RESPIRATORY ARREST

Interruption of pulmonary gas for greater than 5 mins can cause irreversible damage to our vital organs.
Esp. for the brain

If respiratory function is not rapidly restored a cardiac arrest may occur.

When a respiratory arrest occurs the main goal is to restore ADEQUATE ventilation and Oxygenation.
Because aggressive ventilation and oxygenation can lead to more negative effects.

We can check for a person’s o2 saturation level by using a pulse oximeter. (lagay pic)

Etimology

Respiratory arrest and impaired respiration can be caused by

1. Airway obstruction
There are two types of airway obstruction:
A. Upper airway obstruction
B. Lower airway obstruction
 Upper obstruction
- May occur in infants less than 3 mos of age, they are usually nose breathers so they
are more prone to nasal blockage
- At all ages, the loss of muscle tone (helps maintain posture and helps muscles resist
the force of gravity) with decreased consciousness may lead to obstruction because
of the posterior part of the tongue goes into the oropharynx causing the person to
choke.
- Upper Obstruction also includes blood, mucus, vomit, or foreign body (spasm or
edema of the vocal cords)

 Lower obstruction
- . Lower airway obstruction condition occur when the vocal cords close or
become narrow. This prevents the right amount of air inhaled in each breath
and it also prevents the pulmonary arteries from receiving the right amount of
oxygen.
- Lower obstruction Can be caused by aspiration, bronchospasm, airspace filling
disorders such as pneumonia, pulmonary edema (excess fluids in the lungs), and
pulmonary hemorrhage (when blood leaks from blood vessels into the windpipe or
airways into the main lung), or drowning.

2. Decreased respiratory effort

- Central nervous system disorders that affect the brain stem example
stroke , infection, tumor) these can cause hypoventilation.
 - Drugs that decrease respiratory effort this includes drugs under opioids
and sedative-hypnotics Combinations of these drugs further increase the
risk of respiratory depression

3. Respiratory muscle weakness

- Neuromuscular causes include spinal cord injury, neuromuscular
diseases and neuromuscular blocking drugs.
- Respiratory muscle fatigue can occur if patients breathe for extended
periods at a minute ventilation exceeding about 70% of their maximum
voluntary ventilation (eg, because of severe metabolic acidosis or
hypoxemia).

Next we have the Symptoms

Low oxygen levels, high carbon dioxide levels, and increasing acidity of the blood
can cause confusion and sleepiness. If the drive to breathe is normal, the body tries to rid itself of
carbon dioxide by deep, rapid breathing. If the lungs cannot function normally, this breathing
pattern may not help. Eventually, the brain and heart malfunction, resulting in drowsiness
(sometimes to the point of becoming unconscious) and abnormal heart rhythms  (arrhythmias),
both of which can lead to death.

Hypoxemic respiratory failure

- means that you don't have enough oxygen in your blood, but the
carbon dioxide levels are close to normal.
-  Low oxygen levels in the blood cause shortness of breath and result in a
bluish coloration to the skin known as cyanosis

Hypercarbic

-  The level of carbon dioxide in the blood becomes too high 

- Acute hypercarbic respiratory failure is usually caused by defects in the
central nervous system, impairment of neuromuscular transmission,
mechanical defect of the ribcage and fatigue of the respiratory
muscles.

Treatment

Supplmental oxygen

- given to correct any lack of oxygen in people with respiratory failure.

- Oxygen can be given using small plastic prongs placed in the nose called
nasal cannula) or using a face mask, depending on how much oxygen
people need. Oxygen is usually given initially in a greater amount than is
needed and adjusted down later.

Mechanical ventilation
 - corrects the problem of ventilating the lungs (and decreases carbon dioxide
levels) in people with hypercarbic respiratory failure. In mechanical
ventilation, a machine (ventilator) is used to help air get in and out of the
lungs. 
- The air is delivered under pressure from the machine through a face mask
(noninvasive positive pressure ventilation) or through a tube placed in the
windpipe (invasive positive pressure ventilation). Doctors often try
noninvasive methods first, but invasive mechanical ventilation may be
necessary unless respiratory failure resolves rapidly with noninvasive
treatment. Most people with respiratory failure are treated with both
supplemental oxygen and some kind of mechanical ventilation.

Treatment of the cause

- the underlying disorder causing the respiratory failure must be treated. For
example, antibiotics are used to fight pneumonia caused by bacterial
infection, and bronchodilators are used in people with asthma to open the
airways.

First Aid

1. Check breathing by tilting their head back and looking and feeling for
breaths.

When a person is unresponsive, their muscles relax and their tongue can
block their airway hindering them to breathe. Tilting their head back opens the
airway by pulling the tongue forward.

If they are breathing, you will see their chest moving and you may hear their
breath or feel it on your cheek. If these are not present then the victim is not
breathing.

if the person is breathing, Move them onto their side and tilt their head back
and call for help as soon as possible.

If the person is not breathing, Give chest compressions: push firmly

downwards in the middle of the chest and then release.

Continue to push in this way at a regular rate until help arrives.

Chest compressions keep blood pumping around their body helping to keep
the vital organs, including the brain, alive.