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Respiratory arrest cases occur when a patient has a pulse but is not breathing normally. It's important to remember that agonal aspirations is not considered normal breathing.
In this lesson, we'll cover signs of respiratory distress and respiratory arrest, normal respiratory rates for adults, and some tools you may use when helping to properly oxygenate a patient in either respiratory distress or arrest. At the end of the lesson, we'll take a more in-depth look at airway management.
Pro Tip #1: One sure-fire reliable sign of inadequate breathing is when the patient's breathing attempts do not produce visible signs of chest rise and fall. If you're unsure whether breathing is normal or not, look for this tell-tale sign.
Respirations are only considered effective if there's enough volume of air inspired to circulate oxygen to the patient's brain and other vital organs, along with enough volume of air expelled to remove the proper amount of CO2.
Pro Tip #2: The key element for helping a patient with respiratory problems is to recognize respiratory distress quickly and treat it appropriately before it transitions into respiratory arrest, which is much more serious and more difficult to treat.
Signs of respiratory distress include:
- Pale, cool skin
- Changes in the patient's level of consciousness
- Changes in the patient's level of agitation
- The use of abdominal muscles to assist in breathing
- Wheezing
- Tachypnea (fast breathing)
- Bradypnea (slow breathing)
The normal breathing rate for an adult is between 12 and 20 breaths per minute. Respiratory rates that are less than 8 breaths per minute require the healthcare provider to assist the patient with ventilations using a bag valve mask, a basic airway, or an advanced airway with 100 percent oxygen, or titrate to ensure SpO2 is greater than or equal to 94%.
Pro Tip #3: As mentioned above, agonal gasps are not normal breathing. A patient who gasps will often look like he or she is drawing air in very quickly. The mouth can be open, and the jaw, head, or neck can move with the gasps. Gasps can appear forceful or weak. Some time can pass between gasps because they usually happen at a slow rate. The gasp can sound like a snort, snore, or groan. Again, this type of gasping is not normal breathing. Instead it is a sign of cardiac arrest.
Tools such as capnography and oxygen saturation monitors can help to determine if enough oxygen is being delivered to the patient.
Warning: Although oxygen is vitally important for a patient in respiratory distress or respiratory arrest, keep in mind that more oxygen isn't always better. Excessive ventilation can actually be harmful to the patient by reducing venous return and decreasing cardiac output.
A Word About Airway Management
Management
Initial management for a patient in respiratory arrest involves maintaining a patent airway using a combination of manual head positioning and the insertion of a basic airway adjunct, such as an oropharyngeal airway (OPA) or nasopharyngeal airway (NPA).
Positive-pressure ventilations are then provided using a bag-valve mask or a pocket mask device at a rate of 10 breaths per minute, or around 1 breath every 6 seconds. You should ensure that supplemental oxygen is attached to the ventilatory device you are using to deliver high concentrations of oxygen.
Foreign Body Airway Obstruction (FBAO)
A foreign body, such as a piece of food, can obstruct the airway and prevent the patient from moving air. FBAO is suspected when there is airway resistance and/or a lack of chest rise and fall when the airway is open, and attempts are made to ventilate.
This is clearly a serious emergency that should be immediately corrected. Further management of the patient would obviously be futile if the airway is not patent.
If the chest does not rise visibly and/or there is resistance during your initial attempts to ventilate the patient, reposition their head, and then reattempt to ventilate the patient. If subsequent breaths do not produce visible chest rise, you should perform 30 chest compressions to attempt to dislodge the obstruction.
If your chest compressions fail to dislodge the airway obstruction, visualize the vocal cords with a laryngoscope, and remove the obstruction using Magill forceps.
Advanced Airway Management
While there are numerous advanced airway devices that you can use to secure a patient's airway, endotracheal intubation provides the best protection against aspiration if the patient regurgitates.
Patients in both respiratory and cardiac arrest usually require prolonged ventilatory support and are at an increased risk for regurgitation and aspiration of stomach contents. Therefore, you should secure the patient's airway with an endotracheal tube or another advanced airway device.
