🚦 Who Do You See First? · Lesson 1 of 6 · 6 min
Airway, Breathing, Circulation: The Tiebreaker
🫁 Four clients, one nurse, one question. Every option sounds urgent. The exam does not want you to feel urgent. It wants you to apply one rule in one second: who cannot breathe?
💡 Key idea
Airway, then breathing, then circulation, with two exceptions: cardiac arrest in an adult, child or infant is C-A-B (a newborn at birth gets ventilation first), and an expected stable finding loses to an unexpected change.
🧠 Why it matters
When options involve different clients or different body systems, rank by AIRWAY first, BREATHING second, CIRCULATION third. An obstructed or threatened airway (stridor, swelling after a neck surgery, an anaphylactic reaction, a decreased level of consciousness with vomiting) beats everything. Next comes breathing: respiratory rate, effort, oxygen saturation, chest tube problems. Then circulation: bleeding, chest pain, hypotension, arrhythmias. Two cautions. First, an adult, child or infant in CARDIAC ARREST gets compressions first (C-A-B), because without circulation nothing else matters. Newborn resuscitation at birth is the exception: effective ventilation comes first, and compressions are added only if the heart rate stays below 60/min despite effective ventilation. Second, an ABC problem that is EXPECTED and stable (a chronic COPD client at a usual saturation of 90%) can lose to an unexpected change in another client.
🏥 In the real world
🏥 Options: a client two days post-hip replacement with pain 6/10; a client with a new onset of stridor after thyroidectomy; a client whose IV pump is beeping; a client requesting discharge teaching. Stridor after neck surgery signals an airway that is closing. Causes include swelling, a hematoma, hypocalcemic laryngospasm or bilateral recurrent laryngeal nerve injury. Pain, pumps and teaching all wait. The right answer is the one you would run to, not the one you would feel worst about delaying.
📌 Takeaways
- Airway beats breathing beats circulation
- Stridor, swelling, anaphylaxis and a falling level of consciousness are airway emergencies
- Cardiac arrest is the exception: compressions first
📖 Terms in this lesson
ABCs: The first prioritization rule: airway problems outrank breathing problems, which outrank circulation problems.
✅ Test yourself
Which client should the nurse assess first?
- A client with a chronic cough and a stable oxygen saturation of 91%
- A client reporting throat tightness and a hoarse voice after a bee sting
- A client with a blood glucose of 180 mg/dL before lunch
- A client with 3/10 incisional pain
Answer: B · A client reporting throat tightness and a hoarse voice after a bee sting
Throat tightness and hoarseness after a sting are early signs of airway swelling from anaphylaxis. Airway comes before all the others.
A client is found pulseless and not breathing. Using current resuscitation guidance, what is the first action?
- Open the airway and give two breaths
- Begin chest compressions
- Apply oxygen by non-rebreather
- Check the blood pressure
Answer: B · Begin chest compressions
In cardiac arrest the sequence is C-A-B: compressions first to restore circulation, then airway and breathing.
Which client with a breathing concern should be seen first?
- A client with COPD at the usual baseline saturation of 89% on 2 L of oxygen
- A client with asthma whose wheezing has stopped and is too breathless to speak
- A client who is anxious and breathing 22 times per minute
- A client requesting an incentive spirometer
Answer: B · A client with asthma whose wheezing has stopped and is too breathless to speak
A 'silent chest' in asthma means air is no longer moving. It is a sign of impending respiratory failure, far more dangerous than loud wheezing.
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