Education and care-planning support only — does not replace clinical judgment or local protocols.

🩺 CP-BREATH — Breathing & Circulation Check

Quick bedside check of breathing and circulation. · Group B Breathing and circulation · Links to: B1–B14

Original tool, not yet validated. Pilot and review with clinicians before clinical decisions. Supports, but does not replace, clinical judgment, validated scales and local policy.

Patient

Date/Time

Nurse

Item	0	1	2
Breathing rate (/min)	0 · 12–20	1 · 21–24 or 9–11	2 · ≥25 or ≤8
Oxygen saturation	0 · ≥95%	1 · 92–94%	2 · ≤91%
Work of breathing	0 · Normal, full sentences	1 · Some effort, short sentences	2 · Neck muscles, 1–3 words
Heart rate (/min)	0 · 51–100	1 · 41–50 or 101–130	2 · ≤40 or ≥131
Systolic BP (mmHg)	0 · 101–160	1 · 91–100 or 161–199	2 · ≤90 or ≥200
Skin and limbs	0 · Warm, pink	1 · Cool or mild swelling	2 · Cold, mottled, blue

⚠ Red flags — escalate at once regardless of score

New chest pain SpO₂ ≤88% unresponsive

Total: 0 — select a score for each item

Score	Level	Action
0–2	Low	Routine checks every shift
3–5	Medium	Recheck within 1 hour, inform nurse in charge
≥6 or any item = 2	High	Escalate now (SBAR), stay with patient

Nursing notes / action taken

⬇ Blank form (PDF)