A Proposed New Mnemonic (ABCDE-FFFF) for the Management of Critically Ill Patients in a Low-Resource Setting - Review Article

Sep 23, 2026

Uploaded by Theodore

Proposes a new mnemonic, “ABCDE-FFFF,” intended to improve the management of critically ill patients in low-resource settings. Frames the clinical dilemma between individual and community needs during mass critical illness events, noting persistent shortages of staff, supplies, and other resources. Discusses how lettered mnemonics and algorithmic sequences support rapid recognition and life-saving priorities, comparing established models such as ATLS “ABCDE” and related adaptations, and motivates the need for a revised approach suited to constrained environments.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages3

Reading Time8 min

AccessFree to download

Introduction

Algorithms for dealing with critically ill/injured patients

Standard ABCDE approach and adaptations

Mnemonics for pediatric and critical care

Futility

REVIEW ARTICLE Open Access A Proposed New Mnemonic (ABCDE-FFFF) for the Management of Critically Ill Patients in a Low-Resource Setting Authors: O. F. Umuhire1,2,3,*; G. N. Cattermole1,4 Affiliations: 1 University of Rwanda, Kigali, Rwanda; 2 University of Toronto, Toronto, Canada; 3King Faisal Hospital, Kigali Rwanda; 4King’s College Hospital NHS Trust, UK INTRODUCTION The COVID-19 pandemic has brought the world’s attention to the difficulty of suddenly being confronted with a large number of critically ill patients such that the health care system is overwhelmed. There is tension between doing what is best for the individual patient and doing what is best for the community at large [1-5] . High-Income Countries (HIC) are rarely faced with such dilemmas. On the other hand, Low-and-Middle Income Countries (LMICs) face chronic shortages of health care workers, supplies, and other resources. Whether natural or man-made, including the current coronavirus pandemic, disasters make it imperative that LMICs develop strategies to deal with such situations since they will likely be left to fend for themselves with little or no outside help. keywords (MeSH): Ethics, Health Resources, Resuscitation, Pandemics ALGORITHMS FOR DEALING WITH CRITICALLY ILL/INJURED PATIENTS Management of critically ill or injured patients requires rapid and systematic care, focusing on life-saving priorities [6, 7] . The emphasis is on the immediate recognition and treatment of threats to life. This approach enables the clinician to make the best use of the limited time available to avert tragedy. Algorithms have been shown to improve teamwork and increase confidence in recognizing and managing acutely ill patients [8] . Since the development of the Advanced Trauma Life Support (ATLS) course forty years ago [9], it has become the standard practice internationally to use an ‘ABCDE’ model for the initial evaluation and treatment of severely injured patients (table 1)[9,10,11] . The utility of lettered mnemonics and algorithms is apparent. They help healthcare providers, especially those with limited clinical experience, follow a defined sequence of steps to pro- vide the best possible outcomes for severely ill and injured patients. The American Heart Association Basic Life Support (BLS) course uses the mnemonic CAB for compression, airway, and breathing. Likewise, the Advanced Cardiac Life Support (ACLS) extends the list to CABD with D standing for defibrillation [12,13] . Adaptations of the ATLS algorithm (ABCDE) include one for military trauma (ABCDE) where the added stands for “catastrophic hemorrhage” because of the recognition that blast and high-energy penetrating trauma can cause death from massive hemorrhage even before airway obstruction does [14] . Similarly, there is an adaptation specific to burns. The Emergency Management of Severe Burns course adds another E and F to the standard trauma ABCDE, with the additional E standing for an estimate of the burn surface area, and the F meaning the fluid regimen required in burns—the algorithm becomes ABCDEEF [15] . Alongside the standard ‘ABCDE’, some pediatric courses also add *Corresponding author: Olivier Felix Umuhire, [Email: olivierfelixu@yahoo.fr](Email: olivierfelixu@yahoo.fr), ORCID [https://orcid.org/0000-0003-4064-3302](https://orcid.org/0000-0003-4064-3302); University of Rwanda, Kigali, Rwanda; University of Toronto, Toronto, Canada; King Faisal Hospital, Kigali Rwanda; Potential Conflicts of Interest (CoI): All authors: no potential conflicts of interest disclosed; Funding: All authors: no funding was disclosed; Academic Integrity. All au thors confirm that they have made substantial academic contributions to this manuscript as defined by the ICMJE; Informed consent was sought and gained where applicable; Originality: All authors: this manuscript is original has not been published elsewhere; Type-editor:Hannah King (USA) Review: This manuscript was pe

FAQs

What problem does the proposed ABCDE-FFFF mnemonic address?

It targets the difficulty of managing sudden surges of critically ill patients in low-resource settings where systems can be overwhelmed and resources may be scarce.

Why are mnemonic algorithms emphasized in critically ill care?

Lettered mnemonics provide a defined sequence of steps that help clinicians—especially with limited experience—recognize threats to life quickly and work as a team.

How does the article relate ABCDE to other established mnemonics?

It explains that ATLS “ABCDE” is widely used and then describes adaptations such as CAB/CABD, military trauma modifications adding catastrophic hemorrhage, burns algorithms adding burn surface area and fluid regimen, and other pediatric and critical care mnemonic variants.

Sep 23, 2026

Uploaded by Theodore