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Show full transcript for Respiratory Arrest Case Teaching video

In this lesson, we're going to take a look at a respiratory case that you could be confronted with at some point in your career. And at the end of the lesson, we'll take a brief look at alternative airway devices.

For the purpose of this lesson, we're making you the team leader throughout this entire scenario, a move that will be repeated throughout this section of your ProACLS course. Here's what you know about the scene and situation.

You have just come upon a 25-year-old male who appears to be unresponsive. Witnesses tell you that the man was wheezing and having a difficult time breathing. He then collapsed, which is how you find him.

Your initial assessment recap:

  • 25-year-old male
  • Appears to be unresponsive
  • Was having a difficult time breathing
  • The patient then collapsed

Let's also assume that the scene is safe and all personal protective equipment is available or in use.

Pro Tip #1: While we've probably pointed this out before, it's important to remember that before engaging in any advanced life support actions, that you first practice basic life support.

Proper Steps for Treating a Patient in Respiratory Arrest

1. The first thing you need to do is verify that the patient is indeed unresponsive. To this end, you (the team leader) direct a team member to use the tap and shout sequence to determine responsiveness. You find the patient to be unresponsive and call in a code team.

2. You direct a team member to check the patient for a pulse and signs of normal breathing. Your team finds that the male patient has a pulse but is not breathing normally.

3. You then direct the team member in charge of airway management to place a basic airway adjunct and begin rescue breathing with a bag valve mask at 15 liters per minute with oxygen.

4. You direct the airway management team member to give 1 breath every 5 seconds.

Pro Tip #2: Make sure to look for visible signs of good chest rise and fall to ensure the rescue breaths are effective.

5. You then direct the team member in charge of the defibrillator and monitor to get a set of vitals and attach the ECG monitor to the patient. The vitals the team member gives you are as follows:

a. Blood pressure: 100/70
b. Pulse rate: 120 and weak
c. O2 saturation: 94 percent
d. ECG: normal sinus rhythm

How do You Proceed with this Information?

Since the ECG is showing a normal sinus rhythm, oxygenation is good, and the patient's blood pressure is normal, you continue providing rescue breathing and consider possible causes for the patient's respiratory arrest.

In preparation for further treatment, you also decide to place an advanced airway and establish an IV.

A Word About Alternative Airway Devices

If you find yourself in a situation where endotracheal intubation is unsuccessful, and basic airway management techniques do not provide adequate ventilation, alternative airway devices that allow you to secure a patent airway should be considered.

The laryngeal mask airway (LMA) is inserted blindly into the airway while it is guided in place using your middle finger. The mask, when properly seated, will cover the esophagus and facilitate airflow into the lungs.

Dual-lumen airway devices, such as the esophageal Combitube, are also acceptable alternatives to intubation. Dual-lumen devices are also blindly advanced into the airway and will come to rest in the esophagus in most situations.

Proper verification of its placement is accomplished by ventilating into the tube that produces clear and equal breath sounds and no epigastric sounds. This can also be confirmed with waveform capnography.

Other alternative advanced airway devices, such as the King LT, and supraglottic airway devices, such as the LMA and iGel, may also be considered as alternatives to endotracheal intubation.