Post by Deborah Udy Okusaga Akanne (@deborah_udy_okusaga)
The Step Most Skip.
The panel gives you the scenario-
The patient is breathless, their blood pressure is dropping, and their oxygen saturation is falling.
And you — with years of clinical experience — immediately know what is wrong. You go straight to oxygen. You think about IV access. You reach for the escalation call.
You have just failed the station.
Not because your clinical thinking is wrong. Because you skipped A.
ABCDE is not a mnemonic. It is a mandatory structured assessment framework — and in an NHS interview, it is the only acceptable approach to any deteriorating patient scenario.
ABCDE — Airway, Breathing, Circulation, Disability, Exposure — is the assessment framework endorsed by the Resuscitation Council UK, embedded in every NHS Trust deterioration and emergency management policy, and assessed at every clinical interview station from Band 5 to consultant level.
The reason it matters is not because the panel thinks you do not know how to manage an emergency. It is because the panel is assessing your safety culture
Instinct-based clinicians make mistakes. Structured clinicians catch the thing the instinct missed.
Here is a sample correct ABCDE approach for an interview scenario — and every word matters:
A — Airway: I am first assessing the airway for patency. Is the patient able to speak? Are there any signs of obstruction — stridor, gurgling, use of accessory muscles? Even if the patient is talking, I state this assessment aloud because a patent airway is never assumed.
B — Breathing: I am assessing breathing — respiratory rate, depth, effort, oxygen saturation. I apply high-flow oxygen via a non-rebreathe mask at 15 litres per minute if the patient is hypoxic — unless they are a known COPD patient with hypercapnic risk, in which case I target saturations of 88–92% and use Scale 2 NEWS2.
C — Circulation: I assess heart rate, blood pressure, capillary refill time, skin colour and temperature. I establish IV access and take bloods — FBC, U&E, LFTs, CRP, clotting, Group and Save, blood cultures if sepsis is suspected.
D — Disability: I assess level of consciousness using ACVPU — not GCS in the first instance, as ACVPU is the NEWS2-integrated tool. I check blood glucose. New confusion scores 3 on the ACVPU scale and alone can trigger a NEWS2 escalation threshold.
E — Exposure: I expose the patient fully to look for the source — rashes, wounds, surgical sites, signs of haemorrhage, abdominal rigidity. I maintain dignity throughout.
Then — and only then — I calculate the NEWS2 score, determine the escalation threshold, and activate the appropriate response.
That is the answer that scores Outstanding at every band.
DM ABCDE for the guide.
Post 3 drops at 11:00 PM
#ABCDE #NHSInterview2026 #ResuscitationCouncilUK #DeterioratingPatient #Band5NHS #Band6NHS #EmergencyNursing #IMGDoctor #NHSJobs #clinicalgovernance #PatientSafety
(For Educational awareness only)
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