Respiratory Arrest

Question 1

what to look at?

Answer 1

ILS
Managing airway

Question 2

What is a respiratory arrest?

Answer 2

a medical event where the ability of a person to breathe stops

Question 3

What may cause a respiratory arrest?

Answer 3

Airway obstruction

Decreased respiratory effort

Respiratory muscle weakness

Question 4

What may cause Airway obstruction?

Answer 4

Upper airway obstruction
- May occur in infants < 3 months (usually nose breathers so may have upper airway obstruction due to nasal blockage)
- Loss of muscle done with decreased consciousness may cause posterior part of tongue to displace into oropharynx
- Blood, mucus, vomitus, foreign body, spasm or oedema of vocal cords, pharyngolaryngeal or tracheal inflammation, tumor, trauma
- Pts with developmental disorders (eg. Down’s) often have abnormal upper airways

Lower Airway obstruction
- Aspiration, Bronchospasm, Airspace filling disorders (eg. pneumonia, pulmonary oedema, pulmonary haemorrhage), Drowning

Question 5

What causes decreased respiratory effort?

Answer 5

CNS disorders
- That affect brainstem (eg. stroke, infection, tumor) can cause hypoventilation

Adverse medications or illict drug effect
- Opioids, sedative hypnotics
- Gabapentinoids

Metabolic Disorder
- Due to severe hypoglycaemia or hypotension

Question 6

What causes respiratory muscle weakness?

Answer 6

Respiratory muscle fatigue
- If pts breathe for extended periods at a minute ventilation exceeding about 70% of their maximum voluntary ventilation

Neuromuscular disorders
- Spinal cord injury, neuromuscular diseases (eg. myasthenia graves, botulism, Guillain-Barré), neuromuscular blocking drugs (eg. succinylcholine, rocuronium, vecuronium)

Question 7

How does respiratory arrest present?

Answer 7

Pts may have hypoxemia (cyanotic)

Question 8

What may cyanosis be masked by?

Answer 8

Anaemia, carbon monoxide poisoning, cyanide toxicity, pts on high-flow O2

Question 9

What will happen if respiratory arrest remains untreated?

Answer 9

Cardiac arrest follows within minutes of onset of hypoxemia, hypercarbia, or both

Question 10

What may infants develop <3 months?

Answer 10

may develop acute apnea without warning, secondary to overwhelming infection, metabolic disorders, or respiratory fatigue.

Question 11

How is respiratory arrest managed?

Answer 11

• Exclude foreign body obstruction. Clear if present
• Mechanical ventilation (bag-valve-mask or mouth-to mouth), endotracheal intubation