During the primary survey, you encounter an unresponsive patient with a patent airway but slow, shallow breaths. What is your immediate action?

• A. Check pulse.
• B. Provide assisted ventilation with a bag-valve-mask and high-flow oxygen, while checking/relieving potential airway obstruction.
• C. Panics.
• D. Wait and see.

Answer: (B)

When breathing is insufficient in an unresponsive patient, the priority is to support ventilation and oxygenation. Since the airway is currently patent but the breaths are slow and shallow, deliver assisted ventilations using a bag-valve-mask with high-flow oxygen. This provides controlled breaths and a higher oxygen concentration to prevent hypoxia. At the same time, look for and relieve any airway obstruction—such as a collapsed tongue, secretions, or vomiting—so each breath actually reaches the lungs. If you need to open the airway, use the appropriate maneuver (head tilt-chin lift if no spinal injury concern, or jaw-thrust if injury is suspected) and suction as needed. Continue ventilating and reassess: if the patient’s breathing improves, maintain support and monitor; if there’s no improvement and there’s no pulse, be prepared to start CPR.