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  1. What is Respiratory Arrest?

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If a pediatric patient is left in a state of respiratory distress too long, after a while, that will lead to the subject of this lesson – complete respiratory arrest.

Remember, a patient in respiratory arrest has a pulse but no respirations. Advanced life support begins with excellent basic life support skills. So, if you believe the patient to be unresponsive, verify that by tapping on the child's collarbone and shouting.

Step 1 – Call for Advanced Care

If you still do not get a response, call for advanced level care and assistance, as this will be your first step in resolving the respiratory arrest.

In a hospital setting, call in a medical code and follow your appropriate local respiratory and/or cardiac arrest protocol. In pediatric patients, it's important to not let their respiratory arrest deteriorate into a more significant arrest – cardiac arrest.

Pro Tip #1: Practice makes perfect, especially in an emergency situation. So, make sure you're following and carrying out the code in the same ways you've practiced, which will lead to a more efficient and effective emergency response team effort and the delivery of good resuscitation team care.

In a pre-hospital setting, get assistance as needed from another advanced life support unit, which may include a higher level of transportation. This will be relevant in certain communities that use a basic life support ambulance that is then intercepted by another advanced life support vehicle and team.

Step 2 – Assess for Circulation and Breathing

The next thing you'll want to do is assess the patient for circulation and breathing, including checking for a pulse. On a child, check the carotid pulse. On an infant, check the brachial pulse. And look at the patient's face and chest, while checking for a pulse, for any signs of breathing.

Pro Tip #2: Remember, for a patient in respiratory arrest, you'll find a pulse but no adequate breathing. Also worth mentioning again – agonal respirations (or snoring respirations) do not qualify as normal and effective breathing and should be considered the same as no adequate breathing.

Step 3 – Rescue Breathing and Airway Management

At this point, you will have decided to begin to provide rescue breathing, but first open the airway with a proper head-tilt, chin lift. If you have a folded towel, blanket, or diaper available, placing it under the patient's shoulders may help achieve the proper positioning, which will help keep the airway open.

Make sure, though, not to hyperextend the patient's neck, as this will produce the opposite effect – closing the airway, rather than keeping it open.

Placing a basic airway can help keep the tongue out of the back of the throat and ensure more successful ventilations. Get an oropharyngeal airway (OPA) measurement by placing it along side the patient's face, from the corner of the mouth to the lower tip of the ear.

Warning: Getting a proper measurement is important. If the OPA is longer than that area or too wide for the patient, this could cause a blockage of the airway and defeat the purpose.

Pro Tip #3: Remember to check for a gag reflex before you attempt to place an OPA into the patient's airway. If there is a gag reflex, do not attempt an OPA, as this can cause the patient to vomit, which could seriously complicate airway management and oxygenation.

Deliver 1 rescue breath every 3 seconds for a child or infant, which is about 20 breaths per minute. Breaths should be given with a bag valve mask at 15 liters per minute of oxygen.

Step 4 – Assess the Patient's Vital Signs

After you've begun to deliver rescue breathing, attach a heart rate monitor and assess the patient's vitals:

  • Oxygen saturation
  • Blood pressure
  • Pulse rate

As rescue breaths are delivered, it's important to monitor their effectiveness by watching the patient's chest. Do you see it rise and fall? And if the patient is intubated, monitor capnography and avoid gastric inflation.

Step 5 – Advanced Airway and IV or IO Access

The next step is to place an advanced airway and gain IV or IO access. And remember, if the patient's pulse rate drops below 60 beats per minute, start chest compressions immediately.

Pro Tip #4: Also, as part of your resuscitation protocol and care, keep in mind that you'll want to look for, and treat, any underlying causes of the patient's respiratory arrest.