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Impending/Actual Respiratory Arrest

The clinical progression from respiratory distress to respiratory failure to respiratory arrest varies by patient. Respiratory failure can progress rapidly and can be difficulty to reverse.  Therefore, it is important to quickly recognize signs/symptoms of impending respiratory arrest:

  • Drowsiness/Confusion or Altered Mental Status - this can be an important indicator for care settings with limited resources.
  • Hypoventilation - develops more readily in young children
  • Hypercapnia - Arterial blood gases with PCO2 > 42 associated with high risk of impending respiratory arrest
  • Paradoxical Thoracoabdominal Movement or "Seesaw Breathing"
  • Absence of Wheeze - Airway obstruction is so severe that no airflow is auscultated ("silent chest")
  • Bradycardia - Heart rate will transition from tachycardia to bradycardia
  • Resolution of prior pulsus paradoxus - In the absence of improving respiratory status, this suggests respiratory muscle fatigue

Patients exhibiting these signs/symptoms should be transferred to a critical care setting while simultaneously attempting to reverse causes of respiratory distress.

NAEP-EPR-3. (2007). Expert Panel Report 3: Guidelines for the diagnosis and management of asthma. Bethesda MD: U.S. Department of Health and Human Services, National Institutes of Health.

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.