Talk:ABC (medicine)

This

This needs an urgent merge with First aid, Cardiopulmonary resuscitation, Advanced life support or Advanced cardiac life support. This list of ABCs has been covered in numerous articles, and it makes no sense to rehash them in a seperate article. JFW | T@lk 23:13, 25 December 2005 (UTC)

Ok; I was just afraid to add to much content to First Aid; also, i wanted to link other pages, particularly the ABC acronym page to this one. Actually, wait, maybe there could be some more talk, but i'd rather have it here so people could reference it directly. Let me know if that doesn't make sense. JamieJones 05:43, 26 December 2005 (UTC)

There is a good point in moving all ABC stuff to one article. I'd change the title (there's no need for CamelCase) and provide some references here. The ABC is followed even in advanced hospital settings, so you're probably correct that it is best dealt with on its own page. JFW | T@lk 09:35, 26 December 2005 (UTC)

I'm afraid i don't know how to do this. See, I wanted to create a link from the ABC disambiguation page. I can't just have this be the ABC page. So I added the first aid part to make it separate from the ABC disambiguation page. I looked again, and that's what most people did, but sometimes with brackets. Check it out and let me know if there is a way to fix it? I can't move pages because i am new. I think! JamieJones 15:15, 26 December 2005 (UTC)

I suggest the page is renamed to ABC (resuscitation). New users can't do page moves, but I'll perform the move if you think this is the best name. The reason for the page move block is a user called Willy on Wheels who disrupted Wikipedia by moving popular pages around, e.g. to ABC FirstAid on Wheels!. JFW | T@lk 18:00, 26 December 2005 (UTC)

Awesome yeah. If you wouldn't mind. Could you also fix Category:First Aid, CPR and First Aid to have the right links? Thanks! JamieJones 02:08, 27 December 2005 (UTC)

PS - if you have a second, can you look at Talk:Veganism...is that person being sarcastic?

Proposal

Re: the proposed merger/move. We have ABC, ABCD on wikipedia (that I know of, there may be more). We also have ABCDE (from ATLS), ABCDEFG, and many more which exist in the medical world. Nobody really knows what each of the letters is supposed to stand for. Take ABCDE - Airway, Breathing, Circulation, Disability, Exposure is the classic; but we also have A = Airway & cspine control, or assess; B= Breathing, or Bleeding, or Breathing & Bleeding; C = circulation fairly consistently, D = Disability, defecits etc. ; E (which is the most problematic) = Exposure, Environment, Emotions, Examine (or any combination of these, and more!) etc.... Perhaps we should create a page called "Medical assessment priorities" or similar, and talk briefly about each system and its variants? --John24601 07:03, 13 July 2006 (UTC)

That sounds good to me. —Keenan Pepper 15:19, 13 July 2006 (UTC)

I've heard "D" be "deadly bleed" or "defib", depending. Sounds like a good idea John24601. You still doing your first aid project? I've been neglecting it cause it seemed like I was the only one! JamieJones ^talk 19:17, 13 July 2006 (UTC)

I am, I've just been extremely busy in my real life recently. This is my effort to get back onto it! --John24601 19:47, 13 July 2006 (UTC)

Defib revert

Have just reverted an edit adding D (for defib) onto the end, for two reasons. 1) The article is entitled ABC, other variants are discussed in a different place in the article so it was kindof in the wrong place. 2) Whilst the defib does terminate VF/VT, chest compressions are not what causes the heart to "re-sync". Would like to see some inclusion of defib, but it needs properly referencing and adding in the correct place in the article. --John24601 20:29, 28 August 2006 (UTC)

Port to ABC (medical)

I have ported this article to ABC (medical) as is applies beyond first aid in to the hospital clinical arena. It was also originally designed as a training aid for hospital clinicians and nurses, meaning that the first aid moniker is inappropriate. It also brings it in to line with other similar articles, which are postfixed (medical). Owain.davies 21:17, 28 April 2007 (UTC)

"G"

I've never heard of the following, and it needs a reference before being restored (if it is real):

===ABCDEFG===
A 'G' in the protocol can stand for
*Go Quickly! — A reminder to ensure all assessments and on-scene treatments are completed with speed, in order to get the patient to hospital within the [[Golden hour (medicine)|Golden Hour]]

-Dan100 (Talk) 13:45, 11 June 2007 (UTC)

It is real, as it's our protocol, however, i'll have to look for the reference later (likely to be internal training documents though - not that referenceable). i am a little confused though by the querying of only this one point - have you heard every other variation given here? The nature of this page captures different options for each letter - but many are likely to be based on the biases of individual trainers, which could leave us a problem if you insist on cutting bits out of it. Owain.davies 14:02, 11 June 2007 (UTC)

Circulation

Do the resucitation council advise first aiders to check pulse? I thought this was phased out as it is difficult to find a pulse / separate yours from the patients in some patients...

