ACLS FOR RESPIRATORY EMERGENCIES

Respiratory emergencies involve conditions that impair the body’s ability to exchange oxygen (O₂) and carbon dioxide (CO₂), leading to hypoxia (low oxygen) or hypercapnia (high CO₂ levels). Without prompt intervention, these conditions can rapidly progress to respiratory failure and cardiac arrest.

Why It’s Important:
Respiratory failure can cause cardiac arrest if untreated.
Rapid assessment and early intervention prevent deterioration.
ACLS providers must recognize respiratory distress and support ventilation effectively.

 

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RECOGNIZING RESPIRATORY EMERGENCIES

Signs & Symptoms of Respiratory Distress

Dyspnea (Shortness of breath)
Tachypnea (Fast breathing >20 breaths/min)
Bradypnea (Slow breathing <10 breaths/min, ominous sign)
Accessory Muscle Use (Neck/abdominal muscles engaged in breathing)
Retractions (Visible pulling in of the chest wall between ribs)
Cyanosis (Blue discoloration of skin, lips, or nail beds)
Altered Mental Status (Confusion, agitation, drowsiness)
Abnormal Breath Sounds:

• Wheezing (Asthma, COPD)
• Stridor (Upper airway obstruction)
• Rales/Crackles (Pulmonary edema)

Key Takeaway: Respiratory distress can quickly lead to respiratory failure—early recognition is critical!

 

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INITIAL ASSESSMENT & STABILIZATION (ABCs)

Step 1: Airway – Ensure Patency

• Use head-tilt/chin-lift or jaw-thrust maneuver if needed.
• Clear secretions (suction if necessary).
• Consider advanced airway (intubation) if the airway is compromised.

Step 2: Breathing – Assess Oxygenation & Ventilation

• Check respiratory rate, effort, and depth.
• Provide supplemental oxygen (Goal: SpO₂ ≥ 94%).
• If inadequate breathing, assist ventilation with a bag-valve mask (BVM).

Step 3: Circulation – Assess for Compromise

• Monitor HR, BP, capillary refill.
• Respiratory failure can lead to shock—treat accordingly.

Step 4: Monitor Oxygenation & Ventilation

• SpO₂ Monitoring – Maintain oxygen saturation ≥ 94%.
• Capnography (EtCO₂ Monitoring) – Normal EtCO₂: 35-45 mmHg
  • High EtCO₂ (>45 mmHg) = Hypoventilation (e.g., opioid overdose).
  • Low EtCO₂ (<35 mmHg) = Hyperventilation (e.g., PE, shock).

Key Takeaway: ABCs should be assessed IMMEDIATELY—hypoxia is the leading cause of preventable cardiac arrest!

 

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COMMON RESPIRATORY EMERGENCIES & MANAGEMENT

1. Asthma Exacerbation

Pathophysiology: Airway narrowing due to bronchospasm, inflammation, and mucus production.
Signs: Wheezing, prolonged expiration, accessory muscle use.
Severe Asthma Attack (Status Asthmaticus): No wheezing + silent chest = Impending respiratory failure!

Treatment:
Oxygen (Maintain SpO₂ ≥94%)
Nebulized Albuterol (β2 agonist) + Ipratropium (Anticholinergic)
Corticosteroids (e.g., Dexamethasone, Methylprednisolone)
Magnesium Sulfate (For severe cases, 2 g IV over 20 min)
If impending respiratory failure → Intubation & Mechanical Ventilation

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2. Pulmonary Edema (Often due to Heart Failure)

Pathophysiology: Fluid accumulation in alveoli → Impaired gas exchange.
Signs: Crackles/rales, pink frothy sputum, severe dyspnea, tachypnea.

Treatment:
Oxygen (High-flow or CPAP/BiPAP)
Nitroglycerin (Reduces preload & pulmonary congestion)
Diuretics (Furosemide 20-40 mg IV for fluid removal)
If respiratory failure → Intubation & Positive Pressure Ventilation

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3. Pneumonia (Lung Infection)

Pathophysiology: Infection → Inflammation → Fluid-filled alveoli → Impaired oxygen exchange.
Signs: Fever, cough, purulent sputum, crackles, decreased breath sounds.

Treatment:
Oxygen (Maintain SpO₂ ≥ 94%)
Antibiotics (If bacterial pneumonia is suspected)
IV Fluids (If septic shock is suspected)
Consider Intubation if respiratory failure develops

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4. Pulmonary Embolism (PE)

Pathophysiology: Blood clot in pulmonary artery blocks blood flow to the lungs.
Signs: Sudden dyspnea, chest pain, tachycardia, hypoxia, clear lung sounds.

Treatment:
Oxygen Therapy (Maintain SpO₂ ≥ 94%)
Anticoagulation (Heparin or Enoxaparin)
Thrombolytics (e.g., Alteplase) for massive PE with hemodynamic instability
If cardiac arrest occurs → Immediate ACLS protocol + Thrombolysis

Key Takeaway: PE presents with clear lung sounds but severe hypoxia—always consider in unexplained respiratory distress!

 

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WHEN TO INTUBATE?

Signs of Impending Respiratory Failure (Intubation Needed!):
Severe hypoxia (SpO₂ < 90% on high-flow O₂).
Severe hypercapnia (EtCO₂ > 50 mmHg with acidosis).
Altered mental status (confusion, unresponsiveness).
Absent breath sounds (silent chest = near total airway obstruction).
Failure to maintain work of breathing (fatigue, gasping).

Key Takeaway: If a patient cannot maintain oxygenation, ventilation, or mental status—intubate early!

 

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TRANSPORT & DEFINITIVE CARE

Transport to a facility with advanced respiratory support.
Monitor closely for deterioration en route.
Prepare for advanced airway interventions if needed.
Continue high-quality oxygenation and ventilation support.

Key Takeaway: Early transport to a respiratory-capable facility prevents further deterioration!

 

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COMMON MISTAKES & HOW TO AVOID THEM

Key Takeaway: Early intervention prevents respiratory arrest—monitor closely and act fast!

 

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SUMMARY: MASTERING ACLS FOR RESPIRATORY EMERGENCIES

Recognize early signs of respiratory distress (dyspnea, tachypnea, cyanosis).
Assess ABCs immediately—ensure airway patency and support breathing.
Provide supplemental oxygen (SpO₂ ≥94%), consider capnography (EtCO₂ monitoring).
Manage the underlying cause (asthma, PE, pneumonia, pulmonary edema).
Be ready to intubate if respiratory failure develops!

Takeaway: Respiratory emergencies can escalate quickly—early recognition and intervention save lives!