Too fast, too slow, or stopping
Rate must be interpreted with age, condition, depth, effort, and mental status.
Visual roadmap
Where each ABC assessment starts
The picture shows common areas of attention, but the assessment is not limited to one body location. Listen, look, feel, compare, and integrate the whole patient.
Primary-assessment questions
Can air move freely?
- Can the patient speak clearly?
- Is there snoring, gurgling, stridor, choking, or silence?
- Do you see blood, vomit, secretions, swelling, trauma, or a foreign body?
- Can the patient protect the airway?
Is ventilation adequate?
- Assess rate, rhythm, depth, and effort.
- Look for equal chest rise and accessory-muscle use.
- Listen for wheeze, crackles, stridor, diminished, or absent sounds.
- Consider speech, fatigue, mental status, SpO₂, and ETCO₂ when available.
Is perfusion adequate?
- Assess pulse rate, rhythm, and quality.
- Look and feel for skin color, temperature, and moisture.
- Control life-threatening external bleeding.
- Integrate mental status, capillary refill, blood pressure, and shock clues.
A — Airway
Signs the airway may be threatened
Unable to speak or cough effectivelyCan suggest severe obstruction or critically limited airflow.
Snoring or gurglingMay reflect tongue obstruction or fluid/secretions in the airway.
Stridor, hoarseness, or swellingCan point to upper-airway narrowing and possible rapid deterioration.
Altered mental statusMay reduce the patient’s ability to protect the airway from aspiration.
B — Breathing
Breathing present does not always mean breathing adequate
Look for effective chest rise and air movement. A patient may be breathing but still require immediate ventilation support.
Shallow or poor chest rise
Small breaths may not move enough air even when the respiratory rate looks acceptable.
Exhaustion or declining alertness
A tiring patient can shift from distress to respiratory failure as effort and air movement fall.
C — Circulation
Perfusion is more than a blood pressure
Shock can be developing before hypotension appears. Pulse, skin, mental status, bleeding, capillary refill, and trend are all useful.
Rate and quality
A rapid weak pulse may support a shock concern; a very slow or irregular pulse may also impair perfusion when symptoms are present.
Color, temperature, moisture
Pale, cool, clammy, cyanotic, mottled, or abnormally flushed skin can add important context.
Major external bleeding
Rapidly identify and control life-threatening bleeding rather than waiting for a full set of vital signs.
Interactive threat finder
Which immediate threat comes first?
Each case uses terms introduced above. Choose A, B, C, or C-A-B for cardiac arrest.
Knowledge check