What is the immediate course of action to stabilize a patient in a potentially life-threatening situation?

Immediate Stabilization of a Life-Threatening Emergency

Immediately assess and secure the airway, breathing, and circulation in that order—this ABC approach is the universal priority for any patient in a potentially life-threatening situation, as failure to establish a patent airway makes all other resuscitation efforts futile. 1, 2

Initial Scene Safety and Responsiveness Check

• Ensure your own safety first—never approach a victim if the scene poses danger to you as a rescuer 1, 3
• Check responsiveness by gently shaking the patient's shoulders and shouting loudly "Are you all right?" 1, 3
• If the patient responds by answering or moving, leave them in their current position (unless in danger), check their condition, get help, and reassess regularly 1
• If unresponsive, immediately shout for help and activate the emergency response system (call 9-1-1 or equivalent) 1

A: Airway Management

Open the airway immediately using head tilt-chin lift maneuver: place one hand on the patient's forehead and gently tilt the head back while simultaneously lifting the chin with your fingertips under the point of the chin 1, 3. This single maneuver is critical because maintaining a patent airway is the absolute first priority—without it, no amount of breathing support or circulation management will prevent brain death 4, 5.

• Avoid head tilt only if trauma to the neck is specifically suspected 1
• Remove any visible obstruction from the mouth, including dislodged dentures, but leave well-fitting dentures in place 1, 3
• Turn the victim onto their back if not already in this position to facilitate airway management 1

B: Breathing Assessment and Support

Look, listen, and feel for breathing for exactly 10 seconds before deciding breathing is absent: look for chest movements, listen at the victim's mouth for breath sounds, and feel for air on your cheek 1, 3. This structured 10-second assessment prevents both premature intervention and dangerous delays 1.

If Breathing Normally (More Than Occasional Gasps):

• Place the patient in the lateral side-lying recovery position if unresponsive 1
• Continue to monitor breathing 1

If Not Breathing or Only Gasping:

• Treat occasional gasps as absent breathing—gasps do not provide adequate ventilation and are a sign of cardiac arrest 1, 3
• Give 2 effective rescue breaths immediately, each lasting 1.5-2 seconds and delivering 400-600 mL of air that makes the chest visibly rise and fall 1, 3
• Ensure proper technique: pinch the nose closed, maintain chin lift, create a good seal with your mouth around the victim's mouth, and watch for chest rise 1

C: Circulation Assessment and Support

Check for a pulse for no more than 10 seconds—palpate the carotid artery, and if you do not definitely feel a pulse within 10 seconds, immediately begin chest compressions 1, 3. Healthcare providers frequently take too long to check pulses and have difficulty determining if one is present, so this strict 10-second rule prevents dangerous delays 1.

If Pulse Present But Not Breathing:

• Give 1 rescue breath every 5-6 seconds (approximately 10 breaths per minute) 1, 3
• Recheck pulse every 2 minutes, taking no more than 10 seconds each time 1, 3

If No Pulse or Uncertain:

• Begin high-quality chest compressions immediately with a ratio of 30 compressions to 2 breaths 1
• Compress at least 2 inches (5 cm) deep at a rate of at least 100 compressions per minute 1, 3
• Allow complete chest recoil after each compression and minimize interruptions 1
• Continue cycles of 30 compressions and 2 breaths until advanced help arrives or the patient shows signs of life 1

Important caveat: Even optimal chest compressions achieve only 30% of normal cardiac output, so early defibrillation and advanced care are critical 1. If an AED is nearby and easily accessible, retrieve it immediately after activating emergency services 1.

D: Disability and E: Exposure

Once ABC is stabilized, rapidly assess neurological status (level of consciousness, pupil response) and expose the patient as needed to identify injuries or other life threats, while maintaining body temperature 6, 2.

Critical Pitfalls to Avoid

• Never delay resuscitation to assess for cervical spine injury unless there are specific trauma indicators—the risk of death from delayed resuscitation far exceeds the risk of spinal injury in most emergency situations 3
• Do not mistake occasional gasps for adequate breathing—this is a common error that delays life-saving CPR 1, 3
• Do not take more than 10 seconds to check for a pulse—if uncertain, start compressions immediately as the harm from unnecessary compressions is minimal compared to the harm from delayed CPR 1, 3
• Never use abdominal thrusts or Heimlich maneuver unless the patient has a witnessed foreign body airway obstruction—these are not indicated for most emergencies and can cause injury, vomiting, and aspiration 3

Special Circumstances

Tracheostomy Emergency:

If a patient with a tracheostomy is deteriorating and a suction catheter cannot be passed, remove the tracheostomy tube immediately—a non-functioning tracheostomy offers no benefit and considerable potential for harm 1. After removal, reassess both the mouth and stoma, applying oxygen to both sites, and attempt oxygenation via the oro-nasal route while occluding the stoma 1.

Device Malfunction (e.g., Mechanical Circulatory Support):

For patients with implanted devices showing signs of malfunction, immediately contact the primary device management team and ensure backup equipment is transported with the patient 1, 7. Confirm device function by auscultation (listening for mechanical hum) before assuming device failure 1.