Study Materials: Managing Respiratory Arrest

ACLS and BLS interventions in managing respiratory arrest may include:

  • O2 supplementation
  • Opening of the airway
  • Basic ventilation
  • Use of OPA and NPA basic airway adjuncts
  • Suctioning
  • Ventilation with advanced airways

Ventilation (if patient is in respiratory arrest but pulse is maintained)

  • Supply every 5-6 seconds (10-12 breaths per minute)
  • Each should last >1 second and visibly raise patient's chest
  • Avoid excessive ventilation (both quantity and volume)

NEW for 2010

Continuous waveform capnography is recommended in addition to clinical assessment to verify placement and monitor ET tube

Supplementary O2

  • May be given to patients in respiratory distress or those with acute cardiac symptoms.
  • Monitor O2 saturation (>94%), use supplementary O2

Opening the Airway - Manual Maneuvers

  • Tongue may obstruct airway if patient is unconscious
  • Snoring respirations in breathing patients may indicate an obstructed airway
  • Airway obstruction by tongue may be resolved by repositioning head and jaw
  • Maintenance of an open airway is the priority in CPR, BLS, and ACLS
  • If patient is unconscious without gag reflex, insert OPA or NPA
Study-material

Head tilt/chin lift maneuver (Do not perform if neck trauma is suspected)

  1. Place patient in supine position
  2. With one hand on patient's forehead, apply pressure with your palm to tilt patient's head
  3. Place fingertips under the bony part of patient's chin. Lift and pull patient's jaw forward without applying pressure to soft tissue which may cause obstruction of airway
  4. Open patient's mouth with thumb of hand used to lift chin by pulling downward on lower lip

Jaw-thrust technique

  • Use when neck trauma is suspected
  • Opens airway without head extension
  • No longer taught to lay rescuers
  • Steps:
    1. Place patient in supine position. Use log-roll technique to avoid flexing of spinal column
    2. Rest elbows on the same surface patient is lying on
    3. Stabilize patient's head in neutral position. Gently grasp the angle of the mandible with two or three fingers
    4. Gently lift jaw upward with three middle fingers; use thumbs to open jaw

Basic Ventilation Skills

  • Bag Mask Ventilation
    • Device composed of ventilation bag attached to a facemask
    • Most common means of positive-pressure ventilation
By John Lustig