💨 ACLS Deep Dive: Respiratory Arrest (With a Pulse) 🫁

1️⃣ BLS Foundation — Keep It Basic, Keep It Alive Scene safe ✅ → Check responsiveness → Shout for help 📣 → Activate emergency response 🚑 → Check breathing + pulse simultaneously (≤10 sec). 💤 If no breathing but pulse present → Respiratory Arrest. 👉 Deliver 1 breath every 6 seconds (10/min) via BVM or advanced airway. 👉 Recheck pulse every 2 minutes (5–10 sec). 👉 If pulse disappears → start CPR immediately.

2️⃣ Airway Priorities — The ABCs Still Rule 🫀 Open the airway:

• Most common obstruction = tongue fall-back.
• Use head-tilt chin-lift (no trauma) or jaw-thrust (suspected trauma). 💨 Ventilation:
• 1 breath q6 sec (10/min) with visible chest rise.
• Tidal volume ≈ 500–600 mL (6–7 mL/kg).
• Avoid hyperventilation — it kills perfusion. 🧩 Adjuncts:
• OPA: Only in unresponsive pts w/out gag/cough reflex.
• NPA: Use if conscious, semi-conscious, or intact gag reflex. 🚫 Wrong size → gastric inflation or esophageal placement → ↓ventilation & ↑aspiration risk. 🧠 If opioid overdose suspected: Administer Naloxone per protocol.

3️⃣ Ventilation Traps — “Less is More” ⚠️ Overventilation is deadly: 🚫 ↑ Intrathoracic pressure → ↓ venous return. 🚫 ↓ Cardiac output → ↓ perfusion → ↓ survival. 🚫 Cerebral vasoconstriction → ↓ brain blood flow. 🚫 Gastric inflation → aspiration risk. 🎯 Goal: Just enough air to see chest rise — no more.

4️⃣ Algorithm Snapshot 🧩 If Respiratory Arrest (Pulse Present):

1️⃣ Open airway (head-tilt or jaw-thrust).

2️⃣ Use OPA/NPA if needed.

3️⃣ Ventilate 1 breath q6 sec w/ 100% O₂.

4️⃣ Avoid excessive ventilation.

5️⃣ Check pulse every 2 min.

6️⃣ If no pulse → switch to CPR.

🧾 Use waveform capnography for ET tube placement & ventilation quality monitoring.

5️⃣ Meds & Extras 💉 Epi, Amio, Adenosine = not indicated here. Only drug of note: Naloxone for suspected opioid overdose. Some settings may initiate RSI (rapid sequence intubation) if trained and equipped.

6️⃣ Nursing Priorities 🩺 ✅ Maintain airway patency. ✅ Ensure effective ventilations (visible chest rise, SpO₂ monitoring). ✅ Avoid gastric inflation — slow, gentle breaths. ✅ Reassess pulse + airway every 2 min. ✅ Use ETCO₂ to confirm airway placement + monitor ventilation quality. ✅ Activate additional help early if ventilation difficult or ineffective.

7️⃣ “Gotcha” Exam Traps 🎯 🚫 Never use OPA in any patient w/ gag or cough reflex. 🚫 Don’t hyperventilate — it reduces cardiac output. 🚫 Don’t skip the pulse check before starting compressions. 🚫 Don’t forget airway adjuncts — tongue obstruction is #1 cause.

8️⃣ 2-Min Quick Recall 🔥

1️⃣ 1 breath every 6 sec (10/min).

2️⃣ 500–600 mL or just enough for visible chest rise.

3️⃣ Avoid excessive ventilation — kills perfusion.

4️⃣ OPA = only if no gag; NPA = okay if gag present.

5️⃣ Check pulse q2 min; if absent → CPR.

6️⃣ Use capnography to confirm airway & monitor effectiveness.