The ABCDE of emergency medicine – the stabilisation of the acutely unwell – is well known. The mantra of Airway, Breathing, Circulation (followed by assessment of Disability and full Exposure of the patient) is drummed into everyone who works in the field.
But working in the field – especially for new recruits – can be a truly worrisome business. To help people working in the ER for the first time, here’s a parallel mnemonic:
A= Always Ask
Seek assistance if you’re not sure (and talk to your colleagues even if you are) . Trust the judgement of staff who have been doing this longer than you, whatever their role. Remember there are no prizes for bravery.
B = Be Benign
Believe what your patients tell you. It’s all too easy to rush to judgement – which will blind you to people’s needs. If unsure, give them the benefit of the doubt. Remember that beneficence pays dividends – for you as well as the patient.
C = Consider Catastrophe
What is the worst case scenario? What is the condition that will put you in front of the coroner or the court? Only discharge someone when you have eliminated all these possibilities beyond reasonable doubt.
D = Document Diligently
Date and ID everything. Put both your name and the patient’s name on every page. Decide: make a clear diagnosis or impression. Remember that everything you write or type needs to stand up in court, so be legible. Where possible, write a clear discharge summary to help those that come after you.
E = Explain Everything
Use everyday language to describe simply what you are doing. Guide and educate the patient where possible. Describe to them what you are thinking. If you’re unsure, say so. Be honest: tell them why. Write down what the patient needs to do for themselves in a language they can understand. Communicate with the patient’s GP wherever possible.