RESPIRATORY ARREST

Lalith Sivanathan 2015

ADVANCED CONCEPTS IN EMERGENCY CARE (EMS

483)

Outline

• BLS• Airway

– Assessment and management• Breathing

– Assessment and management• Circulation

– Assessment and management• Basic airway skills• Airway adjuncts• Suctioning• Ventilation using advanced airway devices

BASIC LIFE SUPPORT

• Check responsiveness –– Tap and shout , “Are you alright?”– Check for absent or abnormal breathing (no

breathing or only gasping) by looking at or scanning the chest for movement (about 5 to 10 secs)

• Activate emergency response system/ get AED

– Check carotid pulse for 5 to 10 seconds– If no pulse, start CPR (30:2) beginning with chest

compressions• Compress the centre of the chest (lower half of the

sternum) hard and fast with at least 100 compressions per minute at a depth of at least 2 inches• Allow complete recoil after each compressions per

minute at the depth of 2 inches• Allow complete chest recoil after each compression

Circulation

• Minimize interruptions in compressions (10 sec or less)• Switch providers about every 2 minutes to

avoid fatigue• Avoid excessive ventilation

– If there is pulse, start rescue breathing at 1 breath every 5 to 6 seconds (10 to 12 breaths per minute). Check pulse about every 2 mins

Defibrillation

• If no pulse, check for a shockable rhythm with an AED/defibrillator as soon as indicated

• Follow each shock immediately with CPR, beginning with compressions

Ventilation ratesAIRWAY DEVICE VENTILATIONS

DURING CARDIAC ARREST

VENTILATIONS DURING RESPIRATORY ARREST

BAG MASK 2 Ventilations after every 30 compressions

1 ventilation every 5 to 6 seconds (10 to 12 breaths per minute)

ANY ADVANCED AIRWAY

1 ventilation every 6 to 8 seconds (8 to 10 breaths per minute)

Airway management in Respiratory arrest

• Assess– Is the airway patent– Is an advanced airway indicated– Is proper placement of airway device confirmed– Is tube secured and placement reconfirmed

frequently

Action as appropriate

– Maintain airway patency in unconscious patients by use of head tilt and chin lift, OPA and NPA

– Use advanced airway management if needed– Confirm proper integration of CPR and ventilaton– Confirm proper placement of advanced airway

devices– Secure the device to prevent dislodgement– Monitor continuous quantitative waveform

capnography

Breathing

• Assess• Are ventilation and oxygenation adequate• Are quantitative waveform capnography and

oxyhemoglobin saturation monitored?

Action as appropriate

– Give supplementary oxygen when indicated

– Monitor the adequacy of ventilation and oxygenation

– Avoid excessive ventilation

Circulation

• What is the cardiac rhythm?• Is the patient with a pulse unstable?• Is defibrillation or cardioversion indicated?• Are chest compressions effective?• Is ROSC present?• Has IV/IO access been established?• Are medications needed for rhythm or BP?• Does the patient need volume for resuscitation?

Action as appropriate

– Monitor CPR quality– Attach monitor/defibrillator for arrhythmias or

cardiac arrest rhythms– Defibrillation / cardioversion– Obtain IV/IO access– Give appropriate drugs to manage rhythm and

blood pressure– Give IV/IO fluids if needed

Basic Airway Skills

• Head tilt – chin lift• Jaw thrust without head extension (suspected

cervical spine trauma)• Mouth to mouth ventilation• Mouth to nose ventilation• Mouth to barrier device (using pocket mask)

ventilation• Bag mask ventilation

Basic airway adjuncts

• OPA– OPA is used in unconscious patients without gag

reflex and should not be used in a conscious or semiconscious patient

• NPA– May be used in conscious or semi conscious

patients with an intact cough and gag reflex

SuctioningCatheter type Use forSoft Aspiration of thin secretions from the

oropharynx and nasopharynxPerforming intratracheal suctioningSuctioning through an in-place airway (i.e., NPA) to access the back of the pharynx in a patient with clenched teeth

Rigid (yankauer) More effective suctioning of the oropharynx, particularly if there is think particulate matter

Oropharyngeal suctioning

– Measure the catheter before suctioning and do not insert it any further than the distance from the tip of the nose to the earlobe

– Gently insert the suction catheter or device into the oropharynx beyond the tongue

– Apply suction by occluding the side opening of the catheter while withdrawing with a rotating or twisting motion

– If using a rigid catheter place the tip gently into the oral cavity. Advance by pushing the tongue down to reach the oropharynx if necessary

Endotracheal tube suctioning

– Use sterile technique to reduce the likelihood of airway contamination

– Gently insert the catheter into the ET tube. Be sure the side opening is not occluded during insertion

– Insertion of the catheter beyond the tip of the ET tube is not recommended because it may injure the endotracheal mucosa or stimulate coughing or bronchospasm

– Apply suction while withdrawing the catheter in rotating or twisting motion

– Suction attempts should not exceed 10 seconds

– To avoid hypoxemia, precede and follow suctioning attempts with a short period of administration of 100% oxygen

Ventilation using advanced airway

• Advanced airway includes– Laryngeal mask airway– Laryngeal tube– Esophageal tracheal tube– Endotracheal tube

Summary

• BLS• Airway

– Assessment and management• Breathing

– Assessment and management• Circulation

– Assessment and management• Basic airway skills• Airway adjuncts• Suctioning• Ventilation using advanced airway devices

Thank you….