Learn how the ABCDE approach helps nurses and student nurses assess an acutely unwell or deteriorating patient in a structured, systematic way — and recognise when urgent escalation is needed.
The ABCDE approach provides a systematic way to assess a patient who may be acutely unwell. It encourages clinicians to identify and deal with the most immediately life-threatening problems first.
The sequence is particularly useful because it reduces the risk of becoming distracted by one finding while missing a more urgent problem elsewhere.
For student nurses, learning ABCDE also provides a useful structure for thinking about patient deterioration and communicating concerns to other members of the clinical team.
The exact assessment and interventions will depend on the patient's condition, your level of competence, local policy and the clinical setting. Student nurses should always work within appropriate supervision.
Begin by checking whether the patient's airway is open and clear. Airway obstruction can rapidly become life-threatening and must be recognised promptly.
Assess how effectively the patient is breathing and whether there are signs of respiratory compromise.
Consider whether circulation appears adequate and look for evidence of cardiovascular compromise or poor perfusion.
Disability focuses on neurological status, including the patient's level of consciousness and any acute changes.
Complete the assessment by looking for other clinical signs while protecting the patient's dignity and maintaining temperature.
The framework is most useful when you understand the clinical principles that sit behind it.
Do not continue mechanically through the assessment if you identify an immediate threat that requires urgent help or intervention.
Escalation should not be delayed simply because you have not completed every stage of the assessment.
After treatment, intervention or a significant change, reassess the patient to determine whether their condition has improved.
Combine observations with appearance, symptoms, history and your clinical concern rather than focusing only on monitoring equipment.
Use a structured communication tool such as SBAR when escalating concerns or handing over important information.
Student nurses should recognise the boundaries of their competence and seek support whenever they are uncertain or concerned.
NEWS2 can help identify abnormal physiological observations, while ABCDE provides a structured way to assess the patient and look for immediate clinical problems.
A patient's condition can cause concern even when a score or single observation does not appear dramatically abnormal. If the patient looks unwell, their condition is changing, or you are worried, escalate your concern according to local policy.
Once you have identified a concern, communicate the key information clearly and concisely to an appropriate member of the clinical team.
Make the immediate clinical concern clear rather than beginning with unnecessary detail.
Include relevant vital signs, NEWS2 information and significant changes from previous observations.
Communicate the abnormalities or clinical findings you have identified during the assessment.
Be clear that you require review, support or urgent assistance, depending on the clinical situation.
The best way to become confident with ABCDE is to practise using the framework under appropriate supervision and relate each part of the assessment to real patient presentations.
Now that you understand the ABCDE structure, the next guide explores the clinical signs and changes that may indicate patient deterioration.
Continue to patient deterioration
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