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Respiratory arrest

Specialties > Child health

Background knowledge 🧠

Definition

  • Respiratory arrest is the cessation of breathing, leading to an absence of respiratory effort or airflow.
  • It differs from cardiac arrest, although both may occur simultaneously.
  • A medical emergency requiring immediate intervention.

Epidemiology

  • Respiratory arrest can occur in any age group but is more common in critically ill patients.
  • Higher incidence in hospital settings, especially in intensive care units.
  • Leading causes include airway obstruction, severe respiratory disease, and drug overdose.
  • Significant morbidity and mortality associated, with outcomes dependent on prompt intervention.

Aetiology and Pathophysiology

  • Common causes: airway obstruction, CNS depression, neuromuscular disorders.
  • Pathophysiology involves interruption of oxygenation, leading to hypoxia and hypercapnia.
  • If untreated, can lead to cardiac arrest and death.
  • Potentially reversible if rapidly identified and treated.

Types

  • Obstructive: due to airway blockage (e.g., foreign body, anaphylaxis).
  • Central: caused by brainstem injury or CNS depression.
  • Mixed: combination of obstructive and central factors.
  • Other types include respiratory arrest secondary to neuromuscular diseases (e.g., myasthenia gravis).

Clinical Features 🌡️

Symptoms

  • Preceding symptoms may include shortness of breath, confusion, and cyanosis.
  • Patients may become unconscious quickly without intervention.
  • Absence of breathing or abnormal breathing patterns such as gasping.
  • May be associated with signs of airway obstruction.

Signs

  • Absence of breath sounds on auscultation.
  • Cyanosis (central and peripheral).
  • Unresponsiveness to stimuli.
  • No chest rise during attempted breaths.
  • Possible abnormal heart rhythms.

Investigations 🧪

Tests

  • Arterial blood gases (ABGs): check for hypoxia, hypercapnia, and acidosis.
  • Chest X-ray: assess for lung pathology (e.g., pneumothorax, consolidation).
  • ECG: identify potential cardiac arrhythmias or ischemia.
  • Toxicology screen: important in cases of suspected overdose.
  • Full blood count and electrolytes: assess for underlying metabolic disorders.

Management 🥼

Management

  • Immediate intervention: call for help, initiate basic life support (BLS).
  • Ensure airway patency: head tilt, chin lift, or jaw thrust manoeuvres.
  • Ventilation: use of bag-valve mask, consider advanced airway management.
  • Administer 100% oxygen and assess the need for intubation.
  • Address underlying cause (e.g., antidote for overdose, bronchodilators for asthma).
  • Consider ICU admission and mechanical ventilation in severe cases.

Complications

  • Hypoxic brain injury if prolonged.
  • Cardiac arrest if not promptly managed.
  • Aspiration pneumonia.
  • Long-term neurological deficits.
  • Increased risk of mortality.

Prognosis

  • Dependent on the cause, duration of hypoxia, and promptness of intervention.
  • Poor outcomes associated with delayed treatment.
  • Better prognosis if reversible causes are promptly treated.
  • Long-term monitoring and follow-up may be required for those with significant recovery.

Key Points

  • Respiratory arrest is a life-threatening emergency requiring immediate intervention.
  • Identifying and addressing the underlying cause is crucial for successful management.
  • Basic life support skills are essential for all healthcare professionals.
  • Prognosis depends on promptness of intervention and the cause of arrest.

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Child health