Trauma Assessment Mnemonic
Author: Emily Miao, MD, PharmD
Editor: Alyssa Haag, MD
Editor: Ian Mannarino, MD, MBA
Editor: Kelsey LaFayette, DNP, ARNP, FNP-C
Illustrator: Jannat Day
Modified: Jan 06, 2025
What is ABCDE?
The ABCDE trauma assessment is a systematic evaluation used in the setting of trauma. The ABCDE approach allows emergency medical services and emergency clinicians to quickly identify and address life-threatening injuries to an individual. Examples of trauma include high-speed motor vehicle accidents, gunshot wounds, and falls, among others. Each letter of ABCDE stands for a different assessment: airway, breathing, circulation, disability, and exposure. Assessments and treatments are often simultaneously and promptly performed by a multidisciplinary team.
What does the “A” in ABCDE mean?
The “A” in ABCDE stands for airway which refers to evaluating the airway and/or establishing an artificial airway so that the individual can breathe adequately. If the individual can speak or talk with clear phonation, they can maintain their airway. One should assess for the presence of stridor or gurgling, the presence of blood or secretions in the airway, facial fractures, expanding hematoma, or cutaneous emphysema (i.e., air under the tissue of the skin), as these may be indications of airway obstruction or damage. If the individual is obtunded or if their Glasgow Coma Scale (GCS) is less than 8, they should be intubated to establish an airway. Endotracheal intubation (i.e., an endotracheal tube placed within the trachea) is often performed with rapid sequence anesthesia (e.g., an airway management technique that produces immediate induction and intubation, while minimizing pulmonary aspiration, achieved using sedative agents like etomidate and neuromuscular blocking agents like rocuronium). In certain emergencies, such as severe facial trauma or when endotracheal intubation is ineffective or contraindicated, a cricothyrotomy may be performed to secure the airway, which involves placement of a tube into the trachea through an incision made in the cricothyroid membrane.
What does the “B” in ABCDE mean?
The “B” in ABCDE stands for breathing, where the clinician auscultates the individual’s chest for breath sounds to assess for abnormalities such as wheezing, rales, or stridor. During this time, one can also palpate and percuss the chest to see if there is presence of any deformities, which may suggest fractures. Hyperresonance on percussion suggests a pneumothorax which is a collection of air outside of the lung but within the pleural cavity, whereas dullness on percussion suggests a consolidation or collection of pleural fluid or blood. Oxygen saturation and respiratory rates can also be obtained to further evaluate whether the individual is ventilating and breathing adequately.
What does the “C” in ABCDE mean?
The “C” in ABCDE stands for circulation which refers to the assessment of heart rate, blood pressure, pulses, skin temperature, capillary refill time, and heart sounds. These parameters provide objective data as to whether the individual can effectively perfuse their vital organs or whether there has been significant blood loss. For example, prolonged capillary refill times of >3 seconds may suggest dehydration or severe blood loss, especially if there are contusions and overt signs of bleeding and open wounds. During this assessment, the clinician will establish intravenous (IV) access with 2 large bore IVs 16 gauge or larger. If there are obvious signs of bleeding, direct pressure or a tourniquet can be applied. Fluid resuscitation can be implemented when there are signs of shock such as hypotension, tachycardia, altered mental status, decreased urine output and blood products can be given in the case of blood loss.
What does the “D” in ABCDE mean?
The “D” in ABCDE stands for disability. During this assessment, the clinician utilizes the Glasgow Coma Scale to measure the individual’s level of consciousness. The GCS uses a scoring system that assesses three items: eye movement, verbal response, and motor response. The points are added to provide a total score of 3 to 15, with three representing a comatose state and 15 representing a normal, alert state.
A brief neurologic assessment is also performed at this step. This includes assessing neurologic reflexes, pupillary response, sensation, and gross motor function, some of which may have already been covered during the GCS scoring system. A blood glucose test should also be performed at this step to assess for hypoglycemia. If possible, a history of the patient's medical conditions and medication use should be obtained as well.
What does the “E” in ABCDE mean?
The “E” in ABCDE stands for exposure which refers to exposing the individual to evaluate their entire body for injury, including the back. During this step, it’s important to maintain patient dignity as best as possible, and can include pulling curtains, closing blinds or doors, or using drapes to cover areas already inspected while also explaining the actions to the patient as able. During inspection of the back, the spinous processes should also be palpated to evaluate for spinal tenderness or step offs which may indicate an untreated spine injury. Any dermatologic abnormalities should also be noted. A rectal exam can also be performed to assess for rectal tone, which if present, confirms that the sacral nerves are not injured. After this exam, the individual is covered with warm blankets in order to keep the patient warm and prevent hypothermia.
What are the most important facts to know about the ABCDE mnemonic?
The ABCDE trauma assessment is a systematic evaluation that is used in the setting of trauma. Each letter of ABCDE stands for a different assessment: airway, breathing, circulation, disability, and exposure. The ABCDE approach allows emergency medical services and emergency clinicians to quickly identify and address life-threatening injuries to an individual. Of note, vital signs are constantly checked and reassessed while multiple components of the ABCDE exam are performed simultaneously. Medical conditions that are uncovered are promptly addressed as the clinician is performing each assessment.
