What is the first step in managing respiratory failure?

• A. Schedule imaging
• B. Assess respiratory rate, effort, and adequacy including SpO2 and ETCO2
• C. Start broad-spectrum antibiotics
• D. Initiate mechanical ventilation immediately

Answer: (B)

The best first step is to quickly assess breathing status by checking respiratory rate, work of breathing, and how well gas exchange is happening using SpO2 and end-tidal CO2. This gives an immediate read on whether the patient is ventilating adequately and oxygenating properly, and it guides the next actions (like supplemental oxygen, noninvasive support, or escalation to airway management). Imaging can help diagnose the cause but doesn’t stabilize gas exchange right away; antibiotics address infection only if present, and mechanical ventilation is a major intervention reserved for when the assessment shows insufficient ventilation or oxygenation after initial stabilization.