Cardiorespiratory failure

Respiratory arrest is caused by apnea (cessation of breathing) or respiratory dysfunction severe enough it will not sustain the body (such as agonal breathing). Prolonged apnea refers to a patient who has stopped breathing for a long period of time. If the heart muscle contraction is intact, the condition is known as respiratory arrest. An abrupt stop of pulmonary gas exchange lasting for more than five minutes may damage vital organs especially the brain, possibly permanently. Lack of oxygen to the brain causes loss of consciousness. Brain injury is likely if respiratory arrest goes untreated for more than three minutes, and death is almost certain if more than five minutes. Respiratory arrest is caused by apnea (cessation of breathing) or respiratory dysfunction severe enough it will not sustain the body (such as agonal breathing). Prolonged apnea refers to a patient who has stopped breathing for a long period of time. If the heart muscle contraction is intact, the condition is known as respiratory arrest. An abrupt stop of pulmonary gas exchange lasting for more than five minutes may damage vital organs especially the brain, possibly permanently. Lack of oxygen to the brain causes loss of consciousness. Brain injury is likely if respiratory arrest goes untreated for more than three minutes, and death is almost certain if more than five minutes. Damage may be reversible if treated early enough. Respiratory arrest is a life-threatening medical emergency that requires immediate medical attention and management. To save a patient suffering from respiratory arrest, the goal is to restore adequate ventilation and prevent further damage. Management interventions include supplying oxygen, opening the airway, and means of artificial ventilation. In some instances, an impending respiratory arrest could be predetermined by signs the patient is showing, such as the increased work of breathing. Respiratory arrest will ensue once the patient depletes their oxygen reserves and loses the effort to breathe. Respiratory arrest can be used interchangeably with complete respiratory failure. The former refers to the complete cessation of breathing, while respiratory failure is the inability to provide adequate ventilation for the body’s requirements. However, both lead to death without intervention. Respiratory arrest is also different from cardiac arrest, the failure of heart muscle contraction. If untreated, one may lead to the other. One common symptom of respiratory arrest is cyanosis, a bluish discoloration of the skin resulting from an inadequate amount of oxygen in the blood. If respiratory arrest remains without any treatment, cardiac arrest will occur within minutes of hypoxemia, hypercapnia or both. At this point, patients will be unconscious or about to become unconscious. A condition that frequently precedes respiratory arrest is respiratory distress, which is a gradual, subtle imbalance in patient response that can result in eventual respiratory failure and arrest. Symptoms of respiratory compromise can differ with each patient. Complications from respiratory compromise are increasing rapidly across the clinical spectrum, partly due to expanded use of opioids combined with the lack of standardized guidelines among medical specialties. While respiratory compromise creates problems that are often serious and potentially life-threatening, they are almost always preventable with the proper tools and approach. Appropriate patient monitoring and therapeutic strategies are necessary for early recognition, intervention and treatment. Before respiratory arrest officially occurs, patients may experience some neurologic dysfunctions, such as feeling agitated, confused, and struggling to breathe. Tachycardia, sweating, intercostal retractions, and sternoclavicular retractions may occur as well. Patients who have an impaired central nervous system or respiratory muscle weakness may experience irregular patterns of respiration and feeble, gasping attempts to breathe. Patients who developed respiratory arrest from the cause of a foreign body in the airway may choke, call the attention of people nearby to their neck, and give out a harsh sound. By monitoring a patient’s oxygen and carbon dioxide levels, practitioners can prepare for ensuing respiratory arrests in patients. Infants that are under three months may develop respiratory arrest without any signs of warning and must be carefully taken care of. The development of respiratory arrest could come from infection, metabolism disorders, or respiratory fatigue. Another group of patients that should be on the watch list are asthmatics or patients with other chronic lung diseases. They can be become hypercapnic or tired after bouts of respiratory distress. These symptoms will lead to apnea without any signs of warning. Diagnosis requires clinical evaluation. If there was a foreign body obstructing the airway, the first option would be to locate the foreign body. The presence of a foreign body can be detected from resistance to ventilation from the mouth-to-mask or bag-valve-mask ventilation. The foreign body can be extracted during laryngoscopy for endotracheal intubation. The first step to diagnosing patient is to clear and open the upper airway with correct head and neck positioning to determine the cause of respiratory arrest. The practitioner must lengthen and elevate the patient’s neck until the external auditory meatus is in the same plane as the sternum. The face should be facing the ceiling. The mandible should be positioned upwards by lifting the lower jaw and pushing the mandible upward. If a foreign body can be detected, the practitioner may remove it with a finger sweep of the oropharynx and suction. It is important that the practitioner does not cause the foreign body to be lodged even deeper into the patient’s body. Foreign bodies that are deeper into the patient’s body can be removed with Magill forceps or by suction. A Heimlick maneuver can also be used to dislodge the foreign body. The Heimlick maneuver consists of manual thrusts to the upper abdomen until the airway is clear. In conscious adults, the practitioner will stand behind the patient with arms around the patient’s midsection. One fist will be in a clenched formation while the other hand grabs the fist. Together, both hands will thrust inward and upward by pulling up with both arms. Resistance to bag valve mask may suggest presence of a foreign body that is obstructing airways and commonly used as a diagnostic tool and treatment for respiratory arrest. The bag-valve-mask device has a self-inflating bag with a soft mask that rests on the face. When the bag is connected to an oxygen supply, the patient will receive 60 to 100% of inspired oxygen. The purpose of bag-valve-mask is to provide adequate temporary ventilation and allow the body to achieve airway control by itself. However, if the bag-valve-mask is left on for more than five minutes, air may be introduced into the stomach. At that point, a nasogastric tube should be inserted to take the accumulated air out. During this process, practitioners must carefully position and maneuver the bag-valve-mask in order to keep airways open. An oropharyngeal airway is used during bag-valve-mask ventilation to prevent oropharynx soft tissues from blocking the airway. An oropharyngeal airway may cause gagging and vomiting. Therefore, an oropharyngeal airway must be sized appropriately. It should be as long as distance between corner of patient’s mouth and angle of the jaw is calculated correctly. For children, pediatric bags can be used. Pediatric bags have a valve that limits peak airway pressures to around 35–40 cm of water. Practitioners must tweak valve settings to accurately determine each of their patients to avoid hypoventilation or hyperventilation.