172.143.150.96 (talk) 23:13, 1 March 2008 (UTC)

No, first aiders do not check the pulse in resuscitation. If you read the section on 'C' is does note that some protocols use 'compressions' or 'CPR' for C, but Circulation was the original definition laid down by the people who invented the mnemonic. That said, I would expect many first aiders (although it would depend on level) to be making pulse checks if the patient is breathing (and that would also be the time when you went past C through D,E,F & G. OwainDavies ^(about)_(talk) edited at 08:47, 2 March 2008 (UTC)

Also what i've been told, if they're not breathing then they are more than likely to not have a very good circulation anyway (And CPR helps).

172.159.51.45 (talk) 20:46, 2 March 2008 (UTC)

It has been awhile since I’ve been CPR certified here in the USA but the last time that I went through the course I was told that C stood for circulation but to check for consciousness and if they couldn’t be roused to assume that there was no circulation. Has anybody else been told anything similar? --ITasteLikePaint (talk) 21:51, 18 November 2008 (UTC)

I wouldn't even start ABCs unless the person was unconscious. Consciousness check is part of initial patient assessment; without an obvious deficit, there's no need to check. Jclemens (talk) 23:03, 18 November 2008 (UTC)

Under Construction

This article will be undergoing extensive renovations, in an attempt to raise its' level to at least a 'B' from its current 'C'. This will include expansion, inline cites, substantial additional referencing, and the addition of images, where appropriate. Anyone who wishes to is welcome to participate in the process. I feel that since this article is important to both First Aid and Emergency Medicine and EMS, our writing focus should try to avoid creating an article which appears to be focused exclusively on one group or the other. I'm talking about things like references to ECGs to check circulation (currently in the article). No problem with having everyone's techniques available...just make sure that we are clear about what is medical care and what is first aid. If you decide to remove anything from the article, please try to obtain some consensus first, or at least repost the removed material here, so that it won't be lost to future projects. Cheers. Emrgmgmtca (talk) 14:44, 19 December 2008 (UTC)

Definitely a good idea to improve this article, but I have removed one section from your first set of edits, which follows, as i've looked at the reference and it does say it as a 'half-joke' and the protocol does still call for a breathing check before compressions, so still 'ABC'. The bit i removed was: Effectively, this changes the decades old '''ABC''' to '''A-C-B''' for many rescuers.<ref>{{citeweb|url=http://casesblog.blogspot.com/2008/03/chest-compressions-only-cpr-works-as.html|title=Chest Compressions Only CPR Works Just as Well as Standard Technique in Adults|accessdate=2008-12-19}}</ref>.

In either case, blogs aren't really reliable sources for WP, so we really need to be looking for more reliable sources. I'll give the rest of an article a look and see what i can come up with. OwainDavies ^(about)_(talk) edited at 18:51, 19 December 2008 (UTC)

OK, I confess, I may have got a little carried away and rewritten large parts of the article! What i've tried to do is follow Emrgmgmtca's very sensible suggestion of trying to separate what is basic from what is advanced. I've also tried to seperate the use of ABC for CPR from the use for general first aid /EMS/physician diagnosis tool. I'm afraid this has created some citation work in the process, but i've given references for the biggest sections. I'll try and get some time to work on that! OwainDavies ^(about)_(talk) edited at 22:58, 19 December 2008 (UTC)

Hi Owain, very nice additions, for the most part. They've fleshed out some sections of the article very nicely. Thanks for the help! With respect to the references, I will work on that as well. In the meantime, I had deleted ABCDEF and ABCDEFG because they are very infrequently used (by no means universal) and I was simply unable to find quality references for either. Without the references, they would have blocked the re-eval. If you happen to know of decent references for those, I'd be more than happy to see them back in the article. Thanks again for your help on this. Are you ever going to join the Emergency Medicine and EMS Task Force? Emrgmgmtca (talk) 12:46, 20 December 2008 (UTC)

Thanks! I didn't realise i hadn't joined the task force, so now i have. I'll look for some references for the article as a whole, so will try and look out refs for letters past E - the last advanced course i went on ran to 'M'! - Airway, Breathing, Circulation, Disability or dysfunction, Expose & examine, Farenheit, Glucose, Head-to-toe, Inspect the back, Justify findings, Keep records, Load & go, Monitor throughout! OwainDavies ^(about)_(talk) edited at 19:56, 20 December 2008 (UTC)

