DC3 A–>H

D – Danger

• Safe to approach the pt?
• PPE?
• Decon?
• Chemical restraint if needed (ketamine 4-5 mg/kg IM ~ 500 mg )

C – Call for help

• Consultants? – Trauma, NSG, Stroke, Peds, OB, etc.
• Blood?
• CXR? EKG?
• Special equipment?

C – Calm

• Make the room quiet
• Unnecessary personnel to perimeter

C – Cardiac arrest?

• Unresponsive -> pulse check
• Compressions if no certain pulse
• Analyze rhythm and defib if needed
• Consider the interventions for reversible causes

A – Airway

• Assess

  • Voice, secretions, stridor, posturing

• Treat

  • Positioning, jaw thrust
  • Suction, FB Removal
  • OPA/NPA, LMA, intubate, cric

B – Breathing

• Assess

  • Look-WOB, RR, SpO2, EtCO2
  • Listen – Aeration, wheezes, crackles
  • US/CXR

• Treat
  • Oxygen – NC/NRM vs NIV vs intubation
  • Medications – Nebs, nitroglycerine, epinephrine/terbutaline
  • Decompress – consider needle thoracostomy

C – Circulation

• Assess

  • Perfusion – M/S, pulse, skin, BP
  • Heart – Listen, US
  • Bleeding – Quick sweep
  • US – FAST/RUSH in all hypotensive or trauma pts

• Treat

  • Access – IV, EJ, IO, Central
  • Tourniquet or REBOA
  • Fluid – IVF (warm, pressure bag, level 1),
  • Blood – Consider MTP
  • Coagulopathy – TXA, Reversal (PCC)

D – Disability and Dextrose

Disability

• Assess
  • Orientation
  • Extremities
  • Pupils
  • Stat HCT?
• Treat
  • HOB 30 degrees
  • HTS bolus (5% 300 ml) or NaHCO3 2 amps

Dextrose

• Fingerstick
• Dextrose

E – Expose, Exam, Events, EKG

Expose

• Remove clothing, roll and rectal
• Start cooling or warming

Exam

• Head to toe including pits, groin, back and crack

Events

• HPI
• Allergies
• Meds
• PMHx/PSHx

EKG

G – Germs, ‘Gesia, Get, Go

Germs

• Tetanus status
• Cultures (Blood, Urine, CSF)
• Antibiotics

‘Gesia

• Pain medication
• Post intubation sedation

Get

• Extra labs (Pregnancy, CK, Ammonia, TSH etc.)
• Imaging orders

Go

• Package to advanced imaging
• Disposition

* For Oral Boards Add Another ‘C’ for C-spine

Reuben Strayer’s Approach