ACLS | Resp Arrest Extended

Clinical Recognition & Assessment

• Respiratory Arrest Definition: Patient is unconscious and unresponsive with a perfusing pulse, but respirations are absent or inadequate[1]. Agonal gasps do not indicate adequate breathing[1].
• Distress vs. Failure: Normal adult respiration is 12–20 breaths/min with a tidal volume of 6–8 mL/kg[1]. Distress shows tachypnea (>20/min), accessory muscle use, or agitation[1]. Failure is inadequate oxygenation/ventilation marked by severe bradypnea (<12/min), cyanosis, or stupor[1][2]. Rate <6/min requires assisted ventilation with 100% oxygen[1].

2. Ventilation Protocol & Critical Rules

• Ventilation Rate: Deliver 1 breath every 6 seconds (10 breaths/min) using a bag-mask device or advanced airway[3][4]. Deliver each breath over 1 second to produce visible chest rise[3][5].
• Tidal Volume: Provide 500–600 mL (6–7 mL/kg)[2][5]. Adult bag-mask devices often deliver excess volume; caution is advised, and a pediatric bag-mask may be considered[2].
• Pulse Reassessment: Recheck pulse every 2 minutes for 5–10 seconds[3]. If no pulse, start CPR immediately[3].
• Oxygenation Targets: Give 100% oxygen in arrest[1][4]. Maintain SpO2 ≥95% generally, 90% for ACS, and 92–98% for post-cardiac arrest care[4].
• Avoiding Hyperventilation: Excessive ventilation increases intrathoracic pressure, decreases venous return, lowers cardiac output, causes cerebral vasoconstriction, and leads to gastric inflation and aspiration[3].

3. Airway Opening & Adjuncts

• Airway Opening: Tongue displacement due to lost muscle tone is the primary cause of obstruction[4]. Perform head tilt-chin lift, or jaw-thrust without head extension for suspected cervical trauma[4][5].
• Bag-Mask Technique: Two-rescuer BVM using the E-C clamp technique is preferred[5]. Single rescuers should use a pocket mask if available[5].
• OPA (Oropharyngeal Airway): Use only in unresponsive patients without a cough/gag reflex[4][6]. Size from corner of mouth to angle of mandible[6]. Insert curved upward toward palate, then rotate 180°[6].
• NPA (Nasopharyngeal Airway): Suitable for conscious, semiconscious, or unconscious patients[7]. Size length from nose tip to earlobe[7]. Lubricate and insert perpendicular to face[7]. Caution with facial trauma due to cribriform plate fracture risk[7].

4. Suctioning Standards

• Vacuum & Flow: Wall-mounted units must provide >40 L/min airflow and >-300 mmHg vacuum[8].
• Catheter Types: Rigid Yankauer for thick secretions/oropharynx; soft flexible catheter for thin secretions, NPA, or ET tube[8].
• Procedure: Measure catheter and do not insert beyond tongue[8]. Apply suction while withdrawing with a rotating motion, limiting attempts to ≤10 seconds[8].