What??? No Notify hospital, Observe carefully for change, Palpate for crepitation and deformity, Quickly make your way to the hospital, Reassess before arrival, Safely remove patient from ambulance, Tell triage nurse what you've found, etc.??? You have to love these things!!! Oh, and glad you've joined the group!Emrgmgmtca (talk) 11:38, 22 December 2008 (UTC)

Owain, this is really, REALLY nice work! If we can get one or two references for each of the five sections that don't currently contain references (Importance, Simple application, DEF, EFG, AcBC) I can get this copyedited by one of our merry band. I think that we may just have a GA submission here. Thanks so much for your help!Emrgmgmtca (talk) 11:46, 22 December 2008 (UTC)

Assessment comments

Overall, this is a great improvement. There's perhaps a bit too much bold face text to comply with WP:MOSBOLD, but I suspect that this problem will be corrected in a copyedit. WhatamIdoing (talk) 22:54, 23 December 2008 (UTC)

Comments from failed GA

Only one person commented on this article for its GA review, and below is that list of comments, so that editors can easily find them to work on (if appropriate).

1. Cardiac arrest is the ultimate cause of death for all animals is not true. You can stop peoples hearts put them on the heart lung machine and restarted it a few hours latter once we have done the surgery. Were they dead?
2. WP:LEAD is lacking
3. History section does not discuss the rest of the history and belongs at the end
4. What about C spine "In this simple usage, the rescuer is required to open the airway (using a technique such as "head tilt - chin lift")"
5. "In the event that the patient is not breathing normally, the current international guidelines (set by the International Liaison Committee on Resuscitation or ILCOR) indicate that chest compressions should be started." Would need the ref were this is from?
6. Do not like the use of all the lists
7. What about ATLS, PALS, NRP? The ABCs have a lot greater usage than just ACLS, BLS.
8. What about globally? Are they called the ABCs in french, german, japanese?
9. This is written from the POV of a prehospital rescuer. Needs to be written from a NPOV. We use ABCs prehospital and in hospital. It is part of the initial assement of every patient even though we usually do it automatically without thinking. ie. One says hello how are you if the response is normal one has varified their airway breathing and circulation ( poor circulation poor brain function ) therefore confused speech.

Regards, OwainDavies ^(about)_(talk) edited at 18:12, 22 April 2009 (UTC)

CPR Switch: Chest Presses First, Then Give Breaths

This article needs an improvement: Heart group flips the old "ABC" -- airway, breathing, compressions -- to "CAB"! Story --Angeldeb82 (talk) 22:56, 18 October 2010 (UTC)

I think you may have not fully grasped the outcome - patients should still have their airway opened and breathing checked prior to commencing CPR. The acronym is still valid and in the correct order. You don't start CPR on someone who is breathing! OwainDavies ^(about)_(talk) edited at 06:41, 19 October 2010 (UTC)

Actually, Angeldeb82 is correct. The AHA no longer recommends checking or opening the airway, or providing rescue breaths prior to commencement of chest compressions. "Look, listen and feel" was entirely removed from the 2010 guidelines for CPR and ECC. An explanation from 'Highlights of the 2010 American Heart Association Guidelines for CPR and ECC' follows:

"Why: With the new "chest compressions first" sequence, CPR is performed if the adult is unresponsive and not breathing or not breathing normally (as noted above, lay rescuers will be taught to provide CPR if the unresponsive victim is "not breathing or only gasping"). The CPR sequence begins with compressions (C-A-B sequence). Therefore, breathing is briefly checked as part of a check for cardiac arrest; after the first set of chest compressions, the airway is opened, and the rescuer delivers 2 breaths." [pg. 4]

In addition, the lay rescuer will be directed to provide "Hands-only" CPR. But basically, until this is rolled out next year as CPR, you do what you were trained to do. Rmosler | ● 13:14, 21 October 2010 (UTC)

OK, but as stated in both cases it starts with check airway, check breathing, then CPR commences. It is worth noting, but the application of the mnemonic is much more far reaching than simply CPR. And i apologise for not being familar with AHA guidelines, but for Wikipedia, following ILCOR guidance is preferable, due to the regional nature of guidelines. OwainDavies ^(about)_(talk) edited at 20:20, 22 October 2010 (UTC)

I haven't seen any of the new guidelines from ILCOR as the 2010 guidelines have not yet been announced, they still have one more conference in November. Seeing as their work sheets are posted [1] they appear to be consistent with the direction of the 2010 AHA guidelines, I anticipate that they will follow with similar changes. AHA now does not recommend checking airway until the first set of compressions has been completed unless the cause is obviously attributed to airway, such as in asphyxiation or drowning. Rmosler | ● 21:58, 22 October 2010 (UTC)

