Airway, breathing, circulation.
The undifferentiated deteriorating adult. The order isn't tradition, it's physiology: an obstructed airway kills faster than a low pressure. Assess in order, treat as you find, restart at the top after anything you do.
Reviewed August 2026 · verify against current guidelines
Airway, breathing, circulation.
The undifferentiated deteriorating adult. Assess in order, treat as you find, restart at the top after anything you do. The order isn't tradition, it's physiology: an obstructed airway often kills faster than a low pressure.
A — Airway (patent, and protected)
| Assess | Act |
|---|---|
| Speak to them — a full sentence buys the airway for now. | Chin-lift or jaw thrust, suction. |
| Snoring, gurgling, stridor. | NPA if the gag is intact — an OPA in a gagging patient buys vomit. |
| Silent effort is obstruction. | Call the airway team early. |
B — Breathing (oxygenation, then ventilation)
| Assess | Act |
|---|---|
| Count the rate yourself, a full minute — the earliest sign. | Reservoir mask, 15 L/min, now. |
| Work: accessory muscles, tripod. | Then the pattern — bronchodilator, decompression, upright and NIV. |
| Then a gas; sats miss CO2. | Escalate on trajectory. |
C — Circulation (perfusion, not pressure)
| Assess | Act |
|---|---|
| Touch them: refill, mottling. | Two large-bore cannulae; bloods, lactate, gas, cultures. |
| Pulse volume and rhythm, MAP over systolic, JVP for the tank. | 250–500 mL, then reassess. ECG. |
| Confusion and urine come first. | Vasopressor if fluid fails. |
Normal at rest (target 88–92% if CO2 retention)
| RR | SpO2 | HR | MAP | Refill | Lactate |
|---|---|---|---|---|---|
| 12–20 | 94–98% | 60–100 | ≥65 | <2 s | <2 |
Traps
- A rate read off the monitor.
- A reassuring sat in hypercapnia.
- Chasing pressure instead of perfusion.
- A third bolus with no reassessment.
Framework per the Resuscitation Council UK ABCDE approach. Verify against current guidelines and local protocol.
Sources
Verify against current guidelines and local protocol before acting.
- Resuscitation Council UK ABCDE approach
Downloads
Every card for this topic — carousels and tables, print-ready for the wards or for sharing.
