Initial Assessment of a Patient in Resuscitation
Immediately ensure scene safety, check responsiveness by shaking shoulders and shouting "Are you all right?", then rapidly assess airway, breathing, and circulation in that sequence—this ABC approach forms the foundation of resuscitation assessment. 1
Scene Safety and Responsiveness Check
First, ensure your own safety and the patient's safety before approaching. 1 Look for environmental hazards such as electrical sources, traffic, or structural dangers that could harm you or the patient. 1
Check responsiveness by gently shaking the patient's shoulders while asking loudly "Are you all right?" 1 This initial assessment determines consciousness level and guides subsequent actions. If the patient responds by answering or moving, leave them in their current position (unless in danger), check their condition, and get help if needed. 1 If unresponsive, immediately shout for help. 1
Airway Assessment
Open the airway using head tilt-chin lift maneuver: place one hand on the forehead and gently tilt the head back while lifting the chin with fingertips placed under the bony part of the chin. 1 Keep your thumb and index finger free to close the nose if rescue breathing becomes necessary. 1
Avoid head tilt if trauma to the neck is suspected. 1 In trauma cases, use jaw thrust without head extension to minimize cervical spine movement.
Remove any visible obstruction from the mouth, including dislodged dentures, but leave well-fitting dentures in place. 1
Breathing Assessment
With the airway open, look, listen, and feel for breathing for exactly 10 seconds—no more. 1 This involves:
- Looking for chest movements 1
- Listening at the victim's mouth for breath sounds 1
- Feeling for air on your cheek 1
Occasional gasps do not count as normal breathing. 1 If the patient is breathing normally, turn them into the recovery position and continue monitoring. 1 If not breathing, proceed immediately to rescue interventions.
Circulation Assessment
After establishing that the patient is not breathing, assess for signs of circulation by looking for any movement (including swallowing or breathing attempts) and checking the carotid pulse—take no more than 10 seconds for this assessment. 1
If you detect signs of circulation within 10 seconds, continue rescue breathing and recheck circulation every minute (approximately every 10 breaths). 1 If there are no signs of circulation or you are uncertain, immediately start chest compressions. 1
Critical Timing Considerations
The entire initial assessment sequence should be completed rapidly—responsiveness check takes seconds, breathing assessment takes exactly 10 seconds, and circulation check takes no more than 10 seconds. 1 This rapid assessment minimizes delays in initiating life-saving interventions.
If alone and the patient is not breathing, leave the patient to activate emergency medical services (call for help) before returning to start resuscitation. 1 If others are present, send someone immediately to call for help while you begin resuscitation. 1
Common Pitfalls to Avoid
Do not spend excessive time on pulse checks—if uncertain about circulation after 10 seconds, start chest compressions immediately. 1 Delays in starting compressions significantly worsen outcomes, and even optimal chest compressions achieve only 30% of normal cardiac output. 1
Do not perform violent shaking during responsiveness checks, as this could cause head or cervical spine injuries. 1 Gentle shoulder shaking with verbal stimulation is sufficient.
Do not delay moving to the next assessment step if initial maneuvers are unsuccessful. 1 For example, if you cannot achieve effective breaths after 5 attempts, move on to circulation assessment rather than persisting. 1
Special Context: Trauma Patients
In trauma patients with exsanguinating injuries, emerging evidence supports prioritizing circulation before airway (CAB approach) to avoid deleterious effects of post-intubation hypotension. 2 However, the traditional ABC sequence remains standard for most resuscitation scenarios. 1