The guidelines you're referring to do come from ILCOR, you're just hearing about it from your national representative organization. Keep in mind that while there have been press releases and the like, nothing has really changed yet. I believe it'd be responsible to wait until the full implications of these changes are understood by training agencies prior to making changes based on your best guess of what's meant in the changes. But this is Wikipedia, and not Wikibooks.  – mike@enwiki:~$  03:06, 23 October 2010 (UTC)

RMosler- can i just ask as i haven't researched the AHA guidelines in detail, but i believe that you should still open the airway and check for breathing before considering CPR - it would strike me that failing to ascertain absence of breathing before commencing CPR would be risky. On another note, the latest European guidelines have just been released, with no substantial change from the previous version, and it still requires an airway and breathing check, followed by compressions then breaths etc. OwainDavies ^(about)_(talk) edited at 10:49, 23 October 2010 (UTC)

The guidelines are here. The reason why they switched it to CAB is located on page 4. Please remember that talk pages are for discussing the article, not a general forum on the subject. Peter.C • talk 16:22, 23 October 2010 (UTC)

Owen please start providing references so we can address your concerns. Here are the ILCOR guidelines and they too have changed to recommending CAB. The justification is in the text. Hazinski MF, Nolan JP, Billi JE; et al. (2010). "Part 1: executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations". Circulation. 122 (16 Suppl 2): S250–75. doi:10.1161/CIRCULATIONAHA.110.970897. PMID 20956249. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link) Doc James (talk · contribs · email) 22:35, 24 October 2010 (UTC)

In response to Mike Wikipedia is based on the most recent peer reviewed review articles not on training manuals. Yes the training manuals will not be out until spring. But a lot has changed. Many of us will be changing our practice based on the published material in Circulation and not waiting for instruction manuals to appear. Before this many of us also had altered our practice beyond the 2005 guidelines based on published literature in the last few years. Remember AHA are only guidelines.Doc James (talk · contribs · email) 22:40, 24 October 2010 (UTC)

OwainDavies brings up an interesting conundrum. The above cited reference (Circulation (2010);122[suppl 3]:S640 –S656and 250-S275.) says...

" The BLS algorithm has been simplified, and “Look, Listen and Feel” has been removed from the algorithm. Performance of these steps is inconsistent and time consuming. For this reason the 2010 AHA Guidelines for CPR and ECC stress immediate activation of the emergency response system and starting chest compressions for any unresponsive adult victim with no breathing or no normal breathing (ie, only gasps)."

…and…...

" once the provider has verified that the victim is unresponsive and not breathing or is only gasping, the provider should immediately activate the emergency response system, get and use an AED, and give CPR."

The ongoing confusion here is between the “ABC sequence” in reference to rescue actions as opposed to steps in the initial evaluation and determination that must (at least formerly) precede it. In the first case, “ABC” means (1) give rescue breaths, (2) check breathing, (3) give chest compressions… In the second case it means (1) check for obstructed airway, (2) check whether there is breathing (regardless of airway patency) and (3) check for a pulse...all before any rescue breaths or chest compressions are performed. (And BTW, for what it's worth, as a clinician I have always understood "ABC" in the latter, rather than the former, sense... If I thought of a distinction at all.... Further confusing the issue is that "check for obstructed airway" also involves removing an obstruction, if found, in the same motion, which is itself a "rescue action"... But never mind that...)

Looking through the Wikipedia article, there is no effort to distinguish between these two “ABC sequences”…. Remarkably, the same problem exists in the 2010 International Consensus summary !! What is clear from the summary is that guidelines will change such that the sequence of rescue actions will change to “CAB” as the sequence is initiated. (Except for drowning victims and neonates, where ABC will remain the correct sequence.) The reason for this is to get quickly to what is now considered the more important intervention (chest compressions) without wasting time. But will “ABC” continue to prevail for the sequence of initial evaluation maneuvers?? Even after a careful reading of the summary, this is unclear. Read the above quotes again. “Look, Listen and Feel” will not now be done at all. It then seems to be implied that a rescuer is to determine if the unresponsive adult victim has “no breathing or no normal breathing (ie, only gasps)” and, if so, he must alert EMS, get/use an AED and then begin chest compressions, in that order and all without ever checking a pulse! This makes it extremely important that the rescuer ensure that no breathing is happening, otherwise a certain number of syncope patients will be getting “the works”! It makes no sense, but I guess we will really have to wait for the manuals to come out. 140.139.35.250 (talk) 20:19, 21 March 2011 (UTC)

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