrest victims, for normal breathing.[11]
If a patient is breathing, then the rescuer will continue with the treatment indicated for an unconscious but breathing patient, which may include interventions such as the recovery position and summoning an ambulance.[15]
Conscious or breathing patients[edit]
In a conscious patient, or where a pulse and breathing are clearly present, the care provider will initially be looking to diagnose immediately life-threatening conditions such as severe asthma, pulmonary oedema or haemothorax.[14] Depending on skill level of the rescuer, this may involve steps such as:[14]
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History[edit]
The 'ABC' method of remembering the correct protocol for CPR is almost as old as the procedure itself, and is an important part of the history of cardiopulmonary resuscitation. Throughout history, a variety of differing methods of resuscitation had been attempted and documented, although most yielded very poor outcomes.[42] In 1957, Peter Safar[43] wrote the book ABC of Resuscitation,[1] which established the basis for mass training of CPR.[44] This new concept was distributed in a 1962 training video called "The Pulse of Life" created by James Jude,[45] Guy Knickerbocker and Peter Safar. Jude and Knickerbocker, along with William Kouwenhouen[46] developed the method of external chest compressions, while Safar worked with James Elam to prove the effectiveness of artificial respiration.[47] Their combined findings were presented at annual Maryland Medical Society meeting on September 16, 1960, in Ocean City, and gained rapid and widespread acceptance over the following decade, helped by the video and speaking tour the men undertook. The ABC system for CPR training was later adopted by the American Heart Association, which promulgated standards for CPR in 1973.
As of 2010, the American Heart Association chose to focus CPR on reducing interruptions to compressions, and has changed the order in its guidelines to Circulation, Airway, Breathing (CAB).[48]
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