LOC or ABC first?

[Caffeinated RN]

I feel like this is a silly question, but it is a topic that recently came up in class (I am just about to finish nursing school), and it is driving me off-the-wall CRAZY!

We all know that our ABCs are paramount to our practice as healthcare professionals. My instructor, who is a wonderful, very knowledgable ICU/recovery room nurse, recently insisted, in a nutshell, that the ABCs come before establishing the level of consciousness.

Now, as an EMT, I have always been trained to think that LOC comes before ABCs in major part because this can help dictate the airway adjunct. Are they semi-conscious? Well, then, they likely have a gag reflex, so drop an NPA. Are they unconscious? Drop an OPA. That sort of thing....And of course, if they are unconscious, we may very well not have any breathing or circulation, and we need to initiate CPR.

In real life, healthcare professionals can multitask, and we are not sitting there going, "OK - I just evaluated his airway. Now, let me assess his breathing and circulation. Hmm..." In other words, we make several assessments at once regarding LOC, ABCs, what have you.

So, why is this whole thing driving me crazy??? Well, in addition to not feeling like a dummy, I'd like to one day become a Certified ER nurse. And I suppose the NCLEX is important, too ;p

I feel as though my teacher has a slightly different perspective as an ICU nurse, which is why she states this is the correct answer. She, after all, usually receives the patient with an airway in place, etc.

Feedback would be great! Thanks so much!!

[netglow, ASN, RN]

In reality you do it all at the same time in about 15 seconds. It's not a long process you think through and do in order.

Eeek, took too many posts to get to the correct answer.

[FlorenceNtheMachine]

You have to establish nonresponsiveness before doing CPR or you will get punched in the face by an angry patient. To the person that says you would never do CPR until the monitor showed asystole is very incorrect. They are rarely on the monitor yet when CPR starts in the ER. You don't take the time to put a monitor on a look at the rhythm. No signs of life....go directly to CPR. Then you worry about the monitor and iv's and airways.

Just to clarify, I didn't say you wouldn't do CPR until the monitor showed asystole. I said "N

o sane person is going to see asystole on the monitor and start popping ribs without further assessment." There is a big difference in my meaning. More of a patient already on the monitor, and it goes off showing a flat line.

[skylark, BSN, RN]

Just to clarify, I didn't say you wouldn't do CPR until the monitor showed asystole. I said "N

o sane person is going to see asystole on the monitor and start popping ribs without further assessment." There is a big difference in my meaning. More of a patient already on the monitor, and it goes off showing a flat line.

Agreed.

Monitor can show a flat line for all sorts of reasons, nobody is going to start CPR without actually looking at the patient first. Most times its just a lead disconnected, presence of artifact, or some other unhelpful technical glitch.

Asystole is never a true flat line anyway, more a sort of wavy random line, but even then you look at the patient not the monitor : )

[dashingdiva]

ABC should always come first in your assessment. But of course you should not overlook LOC- as this will provide additional cues that will support your ABC assessments.

[brownbook]

Will you all stop it with the ABC'S......a bjaream posted it is now CAB.

But anyway as someone else posted checking if they are responsive (which you always do first) could be the same as checking their LOC?

You say potatoe....I say potatoe......you say tomatoe....I say tomatoe.....(I'm showing my age, an old song, comes out better hearing it than typing it).

[Esme12, ASN, BSN, RN]

Technically you always start with "Annie Annie are you ok??? Look listen and feel..."Somebody call 911!!!!"

But.....regardless of their LOC....if they aren't breathing they aren't leaving.

[Esme12, ASN, BSN, RN]

Will you all stop it with the ABC'S......a bjaream posted it is now CAB.

But anyway as someone else posted checking if they are responsive (which you always do first) could be the same as checking their LOC?

You say potatoe....I say potatoe......you say tomatoe....I say tomatoe.....(I'm showing my age, an old song, comes out better hearing it than typing it).

Lets call the whole thing off....!

[Caffeinated RN]

Wow! I was not expecting so many responses! Thank you! I am no longer going crazy. Haha

[lillymom]

We are still taught ABC first in school for assessment because the NCLEX will probably not be updated. It all about the NCLEX during school.

[joanna73, BSN, RN]

Always ABC, in real life situations, and to answer NCLEX scenarios. Your patient may have altered LOC for various reasons (delerium, coma) to name a few, but they still have a patent airway.

[cardiacrocks, BSN, RN]

You always have your rare situations as well. When someone is hypoglycemic/hyperglycemic, they can lose consciousness and if it's too low you won't be able to wake them. So, in that situation you need to assess their breath, etc. then check BS, you are most likely not going to start chest compression's on this person, just saying. Anyway, I know this is off topic. Basically, when you are taking the NCLEX you need to think like a nurse not an EMT.

[Music in My Heart]

It was never LOC before ABC/CAB... at least back to 1981 when I first became an EMT and started teaching CPR.