When you’re called to an unwell patient, the first 5 minutes matter more than the next 30.

Not because you need to be fast.

Because you need to be structured.

Good doctors don’t rush.

They do the right things in the right order.

Your goal in the first 5 minutes is simple:

👉 Decide: stable or unstable — and treat anything life-threatening immediately

Not:

write notes
take full history
check old letters
order scans

Safety first. Everything else later.

First mindset shift

Stop thinking:

❌ “What’s the diagnosis?”

Start thinking:

✅ “Could this patient deteriorate right now?”

Because early stabilisation saves lives.

Early diagnosis rarely does.

Step 0 — Pause before touching anything

When you arrive:

Don’t dive straight into tasks.

Take 5 seconds and just look.

This quick “end-of-bed assessment” tells you more than most tests.

Ask yourself:

Do they look sick?
Breathing comfortably?
Talking normally?
Pale/sweaty?
Drowsy?

Often your first impression is very accurate.

Trust it.

If they look bad → escalate your urgency immediately.

Step 1 — Do A–E immediately (not notes, not history)

Always.

Every time.

Even if it’s “just confusion” or “just pain”.

Many serious issues hide behind simple referrals.

🅐 Airway

talking?
choking?
gurgling?
reduced consciousness?

If they can’t speak properly → airway problem until proven otherwise.

Fix this first.

🅑 Breathing

RR
sats
oxygen requirement
work of breathing

Give oxygen early if needed.

Don’t wait for permission or tests.

Hypoxia kills fast.

🅒 Circulation

BP
HR
cap refill
peripheries
urine output

If hypotensive:

IV access
fluids
bloods

Don’t “observe and wait”.

Treat early.

🅓 Disability

AVPU/GCS
glucose
pupils
confusion

Always check glucose early.

Hypoglycaemia is common and instantly fixable.

Never miss it.

🅔 Exposure

temp
rashes
bleeding
abdomen
obvious causes

So many diagnoses are visible if you look properly.

Step 2 — Fix simple problems immediately

Don’t wait until after the assessment.

Treat as you go.

Examples:

sats low → oxygen now
hypotensive → fluids now
wheeze → neb now
hypoglycaemia → glucose now

On-call rule:

👉 treat first, investigate second

Step 3 — Call for help early if needed

While assessing, ask yourself:

“Can I manage this safely alone?”

If not → call reg/outreach early.

Not after 20 minutes of struggling.

Early escalation is always safer than late panic.

Step 4 — Only then look at notes/history

Once the patient is stable:

Then:

read notes
take history
check results
think diagnosis

Diagnosis comes after stabilisation.

Never reverse this order.

A simple bedside script (very useful under stress)

When you arrive, mentally say:

“Airway. Breathing. Circulation. Disability. Exposure. Treat anything abnormal.”

Keeps you calm and structured.

Especially at 3am.

What juniors often do (and why it’s risky)

Common mistakes:

❌ opening the computer first
❌ long history before obs
❌ waiting for bloods
❌ forgetting glucose
❌ trying to diagnose immediately
❌ delaying oxygen/fluids
❌ not escalating early

These waste precious minutes.

The first 5 minutes are for stabilisation only.

Real NHS example

Bad approach

Arrive → read notes → history → bloods → later notice sats 82%

Too late.

Good approach

Arrive → A–E → oxygen immediately → stabilise → then investigate

Same patient. Much safer.

Senior doctor mindset

Watch a good registrar.

They always:

Look
A–E
Treat immediately
Escalate early
Then think diagnosis

Same order. Every time.

No panic. Just system.

Simple First 5 Minute checklist

When you reach the bedside:

✅ End-of-bed look
✅ Full A–E
✅ Treat abnormalities immediately
✅ Escalate if unstable
✅ Then history/notes

If you do just this, you’ll avoid most serious mistakes on call.

Take-home concept

The first 5 minutes are about stability, not cleverness.

Don’t try to be smart.

Be systematic.

A–E first. Always.

If you stabilise the patient early, everything else becomes easier.

Most on-call disasters happen when basics are delayed.

Basics save lives.