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ABCDE: The Order That Saves Lives · ABCDE primary survey · acute care prioritization · emergency triage

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ABCDE: The Order That Saves Lives

with Atlas

Atlas the calm guide stands in a bright simulation bay, tilting a practice mannequin's head back to open its airway while narrating the A-step, with a glowing ABCDE checklist projected on the wall behind them.

Recall what each letter of the ABCDE primary survey stands for
Explain why the ABCDE steps must be completed in a fixed order
Apply the ABCDE framework to identify which step is skipped in a described scenario
Analyze a multi-patient scene to rank who requires the most urgent attention
Distinguish between airway patency and breathing effort as two separate clinical checks

Key terms

Airway patency: Whether the physical passage for air is open and unblocked
Breathing effort: Whether the person is actively making muscular respiratory movements
AVPU scale: Rapid neurological check rating Alert, Voice, Pain, Unresponsive
Triage: Sorting multiple patients to treat the most life-threatened first

Why the Order Is Fixed

ABCDE is sequenced by how quickly each problem can kill, so each step is addressed before moving on. A blocked airway kills in minutes, so Airway comes first; absent breathing effort kills next, so Breathing follows even when the airway is open; uncontrolled circulation loss follows, then neurological disability, then full-body exposure. The fixed order prevents salience bias, the human tendency to fixate on a dramatic visible wound while a silent airway or breathing failure goes unnoticed and proves fatal.

Two Separate Checks: Airway and Breathing

A frequent and dangerous error is treating airway and breathing as one check. Airway patency is structural, whether the passage is open, while breathing effort is functional, whether the person is actually moving air, confirmed by the look-listen-feel technique of watching chest rise, listening for breath sounds, and feeling for airflow. A person can have a completely clear airway yet have stopped breathing, which is why B must always be performed independently after A regardless of how the airway appears.

Worked examples

Apply ABCDE to a collapsed person

Start at A and confirm the airway is open, repositioning the head if needed to clear the passage.
Move to B and use look-listen-feel to verify the person is making breathing effort, not assuming it from an open airway.
Proceed to C, checking pulse, skin color, and controlling any heavy bleeding before lower-priority concerns.
Continue to D using AVPU; with no response to voice, the next level is a pain stimulus such as firm nail-bed pressure, then E to expose and examine for hidden injuries while keeping warm.

Answer: Each life threat is addressed in fixed A-B-C-D-E order, escalating to a pain stimulus when voice fails.

Hi, I am Atlas. When something serious happens, trained responders follow one fixed order so nothing important gets missed: A, B, C, D, E. A is Airway. The first question is whether the physical path for air is open and unblocked. I am tilting this mannequin's head back right now — that simple move can re-open an airway. Without a clear path, nothing else matters. B is Breathing. Here is a key distinction: a person can have a perfectly open airway and still have stopped making any breathing effort. B checks whether the person is actually breathing by looking for chest rise, listening for breath sounds, and feeling for airflow — the look-listen-feel technique. C is Circulation. We check pulse, skin color, and any heavy bleeding, because severe blood loss can be deadly within minutes. D is Disability, meaning brain and nervous system function. The standard check uses four levels — Alert, Voice, Pain, Unresponsive (AVPU). If someone does not respond to a loud voice, the next test uses a pain stimulus such as firm pressure on the nail bed, not a light touch. E is Exposure. We carefully check the whole body for hidden injuries or temperature problems while keeping the person warm and their privacy protected. The order matters because each step is ranked by how quickly it can kill. Triage applies the same logic across multiple patients: help the most life-threatened person first. You are a learner, not a clinician — the real-world rule is to call emergency services and let trained adults act. If you ever feel stuck, return to A and work forward again.

Activity

These five emergency-check steps are shown in a shuffled order — drag them into the correct ABCDE sequence from first to last

Practice

Arrange the five ABCDE steps in the correct sequence from first to last.

A patient does not respond to a loud voice during step D; state the correct next action.

Common mistakes to avoid

An open airway means the person is breathingAirway patency is structural while breathing effort is functional, so B must be checked separately.
Dramatic visible wounds should be treated before checking breathingBreathing failure threatens life faster than most surface wounds, so ABCDE order takes priority.

Check your understanding

In the ABCDE assessment, what does the letter A stand for, and why is it checked first?

A person is lying still with their mouth open and their airway completely clear. Why must step B still be performed?

A responder skips straight to bandaging a large, dramatic-looking cut on the leg before checking whether the person is breathing. Why is this a mistake?

During step D, you call the patient's name loudly and get no response. What is the correct next action according to AVPU?

Three people are injured. One has a small scrape and is walking normally; one has a broken arm and is sitting upright; one is barely breathing and not responding to voice. Using triage, who should be helped first?

Recap

The ABCDE primary survey checks Airway, Breathing, Circulation, Disability, and Exposure in a fixed order ranked by how fast each threat can kill, distinguishing airway patency from breathing effort, using AVPU for neurological status, and applying the same logic to triage multiple patients.

Reflect

Why might a responder be tempted to skip ahead, and how does ABCDE prevent it?