Primary Survey (ABCDE)

The primary survey is a rapid search for conditions that can kill the patient within minutes. ABCDE means Airway, Breathing, Circulation, Disability, and Exposure. The sequence is deliberate: an obstructed airway prevents ventilation, inadequate breathing prevents oxygen delivery, and circulatory failure prevents oxygenated blood from reaching tissues. ABCDE is not a one-time checklist. Assess, treat an immediately life-threatening finding, and reassess the sequence. A patient who was speaking can later become obtunded; a previously adequate blood pressure can fall as bleeding continues. In a team, several actions may occur simultaneously, but the nurse still prioritises the threat that will cause the fastest deterioration. The primary survey precedes the secondary survey. Do not allow a detailed head-to-toe examination, a distracting wound, or a request for imaging to delay treatment of an airway, breathing, or circulation emergency.