Nurse Arcade
Airway, Breathing + Circulation
Recognize compromise. Support oxygen delivery. Reassess response.
Part 1 – Primary survey
Use ABC to find the immediate threat
Treat life threats as they are found; do not wait to finish the assessment.
A – Airway
Can air move from the environment to the lungs? Listen for voice changes, snoring, gurgling, stridor, silence, secretions, swelling, or foreign material.
B – Breathing
Is ventilation and oxygenation adequate? Assess rate, depth, pattern, effort, chest rise, breath sounds, SpO2, skin, speech, and mental status.
C – Circulation
Is blood reaching tissues? Assess pulse, rhythm, blood pressure, skin, capillary refill, bleeding, urine output, mental status, and chest pain.
Part 2 – Airway
Airway: decide whether it is patent
A normal voice strongly suggests airflow; a deteriorating voice is an early warning.
Patent
Speaking clearly; air movement present; no obstructive sound.
Partial obstruction
Snoring, gurgling, hoarseness, stridor, drooling, weak cough, retractions, or difficulty speaking.
Complete or failing
Unable to speak or cough effectively, silent airflow, apnea, severe cyanosis, or rapidly decreasing consciousness.
High-risk causes
Tongue obstruction, secretions, vomit, blood, foreign body, edema, trauma, burns, infection, sedation, or neuromuscular weakness.
Part 2 – Airway cues
Airway sounds localize the problem
Listen before the stethoscope; audible sounds may signal severe narrowing or fluid.
Snoring
Soft-tissue or tongue obstruction, often with decreased consciousness. Reposition or open the airway and reassess.
Gurgling
Liquid or secretions in the upper airway. Suction and protect against aspiration per policy.
Stridor
Harsh inspiratory upper-airway sound. Treat as urgent; consider edema, foreign body, or obstruction.
Hoarse or muffled
Voice change can precede worsening edema or obstruction. Escalate and prepare airway equipment.
Silence
Absent air movement in a distressed patient is ominous, not reassuring. Activate emergency support.
Wheeze
Usually lower-airway narrowing; severe asthma may become quiet as airflow falls.
Part 3 – Breathing
Breathing: ventilation and oxygenation are different
SpO2 estimates oxygenation; it does not directly measure ventilation or carbon dioxide.
Ventilation
Air movement removes CO2. Watch rate, depth, tidal volume, effort, mental status, chest rise, and capnography when available.
Oxygenation
Oxygen transfer depends on ventilation, diffusion, hemoglobin, and perfusion. Trend SpO2 with the whole patient.
Work of breathing
Accessory muscles, retractions, nasal flaring, tripod position, pursed lips, inability to speak, diaphoresis, or fatigue signal distress.
Failure cues
Decreasing effort after severe distress, apnea, bradypnea, exhaustion, worsening confusion, cyanosis, or silent chest require immediate support.
Part 3 – Breath sounds
Breath sounds: connect sound to mechanism
Compare side to side and interpret with effort, oxygenation, and symptoms.
Crackles
Discontinuous popping; may reflect fluid, atelectasis, or opening of small airways.
Wheezes
Musical, often expiratory; airflow through narrowed lower airways.
Rhonchi
Low-pitched coarse sounds; may reflect secretions in larger airways.
Diminished
Reduced air movement from shallow breathing, obstruction, effusion, pneumothorax, or other causes.
Absent unilateral
Urgent when new, especially with trauma, severe dyspnea, or tracheal shift.
Pleural rub
Grating sound from inflamed pleural surfaces; correlate with pain and respiratory findings.
Part 3 – Interventions
Support breathing in a stepwise way
Use the least invasive effective support while preparing for deterioration.
Position
Upright positioning often improves expansion; use recovery positioning when appropriate and safe.
Oxygen
Give the ordered or emergency-protocol device and flow; target oxygenation according to condition and local policy.
Suction
Use when secretions obstruct airflow and within competency; preoxygenate and monitor when indicated.
Medication
Administer ordered treatment for the cause and evaluate the response.
Ventilate
If breathing is inadequate, provide bag-mask or advanced support with trained help; monitor chest rise and response.
Reassess
Repeat rate, effort, sounds, SpO2, mental status, color, and vital signs; document the response.
Part 4 – Circulation
Circulation: assess perfusion, not one vital sign
Blood pressure may remain normal early in shock.
Central
Mental status, heart rate and rhythm, blood pressure trend, chest pain, dyspnea, urine output, and lactate when ordered.
Peripheral
Pulse quality and symmetry, skin temperature, color and moisture, capillary refill, edema, and limb pain.
Bleeding
Expose enough to find hemorrhage while preserving dignity and temperature. Control external bleeding immediately.
Shock pattern
Tachycardia, cool clammy skin, delayed refill, weak pulses, anxiety or confusion, oliguria, hypotension, or rising lactate.
Part 4 – Interventions
Match immediate actions to the circulation threat
Activate emergency response for pulselessness or unstable deterioration.
Pulseless
Start the current BLS or ACLS pathway, high-quality CPR, AED or defibrillation as indicated, and team resuscitation.
Hemorrhage
Direct pressure, approved tourniquet or hemostatic measures, rapid escalation, warmth, access, and blood products per protocol.
Hypotension or shock
Position as appropriate, establish monitoring and IV access, obtain ordered labs, and give cause-specific therapy.
Chest pain or ACS
Rapid assessment, ECG, monitoring, access, and ordered therapy; recognize atypical presentations and contraindications.
Dysrhythmia
Assess pulse and stability first. Treat the patient, verify the rhythm, and follow the appropriate emergency algorithm.
Sepsis
Recognize infection plus organ dysfunction, escalate promptly, obtain ordered cultures and labs, and deliver time-sensitive treatment.
Part 5 – Communicate
Rapid ABC handoff
Say the threat, evidence, intervention, response, and next need.
Situation
State the acute airway, breathing, or circulation concern.
Evidence
Report the most abnormal cues and trend: voice, effort, sounds, SpO2, pulse, BP, skin, mental status, and bleeding.
Action
Report positioning, suction, oxygen, ventilation, access, monitoring, medications, fluids, or bleeding control.
Response
State what improved, worsened, or did not change.
Request
Ask for immediate review, rapid response or code activation, respiratory therapy, equipment, orders, or transfer.
Safety
Continue ABC reassessment, assign roles, use closed-loop communication, and document times and response.
Apply
Practice: name the first threat
State the first assessment, immediate action, and reassessment cue.
- Drowsy postoperative patient with snoring and shallow respirations.
- Sudden stridor, hives, and facial swelling after an antibiotic.
- Asthma patient becomes quiet after prolonged severe wheezing.
- Trauma patient with absent left breath sounds and hypotension.
- GI bleed with tachycardia, cool skin, and new confusion.
- Monitor shows VT; patient is awake but hypotensive and pale.
- Patient has organized rhythm on monitor but no palpable pulse.
- SpO2 is 97%, but respiratory rate is 6 after opioid administration.
- Septic patient remains confused with weak pulses after initial therapy.
- After suctioning, gurgling resolves but effort and SpO2 worsen.
Reference notes
Sources + clinical boundaries
Current standards, facility policy, and trained emergency response supersede this guide.