Next week I’ll be re-certifying in Basic Life Support and in Advanced Cardiac Life Support. The post today consists of excerpts from Respiratory Arrest Case, Part 5 of the 2016 ACLS Provider Manual, The Systematic Approach:
This case reviews appropriate assessment, intervention, and management options for an unconscious, unresponsive adult patient in respiratory arrest. Respirations are completely absent or clearly inadequate to maintain effective oxygenation and ventilation. A pulse is present. (Do not confuse agonal gasps with adequate respirations.) The BLS Assessment and the Primary and Secondary Assessments are used even though the patient is in respiratory arrest and not in cardiac arrest.
Normal and Abnormal Breathing
The average respiratory rate for an adult is about 12 to 16/min. Normal tidal volume is 8 to 10 ml/kg maintains normal oxygen and elimination of CO2.
Tachypnea is a respiratory rate above 20/min and bradypnea is a respiratory rate below 12/min. A respiratory rate below 6/min (hypoventilation) requires assisted ventilation with a bag-mask device or advanced airway with 100% oxygen.
Identification of Respiratory Problems by Severity
Identifying the severity of a respiratory problem will help you decide the most appropriate interventions. Be alert for signs of:
- Respiratory Distress
- Respiratory Failure
Respiratory Distress
Respiratory distress is a clinical state characterized by abnormal respiratory rate (eg, tachypnea) or effort. The respiratory effort may be increased (eg, nasal flaring, retractions, and use of accessory muscles) or inadequate (eg, hypoventilation or bradypnea).
Respiratory distress can change from mild to severe. For a patient with mild tachypnea and a mild increase in respiratory effort with changes in airway sounds in mild respiratory distress. A patient with marked tachypnea, significantly increased respiratory effort, deterioration in skin color, and changes in mental status is in severe respiratory distress, Severe respiratory distress can be an indication of respiratory failure.
Respiratory Failure
Respiratory failure is a clinical state of inadequate oxygenation, ventilation, orboth. Respiratory failure is often the end stage of respiratory distress. If there is abnormal central nervous system control of breathing or muscle weakness, the patient may show little or no respiratory effort despite being in respiratory failure. In these situations, you may need to identify respiratory failure based on clinical findings. Confirm the diagnosis with objectivemeasures, such as pulse oximetry or blood gas analysis.
Causes of Respiratory Failure:
- Upper Airway Obstruction
- Lower Airway Obstruction
- Lung Tissue Disease
- Disordered Control of Breathing
- eg, apnea or shallow, slow respirations
When respiratory effort is inadequate, respiratory failure can occur without typical signs of respiratory distress. Respiratory failure can occur with a rise in arterial carbon dioxide levels (hypercapnia), a drop in blood oxygenation (hypoxemia), or both.
Respiratory Arrest
Respiratory arrest is the cessation (absence) of breathing. Respiratory arrest is usually caused by an event such as drowning or head injury. For an adult in respiratory arrest, providing a tidal volume of approximately 500 to 600 ml (6 to 7 mL/kg) should suffice. This is consistent with a tidal volume that produces visible chest rise.
