🫁 A – Airway

• Ensure the airway is clear: No immediate concerns as the patient is breathing comfortably.

🌬️ B – Breathing

• Administer oxygen if SpO₂ falls below 94%.
• If any signs of distress are noted (tachypnea, accessory muscle use, hypoxia), escalate for further review.
• Chest X-ray (CXR): Order if signs of pneumonia or other respiratory infections are noted (e.g., fever, cough, crackles on auscultation).

❤️ C – Circulation

• If the patient becomes hypotensive, consider IV Colloids (e.g., Human Albumin Solution) instead of IV crystalloids (e.g., 0.9% saline). Monitor response and adjust fluid therapy as needed.
• Take bloods: FBC, U&Es, LFTs, coagulation profile, lactate, and blood cultures (aerobic and anaerobic) as part of the sepsis screen to rule out bacteremia.
• Start empirical antibiotics (e.g., IV cefotaxime or piperacillin-tazobactam) for suspected SBP/Sepsis while awaiting ascitic fluid culture results. Always check local trust guidelines!
• Monitor lactate: Elevated lactate can indicate sepsis and poor perfusion.

🧠 D – Disability

• Assess GCS and mental status frequently: The patient is confused. If GCS worsens, escalate for further review.
• Give IV thiamine (especially due to alcohol-related liver disease) to prevent Wernicke’s encephalopathy.

🩺 E – Exposure & Everything Else

• Perform a thorough abdominal examination: The patient has tense ascites, tenderness, and signs of peritonitis, raising suspicion for SBP.
• Perform a repeat ascitic tap to obtain fluid for:
  • White cell count (neutrophil count to confirm SBP),
  • Culture (to identify the causative organism),
  • Albumin (to calculate SAAG and assess for portal hypertension).
• Urine culture: If there’s suspicion of UTI as a secondary infection.

🔄 Monitoring and Escalation

• Escalate to the medical registrar to discuss management plan.
• Monitor NEWS score regularly to assess patient stability.
• Check for improvement in vital signs, urine output, and mental status.
• Ensure consultant review as early as possible for further management decisions.

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