%0 Journal Article
%T Ten rules to assess and manage the acutely deteriorating patient: a practical mnemonic
%A Katherine M Baugher
%A Amal Mattu
%J Patient Safety in Surgery
%D 2011
%I BioMed Central
%R 10.1186/1754-9493-5-29
%X Each year in the United States, an estimated 295,000 people experience out-of-hospital cardiac arrest [1] and another 200,000 experience in-hospital cardiac arrest [2]. Additionally, hospital care providers frequently encounter patients who were previously stable but have begun to rapidly decline. Appropriate awareness and management of peri-arrest characteristics may thwart impending deterioration. Among adults, the most frequent causes of cardiac arrest are cardiac arrhythmia, acute respiratory failure, and hypotension [3]. The unstable, crashing patient requires quick and accurate assessment for appropriate interventions, and the true difficulty in managing this population is reflected by the dismal survival rates. The rate of survival to discharge is higher for in-hospital arrests (21%) [4] than for out-of-hospital arrests (7.9%) [1]. Difficulties arise primarily from the brevity of time available in which to determine the diagnosis. Expending resources and time in pursuit of a misdiagnosis will further harm an already unstable patient. To improve physician response and competence in crisis, we present an easily remembered mnemonic, the A-A-B-B-C-C-D-D-E-E's in the crashing patient.Case scenario: A 55-year-old male who is "not feeling well" is brought to the emergency department by paramedics. He is diaphoretic but awake and alert and is able to speak clearly. On review of vital signs, he is found to be afebrile; tachycardic, with a heart rate in the 120 s; tachypenic, to 28 beats/min; and hypotensive (80/40 mm Hg). The pulse oximetry reading is > 96% and the fingerstick glucose level is 120 dL/mg. An intravenous (IV) line has been established, and the patient is receiving oxygen and is connected to a cardiac monitor. The electrocardiogram (ECG) is non-diagnostic. The patient continues to decompensate, the immediate cause of which is unclear. What should be your early considerations for potential diagnosis and intervention in the next minutes?The clinician shoul
%K ABC's
%K Cardiac arrest
%K Compressions
%K Crashing
%K Defibrillation
%K Resuscitation
%U http://www.pssjournal.com/content/5/1/29