Chapter 7 discusses respiratory arrest. The condition is defined and some of its causes are listed. This lesson goes into detail about CPR in these situations, and the ACLS manual Figure 21 provides further information about the ACLS Survey.
Respiratory arrest is an emergent condition in which the individual is either not breathing or is breathing ineffectively. Individuals in respiratory arrest require immediate attention.
There are many causes of respiratory arrest, including but not limited to cardiac arrest and cardiogenic shock. Resuscitate individuals in apparent respiratory arrest using either the BLS or the ACLS Survey.
The BLS Survey advises to check for responsiveness, call EMS and get AED, check for responsiveness again, and defibrillate. Figure 20 in your corresponding ACLS manual details the BLS survey.
The ACLS Survey follows the ABCD pattern, in which you check for Airway, Breathing, Circulation, and Differential Diagnosis. Refer to Figure 21 in your corresponding ACLS manual to further learning about the ACLS Survey.
When caring for individuals in respiratory arrest, keep in mind the two types of ventilation: advanced and basic. Advanced ventilation includes an esophageal-tracheal tube, endotracheal tube, laryngeal tube, and laryngeal mask airway. Basic ventilation includes mouth-to-mouth or nose, bag-mask ventilation, oropharyngeal airway, and nasopharyngeal airway.
Although OPAs and NPAs are considered to be basic airways, they require proper placement by an experienced provider. Advanced airway insertion requires specialized training beyond the scope of ACLS certification. While the placement of advanced airways requires specialized training, all ACLS providers should know the proper use of advanced airways once they are placed. Regardless of airway type, proper airway management is an important part of ACLS.
CPR is performed with the individual lying on their back; gravity causes the jaw, the tongue, and the tissues of the throat to fall back and obstruct the airway. The airway rarely remains open in an unconscious individual without any external support. Therefore, you have to open the airway by lifting the chin upward while tilting the forehead back. This is known as the head-tilt-chin-lift maneuver. The goal is to create a straighter path from the nose to the trachea.
In individuals with a suspected neck injury, protect the cervical spine by performing the jaw-thrust maneuver to open the airway. While standard practice in a suspected neck injury is to place a cervical collar, this should not be done in BLS or ACLS. Cervical collars can compress the airway and interfere with resuscitation efforts. As a provider, you must ensure an open airway regardless of the basic airway used. It is your responsibility to stabilize the head or ask for assistance while maintaining control of the airway.
During respiratory arrest care, be sure not to over ventilate ACLS management of VF and VT are essentially the same. Resuscitation for VF and pulseless VT starts with the BLS Survey, that is given too many breaths per minute or too large volume per breath. Both can increase intrathoracic pressure, decrease venous return to the heart, diminished cardiac output, as well as predispose individuals to vomit and aspiration of gastrointestinal contents.
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